Mandisa Dukashe, a prominent advocate and leader in HIV activism, has lived openly with HIV for over two decades. Her journey—from diagnosis as a nursing student to her current role at the South African National AIDS Council (SANAC)—embodies resilience and transformation. As co-founder of the U=U Africa Forum and a member of the U=U Global Advisory Board, Mandisa champions a message that is both scientifically profound and deeply human: U=U, or Undetectable = Untransmittable. She shared her story and wisdom recently on a webinar organised by FPD as part of the Improving Mental Health and HIV/TB Service Integration (IMHSI) project.
U=U affirms that individuals living with HIV who adhere to antiretroviral therapy (ARVs) and maintain an undetectable viral load cannot transmit the virus. This message not only reduces stigma but restores dignity and offers hope to those who have long viewed their diagnosis through the lens of shame and fear.
However, Mandisa emphasises that the promise of U=U cannot be fully realised without addressing the mental health challenges faced by 40-60% of people living with HIV. Without psychological resilience, emotional support, and freedom from stigma, the message of U=U cannot take root in the hearts of those who need it most.
Depression and anxiety are common—yet frequently go untreated—leading to missed ARV doses, viral rebound, and disengagement from care. The message confirms the importance of the IMHSI project in this regard.
For those battling mental illness, stigma adds another layer of pain. Some report being turned away from clinics because of conditions like schizophrenia. Others face discrimination within their own families and communities.
Substance abuse often enters the picture too, not as a choice, but as a coping mechanism. Alcohol or drugs may temporarily mask emotional pain, but they increase the likelihood of risky behaviours, including unprotected sex, which leads to poor health outcomes and potential transmission.
“This is how intersectionality works,” Mandisa explains. “Mental health affects HIV, and HIV affects mental health.” Without breaking this cycle, progress in either area remains incomplete.
Mandisa’s own story illustrates this transformation. Initially overwhelmed by depression and fear, she gradually found the strength to disclose her status and reclaim her life. Her advocacy underscores the importance of mental wellness in fostering healthy families and communities.
The impact of U=U is evident in other personal stories Mandisa shared in the webinar:
· A bodybuilder who rediscovered his passion after learning about U=U.
· A woman who overcame marital stigma and embraced her role as a wife.
· An individual who found peace and purpose after contemplating suicide.
It is important to stress, as Mandisa does, that U=U does not replace condoms or other preventive methods. But if someone chooses not to use condoms, ensuring an undetectable viral load offers a way to protect themselves and their partners.
U=U also serves as a powerful public health tool. Research in Cape Town shows that men informed about U=U are more likely to get tested. By reducing fear, U=U creates demand for testing, encourages engagement with health services, and strengthens retention in care.
Realising the vision of U=U requires a holistic, person-centred approach that treats people as whole beings, not just as patients. It demands that health systems, communities, and policymakers see mental health as inseparable from treatment adherence and viral suppression.
Written with the help of CoPilot.