By Dennis Katungi
Since the early to mid-1990s, when AIDS decimated a crop of friends and relatives in Uganda, I took keen interest in doing research on the AIDS pandemic. It was an advantage that I had access to resources at the School of Oriental and African Studies [SOAS] as well as the School of Hygiene and Tropical Medice in London. Both are part of the University of London and these campuses are a stone-throw from each other in Central London.
Universities in London are networked and share resources. Although I was a student at the School of Journalism then, my membership of the Royal African society meant that I could use targeted resources at SOAS. Indeed I delved into several topics of interest and HIV/AIDS was one.
The scenario in the headline above indeed sounds like a contradiction: blood tests can show zero active trace of HIV, especially if the person is on effective Highly Active Retroviral Therapy [HAART]. Yet the patient remains infected and tests would still come out positive for HIV. The upside is that such a person cannot infect, or transmit the virus even if they had unprotected sex. The answer lies in a dormant viral blueprint woven directly into their DNA.
When a doctor says an HIV-positive person is "undetectable," they are referring specifically to the person's viral load. A viral load test draws blood and counts how many copies of the virus are active in a single milliliter. If a person takes daily antiretroviral therapy (ART), the medication strips the virus of its ability to reproduce. Without the ability to create new copies, the active virus in the blood dies off. The count rapidly drops so low—usually below 20 to 50 copies per milliliter—that standard laboratory equipment cannot register it.
If the virus is cleared from the bloodstream, it might seem like the infection is cured. However, because HIV is a retrovirus, it relies on that genetic blueprint hidden in the host's immune cells. While most infected T-cells actively churn out new virus until they die, a small percentage enters a resting state. This creates a "viral reservoir."
These dormant cells do not actively produce new HIV, so antiretroviral medications—which only target the replication process—cannot affect them. Because the cells are resting, the immune system also fails to recognize them as threats. They simply sit in the lymph nodes, gut, and brain, perfectly camouflaged.
The person remains HIV positive because the viral DNA is permanently integrated into their cellular reservoirs. If the person stops taking medication, the resting cells will eventually wake up. The latent virus activates, the cells resume pumping out new copies of HIV, and the viral load rapidly rebounds to detectable levels.
Being undetectable is a highly effective, lifelong stalemate. When the viral load is fully suppressed, the virus cannot progress to damage the immune system. The suppression is so complete that a person with an undetectable viral load has a clinically proven zero percent risk of transmitting HIV to sexual partners, a medical consensus known as Undetectable = Untransmittable (U=U).
There have been major developments in HIV/AIDS in 2025-2026, particularly in prevention, long-acting treatment, and efforts to make HIV services more accessible. The biggest changes are HIV prevention, long-acting treatment, and efforts to make HIV services more accessible. HIV prevention is moving from daily pills to medicines that can be taken only twice a year.
The most important recent development is Lenacapavir, a long acting injectable pre-exposure [PrEP] medicine. It is administered twice a year and has shown extremely high effectivess in preventing HIV infection. The World Health Organisation now recommends twice-yearly injectable lenacapavir as an additional HIV – prevention option, alongside existing PrEP approaches such as daily oral and injectable cabotegravir.
This could be particularly important in Africa because adherence to daily tablets can be difficult for some people due to lifestyle issues. A six monthly injection could make prevention more discreet, convenient and easier to maintain and is already available in Uganda.
The challenge is now getting these innovations to ordinary people. The science is advancing faster than access. For countries such as Uganda, the important question is not simply if preventive technology exists, but rather can we deliver it affordably and at scale?
The writer is Deputy Executive Director – Uganda Media Centre.
@Dennis_Katungi
