Embedding U=U in Public Health Practice
Strengthening how we meet the core competencies of public health in Canada
When I first began sharing my story as The Accidental HIV Activist it was with the belief that lived experience has the power to shift conversations in ways that data alone cannot. Over the years my work has taken me into boardrooms, community spaces, conferences, and health units across Canada with the same purpose in mind: to ensure that Undetectable = Untransmittable (U=U) is communicated clearly, confidently, and compassionately.
Public health officials carry enormous responsibility in shaping how communities understand HIV. The words they choose, the messages they repeat, and the policies they inform ripple far beyond a single campaign. Yet too often U=U is absent or inconsistently integrated into public health practice. That gap has real consequences. It sustains stigma, it limits testing and treatment uptake, and it creates unnecessary barriers for people living with HIV.
When the Core Competencies for Public Health in Canada were updated in 2025, it marked an important moment for reflection. Competencies are not just boxes to tick. They define the knowledge, skills, and values that every public health professional is expected to carry. They shape hiring and evaluation. They guide training and accountability. Most importantly, they represent a collective agreement about what good public health practice looks like. And it is within these competencies that I see the perfect home for U=U.
As Canada’s first and currently only Associate Trainer with U=U University, I know firsthand how powerful this message can be when it is communicated with clarity and consistency. U=U is not just a scientific statement. It is a competency in action. It is communication that builds trust. It is assessment and analysis that interprets data with accuracy and compassion. It is advocacy and partnership that dismantle stigma and invite collaboration. It is equity and social justice made real through the affirmation of human dignity. And it is reflective practice that challenges professionals to consider their own assumptions and biases.
To understand why this matters, we need to step back and think about what public health looks like on the ground. Consider a young man in Simcoe Muskoka opening an at-home test kit, unsure about what his result might mean for his future. Consider a woman in Toronto navigating layers of stigma not only for living with HIV but for being racialized, queer, and an immigrant. Consider a Two-Spirit youth in Northern Ontario who is testing in secret, afraid of being shamed in their community. In each of these situations, the way a public health professional communicates can either reinforce fear or open the door to dignity and care. If U=U is not part of the message, stigma fills the silence. If U=U is missing, a competency like communication is weakened.
The updated competencies place communication at the center of public health practice. Communication is not just about delivering information. It is about doing so in ways that are accurate, accessible, and affirming. U=U is a communication competency because it requires professionals to share the truth that a person living with HIV on effective treatment with an undetectable viral load cannot pass on the virus sexually. That truth, when shared clearly and consistently, reduces stigma, builds trust, and encourages more people to get tested, start treatment, and stay engaged in care. Without it, misinformation fills the void.
Competencies also emphasize assessment and analysis. This goes beyond crunching numbers. It requires public health professionals to examine data through a lens of equity. What do testing rates reveal about communities that are underserved? What do treatment outcomes show about systemic barriers? What does the absence of U=U awareness in certain populations say about the effectiveness of our communication strategies? When assessment and analysis are done without U=U, the picture is incomplete. It risks misinterpreting gaps as failures of individuals rather than failures of systems. By incorporating U=U, assessment and analysis become sharper tools. They do not just describe disparities. They point toward solutions.
Advocacy and partnerships are another cornerstone of the competencies. U=U is advocacy in its purest form. It is about standing up for truth in the face of stigma. It is about ensuring that people living with HIV are not only included in conversations but are leading them. Public health units are competency-bound to advocate, and U=U strengthens that competency by bringing them into partnership with people living with HIV and organizations that have been carrying this message for years. Partnerships grounded in U=U are not symbolic. They are practical. They create campaigns that reach people where they are. They shift media narratives. They reshape policy.
The competencies also place a strong emphasis on health equity and social justice. These are not abstract principles. They are daily practices. U=U is equity in action. It levels the playing field by removing the assumption that HIV is something shameful or dangerous. It affirms that people living with HIV can have families, relationships, and futures without fear of transmission. It challenges systems that continue to treat people living with HIV as risks rather than as full human beings. U=U makes social justice tangible by affirming dignity.
Finally, the competencies call for ethical and reflective practice. This is about more than following codes of conduct. It is about self-awareness. It is about asking hard questions of ourselves. Am I unintentionally reinforcing stigma in the way I communicate? Am I withholding information that could empower someone? Am I making assumptions about who is at risk or who needs to know? U=U invites professionals into reflection. It asks them to consider how their words and actions either dismantle stigma or reinforce it. That is ethical and reflective practice in action.
These competency connections are not theoretical for me. They are lived. When I was diagnosed with HIV in 2015, I was told that with treatment my health would not be compromised, but I was not given the full picture. Nobody explained to me that being undetectable also meant that I could not transmit the virus to my sexual partners. That silence left me carrying unnecessary fear and stigma. When U=U emerged the following year, it changed everything. It gave me the confidence to live and love openly. It gave me language that turned fear into hope. And it gave me a purpose: to ensure that nobody else had to go through the same silence I experienced.
That experience is why I speak so often about the difference between information and transformation. Information alone can sit on a page or in a report. Transformation happens when that information is communicated with clarity, with compassion, and with authenticity. U=U is transformative because it does more than state a fact. It changes how people see themselves. It changes how others see them. It changes how communities respond. And when it is integrated into the core competencies of public health, it changes how systems function.
Take communication as an example. I have seen the power of a single conversation. A physician telling a newly diagnosed patient, “You will not pass this virus to your partner if you stay on treatment.” A nurse explaining to a client that they can still dream of having children without fear of transmission. A public health official answering a journalist’s question with certainty and compassion, rather than hesitation. Each of these moments is a communication competency in action, and each becomes stronger when U=U is at its center.
Or consider assessment and analysis. Too often, I hear HIV statistics presented in ways that strip away humanity. Numbers without context, graphs without stories. Data can inform, but it can also stigmatize if it is interpreted without care. Competencies demand that assessment and analysis be grounded in equity. That means asking not only what the numbers show but also what they hide. Why are testing rates lower in rural areas? Why are racialized communities disproportionately affected? Why do so few Canadians know about U=U? When U=U is factored into data analysis, the conversation shifts from deficits to opportunities. Instead of blaming individuals, we can ask how systems must change to provide access to treatment, information, and support.
Advocacy and partnerships are another area where U=U shines. Public health does not exist in isolation. It is strengthened by collaboration with those most affected. For years, people living with HIV have been leading the way in pushing U=U into public discourse. Public health units that choose to partner with these communities are not only meeting a competency requirement. They are embodying the very spirit of advocacy. They are demonstrating that leadership is not about speaking for communities, but about speaking with them. I have seen firsthand how these partnerships transform campaigns, bringing messages that are not only scientifically accurate but also culturally resonant and deeply human.
Health equity and social justice are central to the competencies, and U=U is one of the clearest expressions of these principles in practice. To say that someone with HIV who is undetectable cannot pass on the virus is to strip away layers of stigma that have accumulated over decades. It is to affirm that people living with HIV have the same right to intimacy, to family, and to a future as anyone else. It is to confront systems that have too often treated them as vectors rather than as people. U=U is equity because it does not discriminate. It applies universally to all people living with HIV who are undetectable, regardless of race, gender, or orientation. It is social justice because it levels the field of possibility.
Finally, ethical and reflective practice is where U=U takes us inward. For every professional in public health, there are moments when the question is not what information we have, but what responsibility we hold. I often ask myself: am I using my voice to dismantle stigma, or am I allowing silence to let stigma grow? Am I creating space for others to lead, or am I centering myself? These are reflective questions, and they are at the heart of what the competencies call for. U=U invites all of us to examine not only what we know, but how we use what we know. That is what makes it both ethical and transformative.
My lived experience is not separate from these competencies. It is woven through them. As someone living with HIV, I bring not only professional expertise but also the perspective of having walked through silence, stigma, and finally into empowerment. That perspective is not an add-on. It is integral. Because when public health professionals hear directly from someone who has lived this reality, it shifts the conversation from abstract theory to lived truth. It makes the science human. It ensures that the competencies are not only fulfilled in principle but embodied in practice.
The return on investment for public health is clear. Stronger communication builds trust. Better assessment and analysis sharpen decision making. Advocacy and partnerships expand reach and relevance. Equity and social justice reduce disparities and improve outcomes. Reflective practice strengthens the ethical foundation of the workforce. All of these competencies are strengthened when U=U is at the center. And the ripple effects extend far beyond HIV. When stigma is dismantled in one area of public health, it creates momentum for addressing stigma elsewhere. When trust is built with one community, it strengthens trust in the system as a whole.
I believe that this is the kind of leadership Canadian public health needs right now. Leadership that is grounded in science, informed by lived experience, and guided by the principles of equity and justice. Leadership that sees competencies not as checkboxes, but as commitments to communities. Leadership that is willing to say the words clearly and consistently: Undetectable equals Untransmittable. Zero possibility of transmission. Endless possibilities for people living with HIV.
This is the work I have dedicated myself to. It is the work that continues to be urgent. And it is the work I am now offering through InclusHIV Consulting.
This training is designed for public health units, for organizations, and for leaders who want to ensure that their staff are not only competent in theory but confident in practice. It is aligned with the updated competencies, rooted in science, informed by lived experience, and focused on reducing stigma while strengthening trust. It is practical, interactive, and designed to leave participants with the knowledge and skills they can apply immediately in their work.
If your public health unit or organization is ready to embed U=U into its practice, I invite you to connect with me. Together we can ensure that the science is understood, the message is shared, and the impact is felt where it matters most, in the lives of people and communities across Canada.