Participatory prototyping of a tailored U=U (undetectable=untransmittable) message to increase HIV testing in men in Western Cape, South Africa

IntroductionTaking daily ART eliminates sufficient virus so that HIV is undetectable via viral load (VL) testing within 24 weeks. HIV-positive individuals with an undetectable VL cannot transmit HIV to sexual partners or through giving birth, a message commonly referred to as U=U (undetectable equals untransmittable). Since South African men have poorer HIV outcomes than women, we used interactive human centred design co-creation workshops to ask men from high HIV burden communities in Cape Town, South Africa to create a U=U message aimed at increasing HIV testing and ART uptake in men.MethodsTwo facilitators explained the U=U message to the men (n =39) attending the workshop and asked them how to effectively communicate the message. Participants designed messages to assuage fears of testing HIV positive, explaining that ART enables HIV positive people to live normally and makes the virus “untransmittable” to their sexual partners.ResultsParticipants developed three insights for the U=U message; 1) “Introduce” the modern antiretroviral pill, 2) positively redefine the man for whom the pill is intended, and 3) simplify the benefits of ART for men. Participants’ messages emphasised 1) “you cannot spread the virus (HIV) to the other person” 2) and “(the pill) keeps on killing the virus so I can live a normal life for the rest of my life.”DiscussionMen in the workshops co-created a simple U=U message to address fears of testing HIV positive, emphasising the pill’s positive effects. Co-created, tailored messaging may improve the uptake of HIV services for South African men.