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Konda KA, Qquellon J, Torres TS, Vega-Ramirez EH, Elorreaga O, Guillén-Díaz-Barriga C, Diaz-Sosa D, Hoagland B, Guanira JV, Benedetti M, Pimenta C, Vermandere H, Bautista-Arredondo S, Veloso VG, Grinsztejn B, Caceres CF. Awareness of U = U among Sexual and Gender Minorities in Brazil, Mexico, and Peru: Differences According to Self-reported HIV Status. AIDS Behav 2024; 28:2391-2402. [PMID: 38662277 PMCID: PMC11199300 DOI: 10.1007/s10461-024-04336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
The slogan Undetectable equals Untransmittable (U = U) communicates that people living with HIV (PLHIV) who are on antiretroviral therapy (ART) will not transmit HIV to their sexual partners. We describe awareness of U = U among sexual and gender minorities (SGM) living in Brazil, Mexico, and Peru by self-reported HIV status (PLHIV, negative, unknown) during 2021 using an online survey. We estimated two models using Poisson regression for each population group: Model A including socio-demographic factors (country, gender, age, race, education, and income), and then Model B including taking ART (for PLHIV) or risk behavior, ever-taking PrEP, and HIV risk perception (for HIV-negative or of unknown HIV status). A total of 21,590 respondents were included (Brazil: 61%, Mexico: 30%, Peru: 9%). Among HIV-negative (74%) and unknown status (12%), 13% ever used PrEP. Among PLHIV (13%), 93% reported current use of ART. Awareness of U = U was 89% in both Brazil and Mexico, which was higher than in Peru 64%. Awareness of U = U was higher among PLHIV (96%) than HIV-negative (88%) and HIV-unknown (70%). In multivariate models, PLHIV with lower education were less aware of U = U, while those taking ART were more aware. Among HIV-negative, non-cisgender, lower income, and those with lower education had lower awareness of U = U, while individuals ever using PrEP had higher awareness. In conclusion, awareness of U = U varied by HIV status, socio-demographic characteristics, and HIV risk behavior. The concept of U = U should be disseminated through educational strategies and include a focus on SGM to combat HIV stigma.
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Affiliation(s)
- K A Konda
- Keck School of Medicine, University of Southern California, 1845 N Soto St, Los Angeles, CA, 90032, USA.
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru.
| | - J Qquellon
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| | - T S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - E H Vega-Ramirez
- Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - O Elorreaga
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| | - C Guillén-Díaz-Barriga
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - D Diaz-Sosa
- Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - B Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - J V Guanira
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| | - M Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - C Pimenta
- Departmento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissiveis, Brazilian Ministry of Health, Rio de Janeiro, Brazil
| | - H Vermandere
- Instituto Nacional de Salud Pública (INSP), Mexico City, Mexico
| | | | - V G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - B Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - C F Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
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Calabrese SK, Zaheer MA, Flores JJ, Kalwicz DA, Modrakovic DX, Rao S, Dovidio JF, Zea MC, Eaton LA. Messaging About HIV Transmission Risk When Viral Load Is Undetectable: Reactions and Perceived Accuracy Among US Sexual Minority Men. J Acquir Immune Defic Syndr 2024; 96:270-279. [PMID: 38905477 PMCID: PMC11196007 DOI: 10.1097/qai.0000000000003417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/29/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Scientific evidence indicates that HIV viral suppression to an undetectable level eliminates sexual transmission risk ("Undetectable=Untransmittable" or "U=U"). However, U=U messaging has been met with skepticism among sexual minority men (SMM) and others. In this survey-based experiment, we manipulated messaging about HIV risk and examined reactions and perceived message accuracy among US SMM. METHODS SMM living with HIV (n = 106) and HIV-negative/status-unknown SMM (n = 351) participated in an online survey (2019-2020). Participants were randomly assigned to 1 of 3 messaging conditions, which varied by level of HIV sexual transmission risk associated with an undetectable viral load (No Risk [U=U]/Low Risk/Control). Participants reported reactions, message accuracy, and reasons for perceiving inaccuracy. We coded open-response data (reactions and reasons) into conceptual categories (eg, "Enthusiasm"). We compared reactions, accuracy ratings, and reasons by condition and serostatus. RESULTS In the No Risk Condition, common reactions were Enthusiasm (40.0%), Skepticism/Disagreement (20.0%), and Agreement (19.4%), reactions common to comparison conditions. A higher percentage of HIV-negative/status-unknown participants (24.1%) expressed Skepticism/Disagreement in the No Risk Condition compared with other conditions (3.2%-9.7%). Participants living with HIV were more likely than HIV-negative/status-unknown participants to perceive the message as accurate in all conditions. In the No Risk Condition, common reasons for perceiving inaccuracy were Risk Misstated (46.1%), Oversimplified/Caveats Needed (17.1%), and Personal Unfamiliarity/Uncertainty (14.5%), reasons common to comparison conditions. Across conditions, 10.3% of participants attributed message inaccuracy to undetectable being misdefined. CONCLUSION Most SMM reacted favorably to U=U messaging. However, many-especially HIV-negative/status-unknown SMM-expressed skepticism. Interventions are needed to enhance U=U understanding and acceptance.
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Affiliation(s)
- Sarah K. Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA
| | - Myra A. Zaheer
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Justino J. Flores
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - David A. Kalwicz
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Djordje X. Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - John F. Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Maria Cecilia Zea
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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Zhang Y, Chow EPF, Sudarto B, Wang D, Stoove M, Medland N, O'Donnell D, Keen P, Ong JJ, Phillips TR. HIV self-testing knowledge, attitudes, and practices among Asian-born gay, bisexual, and other men who have sex with men in Australia: a qualitative study. Front Public Health 2024; 12:1325081. [PMID: 38756874 PMCID: PMC11097899 DOI: 10.3389/fpubh.2024.1325081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Background Achieving virtual elimination of HIV transmission in Australia requires a combination of high treatment rates and high testing coverage among individuals at risk of acquiring HIV. HIV self-testing (HIVST) is an additional testing approach for key populations. Objective We aimed to examine the knowledge, attitudes, and practices of HIVST among Asian-born gay, bisexual and other men who have sex with men (GBMSM). Methods This qualitative study used semi-structured interviews of overseas-born GBMSM of Asian background in Australia. Participants were recruited from personal networks, social media platforms, snowballing, and the Melbourne Sexual Health Centre. Twenty-five participants were purposively sampled with a range of ages and previous levels of experience with HIVST. Interview transcripts were imported into Nvivo 12 for data management. Results The age of the participants ranged from 19 to 44 years, with a median of 30 years. Most were unaware of HIVST before the interview, and only a few had ever used one. All had limited sexual health knowledge (i.e., HIV testing, PrEP) before they arrived in Australia. Upon learning about HIVST during the interview, many expressed willingness to use HIVST, but in limited circumstances, such as traveling overseas, interim testing while taking on-demand PrEP, and point-of-sex testing. Almost all were open to distributing HIVST to their casual partners or friends, especially those they knew who engaged in high-risk sexual practice (i.e., condomless anal sex) and were not engaged in sexual healthcare. About half still preferred conventional serology testing because of regular HIV testing as part of PrEP prescription and the need for testing for other sexually transmitted infections. Conclusion HIVST may be an acceptable additional testing approach for HIV testing among Asian-born GBMSM. Peer education and secondary distribution may help raise HIVST awareness and use.
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Affiliation(s)
- Ying Zhang
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Eric P. F. Chow
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Budiadi Sudarto
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - David Wang
- Better Health Network, Prahran, VIC, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Nicholas Medland
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Darryl O'Donnell
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- Health Equity Matters, Sydney, NSW, Australia
| | - Phillip Keen
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jason J. Ong
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Tiffany R. Phillips
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
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Goodreau SM, Barry MP, Hamilton DT, Williams AM, Wang LY, Sanchez TH, Katz DA, Delaney KP. Behavior Change Among HIV-Negative Men Who Have Sex with Men Not Using PrEP in the United States. AIDS Behav 2024; 28:1766-1780. [PMID: 38411799 DOI: 10.1007/s10461-024-04281-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/28/2024]
Abstract
This study measures changes in condomless anal sex (CAS) among HIV-negative men who have sex with men (MSM) who are not taking pre-exposure prophylaxis (PrEP). It considers the 2014-2019 cycles of the American Men's Internet Survey, a serial, cross-sectional web-based survey of US cisgender MSM aged ≥ 15 years, in which ~ 10% of each year's sample is drawn from the previous year. Among those surveyed for 2 years who remained HIV-negative and off PrEP, reports of having any CAS and of CAS partner number were compared across years. We disaggregated by partner HIV status, and considered demographic predictors. The overall population saw a significant 2.2 percentage-point (pp) increase in reports of any CAS year-over-year. Sub-populations with the largest year-on-year increases were 15-24-year-olds (5.0-pp) and Hispanic respondents (5.1-pp), with interaction (young Hispanic respondents = 12.8-pp). On the relative scale, these numbers correspond to 3.2%, 7.2%, 7.3% and 18.7%, respectively. Absolute increases were concentrated among partners reported as HIV-negative. Multivariable analyses for CAS initiation found effects concentrated among Hispanic and White youth and residents of fringe counties of large metropolitan areas. CAS partner number increases were similarly predicted by Hispanic identity and young age. Although condom use remains more common than PrEP use, increasing CAS among MSM not on PrEP suggests potential new HIV transmission pathways. Concentration of increases among 18-24-year-old MSM portends future increases in the proportion of newly diagnosed HIV that occur among youth. Concentration among young Hispanic MSM will likely expand existing disparities. Although reducing barriers to PrEP remains vital, condom promotion for MSM remains a key public health practice and appears to be missing key audiences. LGBTQ+-inclusive sex education is one avenue for enhancing these efforts.
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Affiliation(s)
- Steven M Goodreau
- Department of Anthropology, University of Washington, Campus Box 353100, Seattle, WA, 98122, USA.
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA.
| | - Michael P Barry
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Center for AIDS & STD, University of Washington, Seattle, WA, USA
| | - Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| | - Austin M Williams
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Li Yan Wang
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - David A Katz
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kevin P Delaney
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Addo PNO, Brown MJ, Nkwonta CA, Kaur A, James T, Qiao S. "I Don't Believe That One": A Qualitative Study of Undetectable = Untransmittable Views Among Older Adults Living With HIV in South Carolina. J Assoc Nurses AIDS Care 2024; 35:135-143. [PMID: 38949907 PMCID: PMC11217588 DOI: 10.1097/jnc.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
ABSTRACT Undetectable = Untransmittable (U = U) means that people with HIV who achieve and maintain an undetectable viral load have effectively zero risk of sexually transmitting the virus to others. However, research on how U = U is perceived by older adults living with HIV (OAH) is currently lacking. This study explored U = U views among OAH. From October 2019 to February 2020, we conducted open-ended interviews with 24 OAH recruited at an HIV clinic in South Carolina. Interviews were audio-recorded and transcribed. We employed thematic analysis in this study. Three themes emerged from the analysis: (a) Conflicting beliefs in U = U; (b) Use condoms regardless; and (c) Fear of HIV reinfection. Despite strong scientific evidence supporting U = U, some OAH do not believe in U = U. This lack of belief could deprive OAH of the benefits U = U offers. Therefore, it is vital to educate OAH about U = U to enhance their understanding and belief in U = U.
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Affiliation(s)
- Prince Nii Ossah Addo
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Titilayo James
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Agarwal H, Yeatts K, Chung SR, Harrison-Quintana J, Torres TS. Perceived Accuracy Around Undetectable = Untransmitable Among Sexual and Gender Minorities Using Smartphones in India. AIDS Behav 2024; 28:1039-1046. [PMID: 37861923 DOI: 10.1007/s10461-023-04212-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
Sexual and gender minorities (SGM) using online venues in India are usually not reached by government HIV interventions, remaining an understudied yet important population. We investigated sociodemographic characteristics, sexual behaviours along with familiarity, knowledge, and correlated factors around perceived accuracy of the Undetectable = Untransmittable (U = U) slogan. Grindr users in India completed an online, cross-sectional survey in May-June 2022. We included individuals ≥ 18 years old who reported sex with men (excluding those who were born female and or identified as cis-gender female). Associations with perceived U = U accuracy were estimated using adjusted prevalence odds ratios (aPOR) with 95% confidence intervals (95% CI). The survey was completed by 3,126 eligible participants. The median age was 28 years and most participants lived in urban areas and had graduate or postgraduate education. HIV prevalence was 3.1%. Only 14% reported familiarity with the U = U slogan and after an explanation was provided, 25% perceived it as completely accurate. This was associated with knowing their HIV status (HIV Negative aPOR 1.37 [95%CI 1.1, 1.71], HIV Positive aPOR 3.39 [95%CI 2.11, 5.46]), having heard of PrEP (aPOR1.58 [95%CI 1.29,1.92]) or have used PrEP (aPOR1.56 [95%CI 1.15, 2.12]) along with use of party drugs (aPOR1.51 [95%CI 1.0 2.10]), being in touch with NGOs (aPOR 1.61 [95%CI 1.27, 2.02], p < .001) and having attended LGBTQIA + events (aPOR1.38 [95%CI 1.1, 1.73]). SGMs in India had low familiarity and low perceived accuracy around U = U. Education about U = U and innovating new strategies to reach this hidden population could reduce stigma around HIV in India.
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Affiliation(s)
- Harsh Agarwal
- UNC Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA.
| | - Karin Yeatts
- UNC Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA
| | - Stephanie R Chung
- UNC Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA
| | | | - Thiago S Torres
- Instituto Nacional de Infectología Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
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Silva KRO, Ferreira RC, Coelho LE, Veloso VG, Grinsztejn B, Torres TS, Luz PM. Knowledge of HIV transmission, prevention strategies and U = U among adult sexual and gender minorities in Brazil. J Int AIDS Soc 2024; 27:e26220. [PMID: 38379186 PMCID: PMC10879640 DOI: 10.1002/jia2.26220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Although strong scientific evidence of the efficacy and effectiveness of treatment-as-prevention (TasP) is available, full endorsement of the "Undetectable = Untransmittable" (U = U) and "zero-risk" messages could be improved. Increasing knowledge about HIV transmission, prevention and treatment is a critical component of care efforts. The study assessed knowledge of HIV transmission and prevention strategies, and the perceived accuracy of the slogan U = U among sexual and gender minorities (SGM) in Brazil. METHODS Cross-sectional web-based survey targeting adult SGM living in Brazil (2021-2022) recruited on social media and dating apps. We used the 12-item HIV Knowledge Assessment (HIV-KA) questionnaire to assess HIV knowledge, three items of which address pre-exposure prophylaxis (PrEP), post-exposure prophylaxis and TasP. Perceived accuracy of the U = U slogan was assessed with the question: "With regards to HIV-positive individuals transmitting HIV through sexual contact, how accurate do you believe the slogan U = U is?". We a priori grouped the study population into three mutually exclusive groups: people living with HIV (PLHIV), HIV negative and HIV unknown. We used logistic regression models to assess factors associated with high HIV knowledge and perception of the U = U as completely accurate. RESULTS Of 50,222 individuals accessing the questionnaire, 23,981 were included: 5071 (21.0%) PLHIV, 17,257 (71.5%) HIV negative and 1653 (6.9%) HIV unknown. The proportion of participants with high knowledge was significantly higher for PLHIV and HIV negative (48.1% and 45.5%, respectively) compared to 26.1% of HIV unknown. More PLHIV perceived U = U as completely accurate (80.4%), compared to 60.0% of HIV negative and 42.9% of HIV unknown. HIV knowledge correlates with perceived accuracy of the U = U slogan across all groups. Higher HIV knowledge was associated with higher income and education regardless of HIV status. Among HIV-negative participants, PrEP awareness and use were associated with higher knowledge and accurate perception of the U = U slogan. CONCLUSIONS Our findings show that HIV knowledge and perceived accuracy of U = U are strongly correlated, that knowledge differs according to HIV status, and that poor socio-economic is linked to poor knowledge among SGM from Brazil. Educational strategies regarding TasP, U = U and zero risk targeting socio-economically vulnerable populations are urgent in Brazil.
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Affiliation(s)
| | | | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Paula M. Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
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Calabrese SK, Kalwicz DA, Zaheer MA, Dovidio JF, Garner A, Zea MC, Treloar C, Holt M, Smith AKJ, MacGibbon J, Modrakovic DX, Rao S, Eaton LA. The Potential Role of Undetectable = Untransmittable (U = U) in Reducing HIV Stigma among Sexual Minority Men in the US. AIDS Behav 2024; 28:741-757. [PMID: 38285293 PMCID: PMC11043859 DOI: 10.1007/s10461-023-04263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024]
Abstract
The Undetectable = Untransmittable (U = U) message and its scientific underpinnings have been widely suggested to reduce HIV stigma. However, misunderstanding and skepticism about U = U may prevent this destigmatizing potential from being fully realized. This cross-sectional study examined associations between U = U belief (belief that someone with a sustained undetectable viral load has zero risk of sexually transmitting HIV) and HIV stigma among US sexual minority men. Differences by serostatus and effects of brief informational messaging were also explored. The survey was completed online by 106 men living with HIV and 351 HIV-negative/status-unknown men (2019-2020). Participants were 18-83 years old (M[SD] = 41[13.0]). Most were non-Hispanic White (70.0%) and gay (82.9%). Although nearly all participants (95.6%) were aware of U = U, only 41.1% believed U = U. A greater percentage of participants living with HIV (66.0%) believed U = U compared with HIV-negative/status-unknown participants (33.6%). Among participants living with HIV, U = U belief was not significantly associated with perceived, internalized, or experienced HIV stigma or with viral load prejudice (prejudice against people who have a detectable HIV viral load). Among HIV-negative/status-unknown participants, U = U belief was associated with less frequently enacted HIV discrimination, more positive feelings toward people with an undetectable viral load, and lower personal endorsement of stigmatizing beliefs. Brief informational messaging about U = U did not affect most stigma dimensions and did not favorably affect any. Interventions are needed to correct commonly held, outdated misconceptions about HIV transmission risk. Such initiatives must not only engage people living with HIV but also engage HIV-negative/status-unknown people to maximize the destigmatizing potential of U = U.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA.
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia.
| | - David A Kalwicz
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Myra A Zaheer
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - John F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Alex Garner
- Hornet Gay Social Network, Los Angeles, CA, USA
- MPact Global Action for Gay Men's Health and Rights, West Hollywood, CA, USA
| | - Maria Cecilia Zea
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - James MacGibbon
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Djordje X Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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Ma J, Chase GE, Black A, Klaphake J, Garcia-Myers K, Baker JV, Horvath KJ. Attitudes Toward and Beliefs in the Effectiveness of Biomedical HIV Prevention Strategies Among Emerging and Young Adult Sexual Minority Men. Int J Behav Med 2023:10.1007/s12529-023-10244-4. [PMID: 38114707 PMCID: PMC11187700 DOI: 10.1007/s12529-023-10244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) and HIV treatment as prevention, which underlies the Undetectable = Untransmittable (U = U) campaign, are two effective biomedical approaches for HIV prevention among sexual minority men (SMM). Attitudes toward PrEP and U = U may differ between SMM emerging adults (EA: 18-24 years old) and young adults (YA: 25-29 years old) to drive differences in sexual behavior. However, to date, few studies assessed the degree to which YAs and EAs differ in their beliefs in the effectiveness of PrEP and U = U. METHOD A national sample of 80 SMM in the USA (Mage = 25.1 years; 53.7% racial/ethnic minority; 38.8% EA; 61.3% YA) participated in a 6-month mHealth intervention for PrEP adherence. Non-parametric tests assessed differences in sexual behaviors and attitudes toward the effectiveness of PrEP and U = U between EAs and YAs using baseline data. RESULTS Compared to EAs, higher proportions of YAs trusted PrEP's effectiveness and considered condom use unnecessary after taking PrEP. More YAs than EAs were willing to engage in sexual behaviors that they felt too risky before learning about U = U and were more comfortable having condomless sex with HIV-positive partners. Conversely, a greater proportion of EAs than YAs preferred to use condoms even when their partners are on anti-HIV medications. CONCLUSION Overall, YAs trusted the effectiveness of U = U and PrEP more than EAs, underscoring developmental differences in SMM's perspectives on biomedical HIV prevention tools. Our findings underscore the importance of tailoring messages on biomedical HIV prevention options differently for EAs and YAs to optimize uptake.
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Affiliation(s)
- Junye Ma
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA.
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.
| | - Gregory E Chase
- Department of Psychology, The University of North Carolina at Greensboro, 296 Eberhart Building, Greensboro, NC, 27402, USA
| | - Ashley Black
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Jonathan Klaphake
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Kelly Garcia-Myers
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Jason V Baker
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
- Department of Medicine, University of Minnesota, 401 East River Parkway VCRC 1st Floor, Suite 131, Minneapolis, MN, 55455, USA
| | - Keith J Horvath
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
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10
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Medina-Marino A, Sibanda N, Putt M, Joseph Davey D, Smith P, Thirumurthy H, Bekker LG, Buttenheim A. Improving HIV testing, linkage, and retention in care among South African men through U=U messaging: A study protocol for two sequential hybrid type 1 effectiveness- implementation randomized controlled trials. RESEARCH SQUARE 2023:rs.3.rs-3349696. [PMID: 37886512 PMCID: PMC10602079 DOI: 10.21203/rs.3.rs-3349696/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Increasing HIV testing and treatment coverage among people living with HIV (PLHIV) is essential for achieving global AIDS epidemic control. However, compared to women, cis-gender heterosexual men living with HIV are significantly less likely to know their HIV status, initiate anti-retroviral therapy (ART) and achieve viral suppression. This is particularly true in South Africa, where men are also at increased risk of mortality resulting from AIDS-related illnesses. While there is growing knowledge of Treatment as Prevention or the concept Undetectable=Untransmittable (U=U) among PLHIV in Western and high-income countries, the reach and penetration of the U=U message in sub-Saharan Africa remains limited, and few studies have evaluated the impact of accessible and relatable U=U messages on ART initiation and adherence. To address these gaps, rigorous evaluations of interventions that incorporate U=U messages are needed, especially among men in high prevalence settings. METHODS Building on our U=U messages that we previously developed for men using behavioral economics insights and a human-centered design, we will conduct two sequential hybrid type 1 effectiveness-implementation trials to evaluate the impact of U=U messages on men's uptake of community-based HIV testing and ART initiation (Trial 1), and retention in care and achievement of viral suppression (Trial 2). A cluster randomized trial will be implemented for Trial 1, with HIV testing service site-days randomized to U=U or standard-of-care (SoC) messages inviting men to test for HIV. An individual-level randomized control trial will be implemented for Trial 2, with men initiating ART at six government clinics randomized to receive U=U counselling or SoC treatment adherence messaging. We will incorporate a multi-method evaluation to inform future implementation of U=U messaging interventions. The study will be conducted in the Buffalo City Metro Health District of the Eastern Cape Province and in the Cape Town Metro Health District in the Western Cape Province in South Africa. DISCUSSION These trials are the first to rigorously evaluate the impact of U=U messaging on HIV testing uptake, ART initiation and achievement of viral suppression among African men. If effective, these messaging interventions can shape global HIV testing, treatment and adherence counselling guidelines and practices.
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11
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Padilla M, Gutierrez M, Basu M, Fagan J. Attitudes and Beliefs About HIV Treatment as Prevention Among People Who are Not Engaged in HIV Care, 2018-2019. AIDS Behav 2023; 27:3122-3132. [PMID: 36862279 PMCID: PMC10474239 DOI: 10.1007/s10461-023-04032-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
Treatment as prevention (TasP) is an effective HIV prevention strategy. Our objectives were to explore TasP attitudes and beliefs among people with HIV (PWH) who are not engaged in care and to examine attitudes and beliefs by selected characteristics. We sampled PWH who had participated in the Medical Monitoring Project (MMP), a structured interview survey, from June 2018-May 2019 to participate in 60-minute semi-structured telephone interviews. We obtained sociodemographic and behavioral quantitative data from the MMP structured interview. We used applied thematic analysis to analyze the qualitative data and integrated the qualitative and quantitative data during analysis. Negative attitudes and beliefs, especially skepticism and mistrust, about TasP were pervasive. Only one participant who identified as female, was not sexually active, and had not heard of TasP held positive attitudes and beliefs about TasP. TasP messages should use clear and unambiguous language, address mistrust, and reach people who are not engaged in medical care.
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Affiliation(s)
- Mabel Padilla
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- DHAP/NCHHSTP/CDC, 1600 Clifton Road NE MS E-46, 30333, Atlanta, GA, USA.
| | - Mariana Gutierrez
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mohua Basu
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Fagan
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Broady TR, Chan C, MacGibbon J, Mao L, Prestage G, Clifton B, Paynter H, Bavinton BR, Holt M. Changing Characteristics of HIV-Positive Gay and Bisexual Men's Relationships in the Era of Biomedical Prevention. J Acquir Immune Defic Syndr 2023; 94:10-17. [PMID: 37195893 DOI: 10.1097/qai.0000000000003224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/06/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To assess changes in personal and relationship characteristics among HIV-positive Australian gay and bisexual men (GBM) as rates of antiretroviral therapy and knowledge and confidence regarding the effectiveness of viral suppression in preventing HIV transmission have increased. DESIGN Repeated behavioral surveillance of GBM recruited from venues, events, and online in 7 Australian states and territories. METHODS HIV-positive participants were included. Trends in demographics, HIV treatment, and relationship characteristics were assessed with binary and multivariable logistic regression. RESULTS A total of 3643 survey responses (2016-2020) were included. Over time, HIV-positive GBM became less likely to identify as gay or report an Anglo-Australian ethnicity. The average length of time since HIV diagnosis increased and the frequency of attending HIV-related clinical appointments decreased. There were no changes in the reported number of recent sex partners or proportion reporting regular male partners over time. Among HIV-positive GBM in relationships, the proportion reporting HIV-positive partners decreased and the proportion reporting HIV-negative partners increased. Levels of condomless sex with regular partners increased over time; however, this was concentrated among HIV-positive GBM in serodiscordant relationships. CONCLUSION Findings suggest that increased accessibility and trust in biomedical prevention strategies have contributed to broader relationship and sexual opportunities for HIV-positive GBM in Australia. Our findings suggest that future health promotion activities could highlight the social and relationship benefits of treatment as prevention to further increase trust in it as an HIV prevention strategy among GBM.
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Affiliation(s)
- Timothy R Broady
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Curtis Chan
- Kirby Institute, UNSW, Sydney, NSW, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Brent Clifton
- National Association of People With HIV Australia, Sydney, NSW, Australia; and
| | | | | | - Martin Holt
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
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13
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Etami Y, Zaheer MA, Marcus JL, Calabrese SK. Accuracy of HIV Risk-Related Information and Inclusion of Undetectable = Untransmittable, Pre-Exposure Prophylaxis, and Post-Exposure Prophylaxis on US Health Department Websites. AIDS Patient Care STDS 2023; 37:425-427. [PMID: 37713285 DOI: 10.1089/apc.2023.0150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Affiliation(s)
- Yasameen Etami
- Department of Psychological and Brain Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Myra A Zaheer
- Department of Psychological and Brain Sciences, The George Washington University, Washington, District of Columbia, USA
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, The George Washington University, Washington, District of Columbia, USA
- Department of Prevention and Community Health, The George Washington University, Washington, District of Columbia, USA
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14
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Shrader CH, Stephenson R, Moody R, Knox J. Binge Drinking Moderates Unprotected Sex Among HIV Sero-Similar Same Sex Male Couples: An Actor-Partner Interdependence Model. AIDS Behav 2023; 27:1824-1835. [PMID: 36441407 PMCID: PMC10149586 DOI: 10.1007/s10461-022-03914-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/29/2022]
Abstract
Most new HIV diagnoses in the US occur among sexual minority men (SMM). The majority (69%) of new HIV diagnoses among US SMM are due to transmission from main sex partners. We identified multilevel correlates of unprotected anal intercourse (UAI; condomless anal intercourse while not using a biomedical strategy) among SMM couples using the Actor Partner Interdependence Model (APIM). Participants were US SMM over 18 years, with a primary male partner > 6 months. Couples were recruited online from April 2016 until June 2017 and interviewed using self-administered computer-assisted surveys. We used a series of APIM regressions to assess multilevel associations with UAI. We also tested the moderating role of an individual's binge drinking on the relationship between HIV status similarity and UAI. Among 798 participants (n = 411 couples), 61% reported UAI in the past 6 months. Binge drinking (52%) and physical intimate partner violence (IPV; 34%) were considerably high within our sample. Actor's binge drinking, reporting experiencing and/or perpetrating physical IPV, and partner's trust were positively associated with UAI. Actor having other sexual partner(s), using illegal drugs (not marijuana), and length of relationship were negatively associated with UAI. Binge drinking positively moderated UAI among HIV serostatus similar partners. HIV prevention programming should integrate components on IPV and binge drinking reduction- especially among HIV serostatus similar couples.
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Affiliation(s)
| | - Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Raymond Moody
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA.
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA.
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
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15
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Borsa A, Siegel K. Barriers to Treatment as Prevention Adoption Among Sexual and Gender Minority Individuals Who Have Sex with Men in the United States. AIDS Patient Care STDS 2023; 37:268-277. [PMID: 37155966 PMCID: PMC10171941 DOI: 10.1089/apc.2023.0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The discovery that people with an undetectable HIV viral load are unable to transmit the virus to sex partners (U = U) has ushered in a new era in HIV care. As a result of this discovery, treatment as prevention (TasP) has become a powerful tool toward ending the epidemic. However, despite its sound scientific basis, many communities affected by HIV face barriers toward adopting TasP as a complete HIV prevention strategy. In addition, most research to date has only focused on TasP in the context of committed monogamous partnerships. To identify barriers to TasP adoption among some of those most affected by HIV, we conducted in-depth qualitative interviews with 62 sexual and gender minority individuals of varying serostatuses. Participants were identified from the results of an online survey, where those who indicated at least some awareness of TasP were invited to partake in a follow-up interview. Interviews were thematically coded to identify emergent themes relating to TasP adoption. Seven primary barriers emerged from data analysis pertaining to TasP science, internalized beliefs about HIV safety, and interactional dynamics between partners: (1) unfamiliarity with TasP science, (2) perceived limitations of TasP science, (3) difficulty changing understanding of "safe sex," (4) unwillingness to rely on partners' reports of being undetectable, (5) persistent HIV stigma, (6) less difficulty finding serosimilar partners, and (7) difficulty incorporating TasP into casual encounters. Together, these barriers confirm the existing findings about TasP adoption, and extend the literature by identifying barriers beyond a lack of education and outside of monogamous contexts.
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Affiliation(s)
- Alexander Borsa
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
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16
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Roth GH, Walker ER, Talley CL, Hussen SA. 'It's a very grey, very messy area': a qualitative examination of factors influencing undetectable gay men's HIV status disclosure to sexual partners. CULTURE, HEALTH & SEXUALITY 2023; 25:664-679. [PMID: 35697340 DOI: 10.1080/13691058.2022.2086708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
HIV disclosure to sexual partners remains a multifaceted yet stigmatised process. The 'undetectable equals untransmittable' (U = U) concept has raised ethical and moral concerns about the obligation and need to disclose, and using Internet applications to seek sex partners has modified disclosure practices. While previous qualitative literature has examined the HIV disclosure process, there is a dearth of information on this topic among gay men in the USA who have an undetectable viral load. Using thematic analysis of data collected during a period of expanded U = U knowledge, this study explores the cognitive, contextual, interpersonal and structural factors impacting undetectable gay men's HIV status disclosure decisions to sexual partners. In-depth interviews were conducted in August 2020 over Zoom with 20 gay men with undetectable viral loads. The main themes included 'sense of obligation,' 'situational disclosure' and 'partners' responsibility in the disclosure process.' Participants balanced the aforementioned factors to inform their disclosure decisions, and disclosure patterns varied across participants dependent upon thoughts regarding ethics and morality of (non-)disclosure. The findings provide new insights to how participants navigate disclosure while considering U = U, HIV criminalisation laws, and finding partners through Internet applications while providing direction for future studies and support for decriminalising HIV and expanding HIV education.
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Affiliation(s)
- Grant H Roth
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elizabeth Reisinger Walker
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Colin L Talley
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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17
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Dowell-Day A, Dobbins T, Chan C, Fraser D, Holt M, Vaccher SJ, Clifton B, Zablotska I, Grulich A, Bavinton BR. Attitudes Towards Treatment as Prevention Among PrEP-Experienced Gay and Bisexual Men in Australia. AIDS Behav 2023:10.1007/s10461-023-04019-x. [PMID: 36877254 PMCID: PMC10386911 DOI: 10.1007/s10461-023-04019-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/07/2023]
Abstract
The introduction of HIV pre-exposure prophylaxis (PrEP) has the potential to impact the attitudes gay and bisexual men (GBM) who consequently choose to take PrEP have towards treatment as prevention (TasP), and the extent to which they are willing to have condomless anal intercourse (CLAI) with an HIV-positive sexual partner who has an undetectable viral load (UVL). Using a cross-sectional sample from an observational cohort study conducted from August 2018 to March 2020, we examined the extent to which PrEP-experienced GBM are willing to have CLAI with a partner who has a UVL. Simple and multiple logistic regression models were used to identify associated variables. Of the 1386 participants included in the analyses, 79.0% believed in the effectiveness of TasP, and 55.3% were willing to have CLAI with a partner who has a UVL. Wiling participants were less worried about getting HIV when taking PrEP and more likely to believe in TasP. Further research is needed to better understand the gap between belief in TasP and willingness to have CLAI with a partner who has a UVL among PrEP-experienced GBM.
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Affiliation(s)
- Alexander Dowell-Day
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Timothy Dobbins
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Doug Fraser
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Brent Clifton
- National Association of People with HIV Australia, Newtown, NSW, Australia
| | - Iryna Zablotska
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, Australia.,Sydney Infectious Diseases Institute, University of Sydney, Westmead, Australia.,Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia
| | - Andrew Grulich
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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18
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Pratt MC, Isehunwa OO, Bassett IV, Kempf MC, Gordon B, Matthews LT. Rapid qualitative analysis approach to stakeholder and client interviews to inform mobile-based HIV testing in the U.S. Deep South. Arch Public Health 2023; 81:24. [PMID: 36793139 PMCID: PMC9930722 DOI: 10.1186/s13690-023-01039-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The severity of the HIV epidemic in the United States' rural South highlights geographic, socioeconomic, and racial disparities that disproportionately affect poor Black Americans. Approximately 16% of Alabamians living with HIV remain undiagnosed and just 37% of rural Alabamians have ever been tested for HIV. METHODS We conducted in-depth interviews with 22 key stakeholders involved in HIV prevention, testing, treatment, or community health initiatives, and 10 adults living in rural communities across Alabama to explore HIV testing challenges and opportunities. We utilized a rapid qualitative analysis approach and engaged community partners for feedback and discussion. This analysis will inform the implementation of a mobile HIV testing service in rural Alabama. RESULTS The following themes were identified: (1) Cultural norms, racism, poverty, and rurality impair access to healthcare. (2) Lack of sex education, low knowledge of HIV and perception of risk reinforce stigmas. (3) Messaging about "Undetectable = Untransmissible" (U = U) is not well understood in communities. (4) Community involvement may promote communication and trust between communities and testing advocates. (5) Novel testing strategies are acceptable and may diminish barriers. CONCLUSIONS Working with community "gatekeepers" may be a key strategy to understand and promote acceptability of interventions new to rural Alabama and ameliorate stigma within communities. The implementation of new HIV testing strategies requires building and maintaining relationships with advocates, especially faith-based leaders, who engage people across many demographics.
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Affiliation(s)
- Madeline C. Pratt
- grid.265892.20000000106344187Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Ziegler Research Building 210, 1720 2nd Ave S, Birmingham, AL 35294 USA
| | - Oluwaseyi O. Isehunwa
- grid.265892.20000000106344187Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Ziegler Research Building 210, 1720 2nd Ave S, Birmingham, AL 35294 USA
| | - Ingrid V. Bassett
- grid.32224.350000 0004 0386 9924Division of Infectious Disease and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA USA
| | - Mirjam-Colette Kempf
- grid.265892.20000000106344187Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Ziegler Research Building 210, 1720 2nd Ave S, Birmingham, AL 35294 USA ,grid.265892.20000000106344187Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL USA ,grid.265892.20000000106344187Departments of Epidemiology and Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Lynn T. Matthews
- grid.265892.20000000106344187Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Ziegler Research Building 210, 1720 2nd Ave S, Birmingham, AL 35294 USA
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19
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Chinbunchorn T, Thaneerat N, Howell S, Sowaprux T, Phiphatkunarnon P, Lujintanon S, Kaewpoowat Q, Phanuphak P, Phanuphak N, Ramautarsing RA. Assessment of U=U understanding, PrEP awareness, HIV risk behaviours and factors associated with low HIV knowledge among users of Hornet, an online dating application for LGBTQ, in Thailand. Sex Transm Infect 2023; 99:21-29. [PMID: 35260436 DOI: 10.1136/sextrans-2021-055300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/23/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Over 50% of HIV infections in Thailand annually occur among men who have sex with men (MSM) and transgender women who use online applications to meet their sexual partners. We conducted a cross-sectional study assessing undetectable=untransmittable (U=U) understanding, pre-exposure prophylaxis (PrEP) awareness, sexual behaviours and factors associated with HIV knowledge among users of Hornet in Thailand. METHODS From November 2019 to January 2020, a survey was conducted using convenience sampling on Hornet in Thailand. HIV literacy was assessed via 22 questions, and multivariable linear regression was performed. RESULTS 960 responses were assessed; median age was 34 years, the majority were MSM (80.4%), Thai (83.8%), had at least bachelor's degree (74.9%). Regarding the risk profiles, 39.1% reported inconsistent condom use, 15.0% used amphetamine-type stimulants, 56.9% had not taken PrEP in the last six months and 20.5% never had an HIV test. Only 22.8% thought that U=U was completely accurate. Lower HIV knowledge was associated with being from Africa (β -8.13, 95% CI -14.39 to -1.87), age of 25 years or younger (β -2.6, 95% CI -4.37 to -0.82), education less than bachelor's degree (β -2.58, 95% CI -3.98 to -1.19), having more than one sexual partners (β -2.41, 95% CI -4.13 to -0.69), paying three or more people to have intercourse (β -2.5, 95% CI -4.26 to -0.74), not knowing one's HIV status (β -3.56, 95% CI -5.45 to -1.68) and not answering about previous PrEP use (β -4.11, 95% CI -7.86 to -0.36). Higher HIV knowledge was associated with being from Europe (β 2.54, 95% CI 0.46 to 4.61), the Americas (β 3.37, 95% CI 0.44 to 6.30) and previous PrEP use (β 2.37, 95% CI 0.94 to 3.81). CONCLUSION Among Hornet users in Thailand, the U=U message was unclear, and PrEP use was suboptimal. Large HIV knowledge gaps and high-risk behaviours were concerning. Educational campaigns in online spaces are needed to promote awareness and HIV prevention strategies.
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Affiliation(s)
- Tanat Chinbunchorn
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand .,Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Natapong Thaneerat
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand.,Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | | | | | | | - Sita Lujintanon
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
| | - Quanhathai Kaewpoowat
- Faculty of Medicine and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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20
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Meanley S, Egan JE, Ware D, Brennan-Ing M, Haberlen SA, Detels R, Palella F, Friedman MR, Plankey MW. Self-Reported Combination HIV Prevention Strategies Enacted by a Prospective Cohort of Midlife and Older Men Who Have Sex with Men in the United States: A Latent Class Analysis. AIDS Patient Care STDS 2022; 36:462-473. [PMID: 36394465 PMCID: PMC9839341 DOI: 10.1089/apc.2022.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Insights into combination HIV prevention (CHP) strategies to reduce HIV incidence among midlife and older adult men who have sex with men (MSM) are limited. The current study is a secondary data analysis evaluating CHP in a sample of sexually active midlife and older adult MSM (N = 566) from the Multicenter AIDS Cohort Study Healthy Aging Substudy. Stratified by HIV serostatus, we used latent class analyses to identify CHP classes based on self-reported sociobehavioral and biobehavioral prevention strategies that participants and their male partners used in the prior 6 months. We identified three CHP classes among men living without HIV (MLWOH), including the following: high CHP overall (43.0%), high anal sex abstention (15.0%), and low prevention overall (42.0%). Among men living with HIV (MLWH), we identified four CHP classes, including the following: high CHP overall (20.9%), high CHP/low condom use (27.1%), high condom reliance (22.3%), and low prevention overall (29.7%). There were small differences by sociodemographic characteristics and sexual behavior practices between the classes; however, poppers use was often linked to being in high CHP groups. Our findings support that CHP is not one-size-fits-all for midlife and older adult MSM. There remains a need to scale up clinical providers' sexual health communication practices to assist midlife and older MSM incorporate prevention strategies, particularly biobehavioral prevention strategies that align with their patients' lived experiences.
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Affiliation(s)
- Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Deanna Ware
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York City, New York, USA
| | - Sabina A. Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roger Detels
- Department of Epidemiology and Infectious Diseases, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Frank Palella
- Department of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mackey R. Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Michael W. Plankey
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
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21
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Walsh JL, John SA, Robles G, Wesche R, Hirshfield S. Talking to My Partners About PrEP: Factors Associated with PrEP-Related Communication in a Longitudinal US Study of Sexual Minority Men Living with HIV. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1438-1447. [PMID: 35524930 PMCID: PMC9810111 DOI: 10.1007/s11121-022-01372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 01/05/2023]
Abstract
Treatment as prevention and pre-exposure prophylaxis (PrEP) have reduced HIV transmission among sexual minority men (SMM). However, little is known about PrEP-related communication in serodiscordant partnerships. In 2015-2016, 965 US SMM living with HIV (Mage = 39; 63% White, 19% Black, 18% Latinx) enrolled in a year-long longitudinal study with surveys every 3 months (2,850 surveys). Multilevel models explored factors associated with PrEP-related communication with HIV-negative partners. Most participants (77%) reported PrEP-related communication. Participants were more likely to discuss PrEP during periods with more sexual partners, AOR = 2.89, p < .001, and group sex, AOR = 1.99, p = .001. Those with more partners on average, β = 0.48, p < .001, and those engaging in other drug use more frequently, β = 0.11, p = .002, were more likely to discuss PrEP. PrEP-related communication was more common for men who disclosed their HIV status, β = 0.22, p < .001, and who had undetectable viral loads, β = 0.25, p = .007. Communication was also more common for those with higher incomes, β = 0.12, p = .02, and from larger cities, β = 0.07, p = .048, and less common for Black participants, β = - 0.29, p = .003, and older participants, β = - 0.18, p < .001. PrEP-related communication increased over the course of the study, AOR = 1.16, p= .02. PrEP can confer additional HIV prevention benefits within serodiscordant partnerships, and future research should continue to explore the role PrEP plays in these partnerships.
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Affiliation(s)
- Jennifer L Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA.
| | - Steven A John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| | - Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Rose Wesche
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Sabina Hirshfield
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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22
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Curley CM, Rosen AO, Mistler CB, Eaton LA. Pleasure and PrEP: A Systematic Review of Studies Examining Pleasure, Sexual Satisfaction, and PrEP. JOURNAL OF SEX RESEARCH 2022; 59:848-861. [PMID: 35089110 PMCID: PMC9329484 DOI: 10.1080/00224499.2021.2012638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective form of Human Immunodeficiency Virus (HIV) prevention for people at potential risk for exposure. Despite its demonstrated efficacy, PrEP uptake and adherence have been discouraging, especially among groups most vulnerable to HIV transmission. A primary message to persons who are at elevated risk for HIV has been to focus on risk reduction, sexual risk behaviors, and continued condom use, rarely capitalizing on the positive impact on sexuality, intimacy, and relationships that PrEP affords. This systematic review synthesizes the findings and themes from 16 quantitative, qualitative, and mixed methods studies examining PrEP motivations and outcomes focused on sexual satisfaction, sexual pleasure, sexual quality, and sexual intimacy. Significant themes emerged around PrEP as increasing emotional intimacy, closeness, and connectedness; PrEP as increasing sexual options and opportunities; PrEP as removing barriers to physical closeness and physical pleasure; and PrEP as reducing sexual anxiety and fears. It is argued that positive sexual pleasure motivations should be integrated into messaging to encourage PrEP uptake and adherence, as well as to destigmatize sexual pleasure and sexual activities of MSM.
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Affiliation(s)
- Christine M. Curley
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- The first two authors are co-authors on this manuscript, as they contributed equally to design and analyses
| | - Aviana O. Rosen
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- The first two authors are co-authors on this manuscript, as they contributed equally to design and analyses
| | - Colleen B. Mistler
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Lisa A. Eaton
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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23
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Coyne R, Walsh JC, Noone C. Awareness, Understanding and HIV Stigma in Response to Undetectable = Untransmittable Messages: Findings from a Nationally Representative Sample in the United Kingdom. AIDS Behav 2022; 26:3818-3826. [PMID: 35687191 DOI: 10.1007/s10461-022-03710-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
'Undetectable = Untransmittable', or 'U = U', is a message which communicates the scientific consensus that people living with HIV who maintain an undetectable viral load cannot sexually transmit HIV to others. This research aimed to empirically test whether a protection-framed U = U message is more effective at decreasing HIV stigma and increasing perceived accuracy of U = U than a risk-framed message. A nationally representative UK sample (N = 707) completed an online experiment. Participants viewed one of two U = U messages (protection-framed or risk-framed) and completed an online questionnaire. No evidence of a difference in HIV stigma at post-test or in perceived accuracy of U = U was found between the two message frame conditions. A minority of participants were aware of U = U prior to participation. Post-intervention, the majority of participants rated U = U as at least somewhat accurate. Higher understanding of U = U was associated with lower post-test stigma following a protection-framed message. Following a brief intervention, among a sample predominantly unaware of U = U previously, there was an overall favourable rating of U = U. No evidence was found for an effect of message framing on HIV stigma or perceived accuracy of U = U, but participants who completed a pre-test measure of stigma rated U = U as less accurate.
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Affiliation(s)
- Rory Coyne
- School of Psychology, National University of Ireland, Galway, Ireland.
| | - Jane C Walsh
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Chris Noone
- School of Psychology, National University of Ireland, Galway, Ireland
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24
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Mendelsohn JB, Calzavara L, Bullock S, Iveniuk J, Tan DHS, Burchell AN, Bourne A, Lebouché B, Daftary A, Moravan V, Loutfy M, Conway B. Disclosure of HIV-serodiscordant relationships and association with viral suppression: results from the Positive Plus One study. AIDS Care 2022; 35:1037-1044. [PMID: 35416092 DOI: 10.1080/09540121.2021.2019669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Little is known about the effects of disclosure of HIV-serodiscordant relationships on clinical outcomes. We aimed to evaluate the effect of relationship disclosure on HIV viral suppression, and hypothesized that disclosure by HIV-positive and HIV-negative partners would be associated with viral suppression in the HIV-positive partner. METHODS We conducted a Canadian national online and telephone-administered survey of HIV-positive and HIV-negative partners in serodiscordant relationships. The primary outcome was self-reported viral suppression. Multivariable analyses were undertaken using Firth logistic regression. RESULTS We recruited 540 participants in current serodiscordant relationships (n = 228 HIV-negative; n = 312 HIV-positive). Similar proportions of HIV-positive and HIV-negative partners disclosed their relationship to healthcare professionals (82% v. 76%, p = 0.13). Among HIV-positive partners, disclosure of the relationship to healthcare professionals increased the odds of viral suppression (aOR = 4.7; CI: 2.13, 10.51) after adjusting for age, education, and relationship turmoil due to HIV. Increasing age (aOR = 1.28; 95% CI = 1.07, 1.55) and education (aOR = 2.43; 95% CI = 1.15, 5.26) were also associated with viral suppression. Among HIV-negative partners, relationship disclosure was not associated with viral suppression and HIV-negative heterosexual men were less likely to report that their HIV-positive partners were virally suppressed (aOR = 0.24; CI: 0.09, 0.61). CONCLUSIONS Disclosure of HIV-serodiscordant status by HIV-positive participants to healthcare professionals was associated with increased odds of viral suppression. Similar effects were not evident among HIV-negative participants. Future work should explore factors that empower relationship disclosure and incorporate them into supportive services for HIV-serodiscordant relationships.
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Affiliation(s)
| | - Liviana Calzavara
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra Bullock
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - James Iveniuk
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Darrell H S Tan
- Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, Latrobe University, Melbourne, Australia.,Kirby Institute, University of New South Wales, Kensington, Australia
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Canada.,Infectious Diseases and Immunity in Global Health Program, Centre for Outcomes Research and Evaluation, Montreal, Canada
| | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, York University, Toronto, Canada.,Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Canada
| | | | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, Canada
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25
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Ryan M, Mendelsohn JB, Daftary A, Yang M, Bullock S, Lebouché B, Calzavara L. Dual pharmaceutical citizenship: Exploring biomedicalization in the daily lives of mixed HIV-serostatus couples in Canada. Soc Sci Med 2022; 298:114863. [PMID: 35279477 DOI: 10.1016/j.socscimed.2022.114863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 01/30/2022] [Accepted: 02/22/2022] [Indexed: 10/19/2022]
Abstract
Positive Plus One is the first large-scale mixed methods study of mixed HIV serostatus couples in Canada. We aimed to understand how biomedicalization i.e., a social process of commodification and expansion of the jurisdiction of medicine over health, influenced the everyday relationships of these couples. We completed 51 semi-structured interviews among a purposive sample of HIV-positive (n = 27) and HIV-negative (n = 24) partners in current or past mixed-serostatus relationships. Participants were recruited after completing an online survey where they consented to be re-contacted for qualitative interviews. Participants represented a diversity of sexual orientations, gender identities, and other sociodemographic characteristics. Drawing on inductive thematic analysis to identify patterns within couples, across serostatus and sexual orientations, we argue that everyday lives of mixed-serostatus couples were shaped by biomedical knowledge and enacted through routine adherence to obtain and maintain viral load undetectability. Our findings illustrated the importance of learning biomedical knowledge for mixed-serostatus couples in this study, the empowering influence of undetectable = untransmittable (UU) discourse, and its role in rendering HIV mundane through routine ART adherence. We introduce the concept of 'dual pharmaceutical citizenship' to underscore a process by which particular biopolitical and biomedical expectations are fulfilled in mixed-serostatus relationships. These findings have implications for people who do not readily accept or have access to biomedical knowledge, particularly when treatment-as-prevention frames a "right" and "wrong" approach to HIV management. Future studies should focus on couples where at least one partner does not readily accept or have access to biomedical knowledge.
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Affiliation(s)
- Molly Ryan
- Dalla Lana School of Public Health, University of Toronto, Canada
| | | | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, York University, Canada; Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, South Africa
| | - Minhui Yang
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Sandra Bullock
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Canada; Department of Family Medicine, McGill University, Canada; Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, McGill University, Canada
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26
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Ferreira RC, Torres TS, Ceccato MDGB, Bezerra DR, Thombs BD, Luz PM, Harel D. Development and Evaluation of Short-Form Measures of the HIV/AIDS Knowledge Assessment Tool Among Sexual and Gender Minorities in Brazil: Cross-sectional Study. JMIR Public Health Surveill 2022; 8:e30676. [PMID: 35348470 PMCID: PMC9132367 DOI: 10.2196/30676] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 01/07/2022] [Accepted: 01/27/2022] [Indexed: 01/26/2023] Open
Abstract
Background In theoretical models of health behavior, knowledge about disease transmission and self-protective behaviors are conceptualized as important drivers of behavior change. Several studies conducted in Brazil point to an unfortunate convergence of sexual and gender minority (SGM) populations with low levels of HIV knowledge and younger age, lower education, engagement in higher-risk sexual behavior, and never having tested for HIV. Measures to assess level of HIV knowledge have been previously published, including the 12-item HIV/AIDS Knowledge Assessment (HIV-KA) tool. However, measure length can be a barrier to assessment. Objective We started from the 12-item HIV-KA tool and developed candidate short forms using statistical procedures, evaluated their psychometric properties, and tested the equivalency of their associations with other measures of HIV knowledge compared to the 12-item version. Methods A convenience sample of SGM was recruited during September 2020 to complete an online survey through advertisements on two social networking apps (Grindr and Hornet). The survey instrument included items on sociodemographic information, prior HIV testing and HIV test results, preexposure prophylaxis (PrEP) and antiretroviral treatment use, sexual behavior, and 3 HIV knowledge measures: the HIV-KA, World Health Organization Knowledge About HIV Transmission Prevention Indicator, and the Brief HIV Knowledge Questionnaire. We used exploratory factor analysis and confirmatory factor analysis (CFA) to assess the factor structure of the of the HIV-KA. We used optimal test assembly (OTA) methods to develop candidate short forms of the HIV-KA and evaluated them based on prespecified reliability, concurrent validity, and statistically equivalent convergent validity criteria. Results Among 2552 SGM individuals from Brazil, mean age was 35.1 years, 98.2% (2507/2552) cisgender men and 1.8% (45/2552) transgender/nonbinary, 56.5% (1441/2552) White, and 31.0% (792/2552) self-reported HIV positive. CFA indicated a 1-factor structure for the 12-item HIV-KA. Concurrent validity correlations were high for all short forms with 6 items, but only versions with 9 items were as reliable as the full-length form and demonstrated equivalency for convergent validity correlations. Suggesting post hoc convergent validity, HIV knowledge scores using the 9- and 10-item short forms were higher for participants who perceived the Undetectable Equals Untransmittable (U=U) slogan as completely accurate versus not accurate. Suggesting post hoc concurrent validity, participants of younger age, of Black, Pardo or indigenous race, and reporting lower education and lower income scored lower on HIV knowledge. Participants who never tested for HIV scored lower than those who tested negative or positive, while those currently using PrEP scored higher than those reporting past or never use. Conclusions OTA methods were used to shorten the 12-item HIV-KA to 9-item and 10-item versions while maintaining comparable reliability and validity among a large sample of Brazilian SGM. However, these short forms did not shorten sufficiently to justify deviation from the full measure.
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Affiliation(s)
- Rayanne C Ferreira
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Daniel Rb Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Departments of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
- Biomedical Ethics Unit, McGill University, Montreal, QC, Canada
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY, United States
- Center for Practice and Research and the Intersection of Information, Society, and Methodology, New York University, New York, NY, United States
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27
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Sauermilch D, Siegel K, Hoppe T, Roth G, Meunier É. Attitudes Toward HIV-Positive Status Disclosure Among U=U-Aware Sexual and Gender Minority Individuals in the USA: a Consensual Qualitative Research Approach. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 20:692-704. [PMID: 35369684 PMCID: PMC8962277 DOI: 10.1007/s13178-022-00710-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 05/28/2023]
Abstract
Introduction The U=U (i.e., undetectable equals untransmittable) campaign is founded upon biomedical advancements that have positioned HIV as a manageable condition with effectively zero risk of transmission. In spite of these developments, attitudes of sexual and gender minority populations regarding the necessity of seropositive status disclosure remain unexamined. Methods The current study analyzed qualitative data regarding the necessity of seropositive status disclosure from 62 sexual minority men as well as transgender and gender non-conforming individuals who have sex with men from 2020 to 2021. Results The majority of participants believed disclosure to be necessary and invoked several social and structural factors that informed their attitudes. Participants cited HIV criminalization laws, the ethics of non-disclosure, and disclosure as a means of educating sex partners when appraising the necessity of disclosure. Participants also presented concerns regarding U=U efficacy and HIV stigma. Conclusions Findings indicate that the disclosure of seropositive status to sex partners is still important to U=U-aware sexual and gender minority individuals. The majority of the study sample, irrespective of HIV status, believed seropositive status disclosure was necessary in advance of sex. Policy Implications Findings suggest opportunities for public health messaging to remediate concerns about U=U efficacy, combat misinformation, and clarify out-of-date information on HIV criminalization.
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Affiliation(s)
- Daniel Sauermilch
- Department of Psychology, Long Island University, 1 University Plaza, Brooklyn, NY 11201 USA
| | - Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, 10032 USA
| | - Trevor Hoppe
- Department of Sociology, University of North Carolina at Greensboro, 337 Frank Porter Graham Building, PO Box 26170, Greensboro, NC 27402-6170 USA
| | - Grant Roth
- Whitman-Walker Institute, Washington, DC USA
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, 10032 USA
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28
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Stutterheim SE, Kuijpers KJR, Waldén MI, Finkenflügel RNN, Brokx PAR, Bos AER. Trends in HIV Stigma Experienced by People Living With HIV in the Netherlands: A Comparison of Cross-Sectional Surveys Over Time. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:33-52. [PMID: 35192394 DOI: 10.1521/aeap.2022.34.1.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We investigated whether HIV stigma has changed in recent years. We compared data on stigma settings and manifestations from 2007 (n = 667) and, specifically for health care, 2009 (n = 262), to data acquired in 2019/2020 (n = 258). Results showed reductions in stigma from friends, family, acquaintances, at work, in the financial services sector, and in media, but stigmatizing messages in media remained highly prevalent. Stigma in the LGBTQI+ community, with sexual partners, and while partying also remained prevalent and, disconcertingly, relatively unchanged. Stigma in health care increased. HIV stigma was positively related to psychological distress, and negatively related to social support and medication adherence. Further, most participants were familiar with U=U and PrEP, but 13.3% questioned the accuracy of U=U. Stigma reduction efforts should focus on reducing stigma in media, in the LGBTQI+ community and while dating, and in health care, with U=U as a key message.
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Affiliation(s)
- Sarah E Stutterheim
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
- Department of Health Promotion/Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Kyran J R Kuijpers
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - Moon I Waldén
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | | | - Pieter A R Brokx
- The Dutch Association of People with HIV [HIV Vereniging], Amsterdam, the Netherlands
| | - Arjan E R Bos
- Faculty of Psychology, Open University of the Netherlands, Heerlen, the Netherlands
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29
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Dennermalm N, Persson KI, Thomsen S, Forsberg BC, Alvesson HM. Conceptualizing safer sex in a new era: Risk perception and decision-making process among highly sexually active men who have sex with men. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000159. [PMID: 36962224 PMCID: PMC10022342 DOI: 10.1371/journal.pgph.0000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are at the epicenter of the HIV epidemic. Efforts to prevent sexually transmitted infections (STIs) and HIV transmission have traditionally focused on condoms and abstinence from high risk sexual practices. Recently, additional methods such as pre-exposure prophylaxis (PrEP) and viral load sorting have been introduced. The aim of this study was to gain understanding about risk management and risk perception strategies for HIV among highly sexually active Swedish MSM with men in Berlin. METHODS Eighteen sexually active Swedish MSM who travelled to or lived in Berlin were recruited and interviewed in this study. The data were analyzed using content analysis. RESULTS AND DISCUSSION These men represent a group of knowledgeable MSM in terms of HIV. They acknowledged that having sex with men in Berlin was linked to high sexual risk taking due to the higher prevalence of HIV/STIs than in Sweden, but reported that they nevertheless did not alter their risk management strategies. The analysis resulted in a conceptual model of risk assessment that allows for a deeper understanding of the complexity of the risk reduction decision-making process. Three ontological perceptions of risk were identified: accepting, minimizing and rejecting risk. Seven practiced risk reduction methods were described. Some informants applied their preferred method or set of methods to all settings and partners, while others faced complex decision-making processes. CONCLUSION HIV is integrated into the core of MSM's sexuality, independently of how they ontologically related to the idea of risk. A constant navigation between pleasure, risk and safety, alongside having to relate to risk created a complex process. Efforts were made to remove HIV from their lives by rejecting the idea of risk, and thereby reject the idea of the homosexual body being a possible vessel for a virus and an epidemic.
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Affiliation(s)
- Nicklas Dennermalm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | | | - Sarah Thomsen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Birger C Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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30
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Bor J, Fischer C, Modi M, Richman B, Kinker C, King R, Calabrese SK, Mokhele I, Sineke T, Zuma T, Rosen S, Bärnighausen T, Mayer KH, Onoya D. Changing Knowledge and Attitudes Towards HIV Treatment-as-Prevention and "Undetectable = Untransmittable": A Systematic Review. AIDS Behav 2021; 25:4209-4224. [PMID: 34036459 PMCID: PMC8147591 DOI: 10.1007/s10461-021-03296-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 12/12/2022]
Abstract
People on HIV treatment with undetectable virus cannot transmit HIV sexually (Undetectable = Untransmittable, U = U). However, the science of treatment-as-prevention (TasP) may not be widely understood by people with and without HIV who could benefit from this information. We systematically reviewed the global literature on knowledge and attitudes related to TasP and interventions providing TasP or U = U information. We included studies of providers, patients, and communities from all regions of the world, published 2008–2020. We screened 885 papers and abstracts and identified 72 for inclusion. Studies in high-income settings reported high awareness of TasP but gaps in knowledge about the likelihood of transmission with undetectable HIV. Greater knowledge was associated with more positive attitudes towards TasP. Extant literature shows low awareness of TasP in Africa where 2 in 3 people with HIV live. The emerging evidence on interventions delivering information on TasP suggests beneficial impacts on knowledge, stigma, HIV testing, and viral suppression. Review was pre-registered at PROSPERO: CRD42020153725
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Affiliation(s)
- Jacob Bor
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02119, USA.
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa.
| | - Charlie Fischer
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02119, USA
| | - Mirva Modi
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02119, USA
| | | | | | - Rachel King
- UCSF Institute for Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | | | - Idah Mokhele
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa
| | - Tembeka Sineke
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
- Division of Infection and Immunity, University College London, London, UK
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02119, USA
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Kenneth H Mayer
- Fenway Health Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dorina Onoya
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa
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Kalichman SC, Kalichman MO, Eaton LA. Undisclosed HIV Status to Sex Partners and Its Unintended Consequences in the Era of Undetectable = Untransmittable. J Acquir Immune Defic Syndr 2021; 88:149-156. [PMID: 34267054 DOI: 10.1097/qai.0000000000002762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) and sustained HIV suppression virtually eliminate HIV transmission, eg, having an undetectable viral load renders HIV untransmittable (U=U). Owing to the greatly reduced likelihood of HIV transmission when viral load is undetectable, we studied one behavioral ramification of adopting a U=U prevention strategy-not disclosing HIV status to sex partners. SETTING Cisgender men recruited through community outreach in the state of Georgia, USA. METHODS We examined HIV status disclosure to sex partners among 345 young (median age = 29 years) men receiving ART. Data were collected using computerized interviews, daily sexual behavior surveys over 28 days, unannounced pill counts for ART adherence, urine tests for drug use and urogenital health, and blood samples for HIV viral load. RESULTS One in 3 participants (34%) engaged in condomless anal/vaginal intercourse with an HIV-negative/unknown HIV status partner over 28 days. Average ART adherence was 76%, and one in 5 men had detectable HIV viral loads. Men who engaged in condomless sex with undisclosed partners demonstrated significantly less HIV disclosure to family and friends and had fewer enacted stigma experiences. Hierarchical regression models showed that endorsing U=U as a personal HIV prevention strategy predicted undisclosed condomless sex over and above substance use, HIV stigma experiences, disclosure to family and friends, ART adherence, and HIV viral load. CONCLUSIONS Interventions are needed to improve ART adherence and assist men living with HIV in their decisions to disclose HIV status to sex partners.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
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Bor J, Musakwa N, Onoya D, Evans D. Perceived efficacy of HIV treatment-as-prevention among university students in Johannesburg, South Africa. Sex Transm Infect 2021; 97:596-600. [PMID: 34510009 PMCID: PMC8606435 DOI: 10.1136/sextrans-2021-055031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/09/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Antiretroviral therapy (ART) nearly eliminates HIV transmission. Yet information on treatment as prevention (TasP) has been slow to diffuse in sub-Saharan Africa. We assessed TasP knowledge among university students in South Africa. Methods We conducted a cross-sectional survey of first-year university students at a large public university in Johannesburg, South Africa, all of whom would have recently completed secondary school HIV curricula. Respondents were asked to consider the likelihood of HIV transmission in a serodiscordant couple having condomless sex with and without virally suppressive ART. Beliefs were elicited using a 0–20 visual scale. Perceived TasP efficacy was computed as the relative reduction in risk associated with virally suppressive ART. We compared beliefs with estimates from the scientific literature and assessed associations with demographics, HIV testing history and qualitative measures of HIV knowledge and risk perception. Results The analysis included 365 university students ages 18-25 years (48% female, 56% from Gauteng Province). On average, perceived annual risk of HIV transmission with virally suppressive ART was 73%; the objective risk is <1%. On average, respondents perceived that virally suppressive ART reduced annual transmission risk by 17%; the objective reduction in risk is >96%. We observed no differences in perceived TasP efficacy by participant characteristics and testing history. Perceived TasP efficacy was correlated with the (correct) belief that HIV risk increases with sexual frequency. Conclusions University students in South Africa underestimated the prevention benefits of HIV treatment. Low knowledge of TasP could limit demand for HIV testing and treatment among young adults.
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Affiliation(s)
- Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA .,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.,Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
| | - Nozipho Musakwa
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
| | - Dorina Onoya
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
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Rivera AV, Carrillo SA, Braunstein SL. Prevalence of U = U Awareness and Its Association with Anticipated HIV Stigma Among Low-Income Heterosexually Active Black and Latino Adults in New York City, 2019. AIDS Patient Care STDS 2021; 35:370-376. [PMID: 34463141 DOI: 10.1089/apc.2021.0070] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The fact that people with HIV (PWH) who have an undetectable viral load cannot sexually transmit HIV has been disseminated under the messaging "Undetectable = Untransmittable" (U = U). U = U messaging intends to destigmatize HIV by demonstrating that PWH can have healthy sexual lives. Among a sample of low-income heterosexually active Black and Latino adults, we aimed to (1) measure the prevalence of U = U awareness and (2) determine its association with anticipated HIV stigma. Low-income heterosexually active adults were recruited through respondent-driven sampling in New York City. Among Black and Latino participants who self-reported not having HIV, multiple linear regression was used to determine the association between U = U awareness with the following types of anticipated HIV stigma, as determined by principal component analyses: (1) general; (2) dating related; and (3) sex related. Of 485 participants, 35% were aware of U = U. Those who were aware reported less dating-related [adjusted B: -0.20; 95% confidence interval (CI): -0.37 to -0.03] and sex-related (adjusted B: -0.15; 95% CI: -0.29 to -0.002) anticipated HIV stigma. Although the prevalence of U = U awareness was much lower than reported in other populations (e.g., gender and sexual minorities and PWH), prevalence was moderate in our sample, given that awareness efforts have generally not focused on heterosexually active adults. Our findings provide preliminary evidence that U = U awareness may have an impact on anticipated HIV stigma related to dating and sex. Additional methods to disseminate U = U messaging and dismantle HIV stigma in this population should be explored.
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Affiliation(s)
- Alexis V. Rivera
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Sidney A. Carrillo
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Sarah L. Braunstein
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
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Felner JK, Mittal ML, Hoenigl M, Amico KR, Grelotti DJ, Eanes A, Hess K, Crawford J, Smith LR. Constructions of HIV Risk Among a Diverse Sample of HIV-Negative Young Men Who Have Sex With Men Who Are Repeat Testers. J Acquir Immune Defic Syndr 2021; 86:e126-e133. [PMID: 33394615 PMCID: PMC7933095 DOI: 10.1097/qai.0000000000002614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To end the HIV epidemic, HIV prevention and pre-exposure prophylaxis (PrEP) promotion efforts must reach young men who have sex with men (YMSM) at greatest risk for HIV. This study qualitatively explored whether common metrics used by clinicians, scientists, and public health officials to objectively assess HIV risk align with how YMSM conceptualize their risk for HIV and the factors that shape YMSM's risk perceptions. METHODS Interviews with a racially/ethnically diverse sample of HIV-negative YMSM (ages 19-24 years, 60% Latinx; n = 20) examined conceptualizations of HIV risk within the context of repeat HIV testing. Iterative, applied thematic analysis examined how participants conceptualized and constructed their HIV risk, and compared participants' descriptions of their risk with a validated quantitative assessment of HIV risk that reliably predicts HIV seroconversion in this group. RESULTS Objective quantitative assessments of HIV risk poorly aligned with participants' perceived HIV risk. Participants described their current risk in relative terms (relative to past risk and relative to friends'/peers' risk) and described age/developmental stage and changes in knowledge about HIV prevention as key factors in risk changes over time. Other factors included substance use and trust/mistrust in sexual partners and scientific advances in HIV prevention (eg, U = U and PrEP). Factors that influenced participants' perceived HIV risk were similar regardless of objective risk assessment. CONCLUSIONS Quantitative assessments of risk may poorly align with risk perception among YMSM. Although objective metrics can effectively target YMSM at greatest risk for HIV transmission, interventions to improve prevention behaviors and PrEP uptake may be more effective when tailored to bridge the disconnection between objective HIV risk assessments and YMSM's constructions of risk.
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Affiliation(s)
- Jennifer K. Felner
- San Diego State University, Institute for Behavioral and Community Health and School of Public Health, 9245 Sky Park Court, Suite 224, San Diego, CA 92123
| | - Maria Luisa Mittal
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
| | - Martin Hoenigl
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
| | - K. Rivet Amico
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
| | - David J. Grelotti
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego School of Medicine, 200 Dickinson St, Suite B, San Diego, CA 92103
| | - Alex Eanes
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
- NASTAD, 444 North Capitol Street NW, Suite 339, Washington, D.C. 20001
| | - Kristen Hess
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
- Clinical Trials Administration, Renown Health, 1155 Mill Street, G14, Reno, NV 89502
| | - Jessica Crawford
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Laramie R. Smith
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
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Calabrese SK, Mayer KH, Marcus JL. Prioritising pleasure and correcting misinformation in the era of U=U. Lancet HIV 2021; 8:e175-e180. [PMID: 33662266 DOI: 10.1016/s2352-3018(20)30341-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
There is widespread unawareness and disbelief regarding the evidence-based conclusion that people who have a sustained undetectable HIV viral load cannot sexually transmit HIV-ie, undetectable=untransmittable (U=U). Long-standing, misguided fear about HIV transmission persists; consequently, so does the policing of sexual expression and the penalisation of pleasure faced by people with HIV. Many people with HIV with an undetectable viral load have unnecessarily abstained from condomless sex, avoided serodifferent partnering, and had anxiety about onward sexual transmission due to perceived HIV risk that is now known to be non-existent. Some health professionals have refrained from correcting this misinformation because of concerns that people with HIV will engage in more condomless sex or have more sexual partners upon learning of U=U. Withholding information about U=U is thus rooted in behavioural assumptions and is scientifically unfounded. Moreover, withholding such information violates medical ethics, perpetuates health inequities, and infringes on the sexual health and human rights of people with HIV. Health professionals and the broader public health community have an ethical responsibility to actively address misinformation about HIV transmission and disseminate the U=U message to all people.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain Sciences, and Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
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36
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Holt M, MacGibbon J, Bear B, Lea T, Kolstee J, Crawford D, Murphy D, Power C, Ellard J, de Wit J. Trends in Belief That HIV Treatment Prevents Transmission Among Gay and Bisexual Men in Australia: Results of National Online Surveys 2013-2019. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:62-72. [PMID: 33617321 DOI: 10.1521/aeap.2021.33.1.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We have tracked belief in the effectiveness of HIV treatment as prevention (TasP) among Australian gay and bisexual men (GBM) since 2013. National, online cross-sectional surveys of GBM were conducted every 2 years during 2013-2019. Trends and associations were analyzed using multivariate logistic regression. Data from 4,903 survey responses were included. Belief that HIV treatment prevents transmission increased from 2.6% in 2013 to 34.6% in 2019. Belief in the effectiveness of TasP was consistently higher among HIV-positive participants than other participants. In 2019, higher levels of belief in TasP were independently associated with university education, being HIV-positive, using pre-exposure prophylaxis, knowing more HIV-positive people, being recently diagnosed with a sexually transmitted infection (STI) and use of post-exposure prophylaxis. Belief that HIV treatment prevents transmission has increased substantially among Australian GBM, but remains concentrated among HIV-positive GBM, those who know HIV-positive people, and GBM who use antiretroviral-based prevention.
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Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | | | - Dean Murphy
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Cherie Power
- New South Wales Ministry of Health, Sydney, Australia
| | - Jeanne Ellard
- Australian Federation of AIDS Organisations, Sydney, Australia
| | - John de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
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Pralat R, Burns F, Anderson J, Barber TJ. Can HIV-positive gay men become parents? How men living with HIV and HIV clinicians talk about the possibility of having children. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:281-298. [PMID: 33222191 PMCID: PMC8170559 DOI: 10.1111/1467-9566.13218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/11/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
It is now established that people living with HIV who have an undetectable viral load and adhere to antiretroviral treatment cannot transmit HIV to their sexual partners. Previous research has shown that 'being undetectable' changes how HIV-positive gay men experience their sex lives. But how does it affect gay men's reproductive behaviours? And what influence does it have on views about parenthood at a time when gay fatherhood has become more socially accepted and publicly visible? Drawing on qualitative interviews with patients and clinicians at four HIV clinics in London, we identify differences in how interviewees talked about the possibility of having children for HIV-positive men. Both groups, unprompted, frequently referred to sperm washing as a method enabling safe conception. However, whereas clinicians talked about sperm washing as an historical technique, which is no longer necessary, patients spoke of it as a current tool. The men rarely mentioned being undetectable as relevant to parenthood and, when prompted, some said that they did not fully understand the mechanics of HIV transmission. Our findings offer new insights into how biomedical knowledge is incorporated into people's understandings of living with HIV, raising important questions about how the meanings of being undetectable are communicated.
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Affiliation(s)
- Robert Pralat
- Department of SociologyUniversity of CambridgeCambridgeUK
| | - Fiona Burns
- Institute for Global HealthUniversity College LondonLondonUK
- Royal Free London NHS Foundation TrustLondonUK
| | - Jane Anderson
- Homerton University Hospital NHS Foundation TrustLondonUK
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Torres TS, Cox J, Marins LMS, Bezerra DRB, Veloso VG, Grinsztejn B, Luz PM. A call to improve understanding of Undetectable equals Untransmittable (U = U) in Brazil: a web-based survey. J Int AIDS Soc 2020; 23:e25630. [PMID: 33156556 PMCID: PMC7646361 DOI: 10.1002/jia2.25630] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Currently, the slogan "Undetectable = Untransmittable" (U = U), launched to disseminate scientific evidence on how people living with HIV (PLHIV) on antiretroviral treatment with suppressed viral load cannot transmit HIV to their sexual partners, is still challenged by individuals with differential acceptance across populations. In this study, we documented the perceived accuracy of U = U in Brazil in three different groups: PLHIV, HIV-negative/unknown cisgender gay/bisexual men who have sex with men (GBM) and HIV-negative/unknown other populations (POP). METHODS Adult (age ≥ 18y) Brazilians were recruited during October 2019 to complete a web-based survey advertised on Grindr, Facebook and WhatsApp. Perceived accuracy of U = U was assessed with the question: "With regards to HIV-positive individuals transmitting HIV through sexual contact, how accurate do you believe the slogan U = U is?" Response options ranged from 1 (Completely inaccurate) to 4 (Completely accurate) plus a fifth option (I don't know what "undetectable" means). Participants' characteristics were described according to perceived accuracy of U = U. Logistic regression models assessed the factors associated with perceived accuracy of U = U (completely accurate vs. partially accurate/inaccurate or completely inaccurate) by group. RESULTS Of 2311 individuals accessing the questionnaire, 1690 (73.1%) met inclusion/exclusion criteria and completed it. Of these, 347 (20.5%) were PLHIV, 785 (46.4%) GBM and 558 (33.0%) POP. More PLHIV perceived U = U as completely accurate (79.0%), compared to 44.2% GBM and 17.2% POP (p < 0.001). Among PLHIV, Black identity was associated with decreased odds of perceiving U = U as completely accurate while having a steady partner was associated with increased odds. Among GBM, being gay, having middle/higher income, being a resident of state capital metropolitan areas and ever testing for HIV were associated with increased odds. Lastly, among POP, ever testing for HIV increased the odds of perceiving U = U as completely accurate. CONCLUSIONS There was a significant difference in perceived accuracy of U = U across population groups. Accurate understanding of the slogan needs to be promoted in more vulnerable populations such as PLHIV of Black identity and GBM of lower income to maximize individual and societal prevention benefits. Moreover, broader understating of U = U among the general population can help decrease societal stigma towards PLHIV.
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Affiliation(s)
- Thiago S Torres
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational HealthFaculty of MedicineMcGill UniversityMontrealCanada
- Research InstituteMcGill University Health CentreMontrealCanada
| | - Luana MS Marins
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
| | - Daniel RB Bezerra
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
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Rendina HJ, Talan AJ, Cienfuegos-Szalay J, Carter JA, Shalhav O. Treatment Is More Than Prevention: Perceived Personal and Social Benefits of Undetectable = Untransmittable Messaging Among Sexual Minority Men Living with HIV. AIDS Patient Care STDS 2020; 34:444-451. [PMID: 33064015 DOI: 10.1089/apc.2020.0137] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Research suggests that the science of undetectable viral load (VL) status and HIV transmission-conveyed with the slogan "Undetectable = Untransmittable" or "U = U"-has gaps in acceptance despite robust scientific evidence. Nonetheless, growing acceptance of U = U creates conditions for a shift in the sociopolitical and personal implications of viral suppression. We conducted an online survey over a 23-month period in 2018 and 2019 among 30,361 adolescent and adult (aged 13-99) sexual minority men living with HIV (SMM-LHIV) across the United States. We examined the impact of U = U on self-image, potential for changing societal HIV stigma, whether SMM-LHIV had ever spoken with a provider about viral suppression and HIV transmission, and primary sources of hearing about U = U. Approximately 80% of SMM-LHIV reported that U = U was beneficial for their self-image and societal HIV stigma, 58.6% reported it made them feel "much better" about their own HIV status, and 40.6% reporting it had the potential to make HIV stigma "much better." The most consistent factors associated with these beliefs centered around care engagement, particularly self-reported viral suppression and excellent antiretroviral therapy adherence. Two-thirds reported ever talking to a provider about VL and HIV transmission, although the primary sources for having heard about U = U were HIV and lesbian, gay, bisexual, transgender, and queer (LGBTQ) news media and personal profiles on networking apps. These findings demonstrate the significant personal and social importance of U = U for SMM-LHIV that go above-and-beyond the well-documented health benefits of viral suppression, suggesting that providers should consider routinely initiating conversations with patients around the multifaceted benefits (personal health, sexual safety and intimacy, increased self-image, and reduced social stigma) of viral suppression.
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Affiliation(s)
- H. Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
- Health Psychology and Clinical Science PhD Program, The Graduate Center of the City University of New York (CUNY), New York, New York, USA
| | - Ali J. Talan
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
| | - Jorge Cienfuegos-Szalay
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
- Health Psychology and Clinical Science PhD Program, The Graduate Center of the City University of New York (CUNY), New York, New York, USA
| | - Joseph A. Carter
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
- Health Psychology and Clinical Science PhD Program, The Graduate Center of the City University of New York (CUNY), New York, New York, USA
| | - Ore Shalhav
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
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Meunier É, Siegel K, Sundelson AE, Schrimshaw EW. Stages of Adoption of "Treatment as Prevention" Among HIV-Negative Men Who Have Sex with Men Who Engage in Exchange Sex. AIDS Patient Care STDS 2020; 34:380-391. [PMID: 32931316 PMCID: PMC7480714 DOI: 10.1089/apc.2020.0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Prior research found low acceptability of HIV treatment as prevention (TasP; or Undetectable = Untransmittable) among HIV-negative men who have sex with men (MSM). This study reports on qualitative data regarding TasP adoption in a sample of 170 self-reported HIV-negative MSM who had engaged in exchange sex (received money, drugs, or other things in exchange for sex). We classified participants along five stages of TasP adoption: 1-unaware of TasP (11.2%); 2-aware, but perceived ineffective (17.1%); 3-perceived effective, but unwilling to use (35.3%); 4-willing to rely on TasP, but had never done so (24.1%); and 5-had relied on TasP (12.4%). Obstacles to TasP adoption included the following: not believing that it could completely prevent HIV transmission; deeply ingrained fears of HIV/AIDS; concerns about viral load fluctuation; and reluctance to trust a partner's claimed undetectable status. TasP promotion efforts, which can decrease barriers to HIV testing and HIV stigma, will be more effective if tailored to the obstacles specific to each stage of TasP adoption.
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Affiliation(s)
- Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Anne E. Sundelson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric W. Schrimshaw
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
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John SA, López-Rios J, Starks TJ, Rendina HJ, Grov C. Willingness to Distribute HIV Self-Testing Kits to Recent Sex Partners Among HIV-Negative Gay and Bisexual Men and an Examination of Free-Response Data from Young Men Participating in the Nationwide Cohort. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2081-2089. [PMID: 32495242 PMCID: PMC7366497 DOI: 10.1007/s10508-020-01752-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 06/11/2023]
Abstract
Sexual minority men (SMM)-and young SMM in particular-are disproportionately affected by HIV. Secondary distribution of HIV self-testing (HIVST) kits-wherein patients deliver kits to partners-is a novel strategy to increase HIV testing access. Using quantitative data, we assessed willingness to distribute HIVST kits to recent sex partners among a U.S. national sample of HIV-negative SMM (n = 786). A thematic analysis was then conducted to identify barriers and facilitators of kit distribution to partners among young SMM (M age = 25.75 years; range: 20-29; n = 165). Overall, 93.5% of SMM (and 97.0% of young SMM) were willing to deliver HIVST kits to recent sex partners. Among young SMM, main barriers and facilitators included concerns about their partners' reaction, availability and cost, protection beliefs for others, HIV stigma and perceived infidelity, packaging and support, communication skill needs, inability to contact partners, requests for anonymity, and dyadic self-testing with their partners. The findings highlight the need for supportive intervention strategies such as informational content for HIVST, using motivational interviewing when providing the testing kits to index clients and providing skills-based training through role-playing exercises. Secondary distribution of HIVST kits through index patients is a potentially acceptable approach that could be used to expand access to HIV testing and aid in efforts to end the HIV epidemic in the U.S.
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Affiliation(s)
- Steven A John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Javier López-Rios
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, The CUNY Institute for Implementation Science in Population Health, 55 West 125th Street, New York, NY, 10027, USA
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - H Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, The CUNY Institute for Implementation Science in Population Health, 55 West 125th Street, New York, NY, 10027, USA.
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42
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Okoli C, Van de Velde N, Richman B, Allan B, Castellanos E, Young B, Brough G, Eremin A, Corbelli GM, Mc Britton M, Hardy WD, de Los Rios P. Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries. Sex Transm Infect 2020; 97:18-26. [PMID: 32732335 PMCID: PMC7841488 DOI: 10.1136/sextrans-2020-054551] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/04/2020] [Accepted: 06/14/2020] [Indexed: 01/06/2023] Open
Abstract
Objectives ‘Undetectable equals Untransmittable’ (U=U) is an empowering message that may enable people living with HIV (PLHIV) to reach and maintain undetectability. We estimated the percentage of PLHIV who ever discussed U=U with their main HIV care provider, and measured associations with health-related outcomes. Secondarily, we evaluated whether the impact of the U=U message varied between those who heard it from their healthcare provider (HCP) vs from elsewhere. Methods Data were from the 25-country 2019 Positive Perspectives Survey of PLHIV on treatment (n=2389). PLHIV were classified as having discussed U=U with their HCP if they indicated that their HCP had ever told them about U=U. Those who had not discussed U=U with their HCP but were nonetheless aware that ‘My HIV medication prevents me from passing on HIV to others’ were classified as being made aware of U=U from non-HCP sources. Multivariable logistic regression was used to measure associations between exposure to U=U messages and health outcomes. Results Overall, 66.5% reported ever discussing U=U with their HCP, from 38.0% (South Korea) to 87.3% (Switzerland). Prevalence was lowest among heterosexual men (57.6%) and PLHIV in Asia (51.3%). Compared with those unaware of U=U, those reporting U=U discussions with their HCP had lower odds of suboptimal adherence (AOR=0.59, 95% CI 0.44 to 0.78) and higher odds of self-reported viral suppression (AOR=2.34, 95% CI 1.72 to 3.20), optimal sexual health (AOR=1.48, 95% CI 1.14 to 1.92) and reporting they ‘always shared’ their HIV status (AOR=2.99, 95% CI 1.42 to 6.28). While exposure to U=U information from non-HCP sources was beneficial too, the observed associations were attenuated relative to those seen with reported discussions with HCPs. Conclusion HCP discussion of U=U with PLHIV was associated with favourable health outcomes. However, missed opportunities exist since a third of PLHIV reported not having any U=U discussion with their HCP. U=U discussions with PLHIV should be considered as a standard of care in clinical guidelines.
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Affiliation(s)
| | | | - Bruce Richman
- Prevention Access Campaign, New York City, New York, USA
| | - Brent Allan
- International Council of AIDS Service Organizations (ICASO), Toronto, Ontario, Canada
| | | | - Benjamin Young
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | | | - Anton Eremin
- AIDS Center Foundation, Moscow, Russia, Moscow, Russian Federation
| | | | | | - W David Hardy
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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43
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Huntingdon B, de Wit J, Duracinsky M, Juraskova I. Belief, Covariates, and Impact of the "Undetectable = Untransmittable" Message Among People Living with HIV in Australia. AIDS Patient Care STDS 2020; 34:205-212. [PMID: 32396476 DOI: 10.1089/apc.2019.0300] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is effectively no risk of transmission of HIV from an HIV-positive person with consistent undetectable viral load (UDVL) to an HIV-negative person during sex. This has been publicly disseminated by an international health campaign called "undetectable = untransmittable" (U = U). This study extends previous research by examining confidence in the U = U message and potential covariates of confidence in U = U, as well as by assessing the perceived personal risk and sexual outcomes in a sample of people living with HIV (PLWH) in Australia. Between October 2017 and June 2018, 139 adult PLWH were recruited through clinics or community-based strategies. They completed an online questionnaire assessing participant characteristics, general agreement with the U = U message, confidence in U = U as an effective HIV prevention strategy, perceived personal risk of onward transmission, and sexual outcomes. While the majority of participants (70.5%) agreed with the general U = U message, only 48.2% were confident in U = U as an effective HIV transmission prevention strategy across sexual situations. Lack of confidence in U = U was more pronounced in the community subsample, minority group participants, and lower educated participants. A minority of PLWH with self-reported UDVL thought they could pass on HIV and indicated poor sexual outcomes, including sexual inactivity, reduced frequency of sex, and reduced sexual satisfaction. General agreement with the U = U message among PLWH may mask lack of confidence in U = U. Community-based information and education tailored to culturally diverse groups and people with low health literacy are required to promote accurate perception of risk of transmission of HIV with consistent UDVL.
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Affiliation(s)
- Ben Huntingdon
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, Australia
| | - John de Wit
- Center for Social Research in Health, UNSW Sydney, Sydney, Australia
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Martin Duracinsky
- Hopital Hotel-Dieu, Unité de Recherche Clinique (URC-ECO), Paris, France
- EA 7334, Patient-Centered Outcomes Research, Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Service de Médecine Interne et d'Immunologie Clinique, Hopital Bicetre, Kremlin-Bicetre, France
| | - Ilona Juraskova
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, Australia
- School of Psychology, Center for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, Australia
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