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Among gay and bisexual men living with HIV in Lima, Peru, we examined (1) sociostructural correlates of U=U awareness; (2) U=U educational experiences and trust; (3) associations between U=U awareness and self-reported ART use; and (4) associations between U=U awareness and viral load.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a sequential explanatory mixed-methods study including a survey (N=310) and individual interviews (N=30).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most participants (86%) were aware of U=U. Awareness was less common among those diagnosed more recently, those without income in the past month, and non-binary participants. Participants aware of U=U were more likely to report linkage to care, current ART use, and viral suppression. Qualitative findings highlighted U=U as a motivator for ART adherence and viral suppression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Together, these findings underscore the importance of integrating clear, consistent U=U counseling into HIV services in Peru and globally.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259582261471983","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T19:04:56Z","timestamp":1785179096000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["\u201cThe First Thing I Must do is Become Undetectable\u201d: Examining U=U Awareness and the HIV Care Continuum Among Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV in Lima, Peru"],"prefix":"10.1177","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6126-8834","authenticated-orcid":false,"given":"Reni","family":"Forer","sequence":"first","affiliation":[{"name":"University of Michigan Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Brisson","sequence":"additional","affiliation":[{"name":"University of Toronto"},{"name":"University of Montreal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Epicentro"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Veneros","sequence":"additional","affiliation":[{"name":"Epicentro"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Lankowski","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Center"},{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Duerr","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Center"},{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00877-2"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.21167"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.334.6063.1628"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02699-5"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(18)30102-4"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002183"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-024-04401-3"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.7108"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-023-00801-3"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0004121"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2024.2332462"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(22)00016-X"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-022-03894-0"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0295046"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.19.1.21166"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.glmedi.2024.100077"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259582251370236"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-024-04336-9"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-021-03296-8"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2020-054551"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-022-03710-9"},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2022.41.248.33079"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2025.2562238"},{"key":"e_1_3_7_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259582241282561"},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-021-03284-y"},{"key":"e_1_3_7_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.13446"},{"key":"e_1_3_7_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae479"},{"key":"e_1_3_7_29_2","unstructured":"Panel on Antiretroviral Guidelines for Adults and Adolescents. 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