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MSM without HIV doubt ‘undetectable = untransmittable’
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In a recent survey, most HIV-negative men who have sex with men were doubtful that maintaining an undetectable viral load through treatment prevents transmission of the virus, whereas most who do have HIV held the opposite view.
The survey was part of a study published in the Journal of the International AIDS Society. Researchers sought to gauge whether MSM accepted the “undetectable = untransmittable” concept, known on Twitter as #UequalsU, which suggests that maintaining an undetectable viral load prevents transmission of HIV even through condomless sex. #UequalsU is supported by studies and translates to treatment as prevention (TasP).
“This study underscores the great need for targeted educational and dissemination strategies and provides data that will be immensely valuable as we work with our partners to scale up campaigns to prevent new transmissions and reduce HIV stigma,” Bruce Richman, executive director of the Prevention Access Campaign, said in a news release.
The Prevention Access Campaign, which promotes #UequalsU, is a group aiming to fight the HIV epidemic and related stigma by educating people who are infected with the virus or at risk for acquiring it.
To conduct their survey, the researchers sought users of a sexual networking app for MSM, as well as Facebook users whose interests were determined by the site to be relevant to the LGBT community. Between May 17 and June 10, 2017, the researchers placed advertisements on the apps seeking survey participants.
The participants were asked about sexual behaviors, what their HIV status was, whether they were on pre-exposure prophylaxis (PrEP) and whether their viral loads were detectable, among other questions. They were asked to rate how accurate they believed #UequalsU to be, on a scale of 1 to 4, with 1 meaning “completely inaccurate” and 4 meaning “completely accurate.” They could also indicate that they did not know what “undetectable” means.
The researchers assessed the survey answers of 12,222 total participants. According to the news release, 70% of those with HIV believed #UequalsU, but only 36% without HIV or who were unsure of their HIV status believed it. However, other factors were associated with #UequalsU acceptance as well.
“We found that HIV-negative and unknown [HIV status] guys were more likely to believe the message was accurate if they got tested for HIV more regularly and if they were taking PrEP, suggesting these prevention services may be a great way to gain a captive audience to provide more information about treatment as prevention,” researcher H. Jonathon Rendina, PhD, an assistant professor of psychology at the City University of New York Hunter College and director of quantitative methods at Hunter’s Center for HIV Education Studies and Training, said in the release.
Also, among those without HIV or of unknown infection status, factors that were strongly associated with believing #UequalsU were identifying as gay or queer, reporting recent condomless anal sex with someone who has HIV, testing every 6 months or more frequently, being less concerned with STD infection and having a lower perceived risk of HIV infection, the researchers said.
Among participants with HIV, the factors most strongly associated with accepting #UequalsU were reporting an undetectable viral load, having been diagnosed with lifetime AIDS and having less concern with STD infection.
Having condomless anal sex with a serodiscordant partner was associated with accepting #UequalsU among participants who have HIV and those who do not have HIV. However, among those with the virus, reporting a detectable viral load was associated with perceiving #UequalsU as being less accurate.
“What we may be seeing is that some guys who aren’t able to maintain a sustained undetectable viral load have lower levels of knowledge potentially due to being less well-retained in care, or they may feel left out of the message and concerned it will lead to additional stigma placed on them,” Rendina said. “There is great promise for the message to reduce HIV stigma, but at the same time we need to make sure we don’t end up marginalizing or stigmatizing those who struggle with keeping their viral loads undetectable.” – by Joe Green
Disclosures: The authors report no relevant financial disclosures. Richman is executive director of the Prevention Access Campaign.
Perspective
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Since its initial identification in the United States in 1981, a vast array of information, knowledge and treatment interventions have been developed for HIV infection, and that has allowed individuals to live longer lives.
The development of ART has become the mainstay of management and has extended lives. It has also recently led to the examination of whether a reduction in viral load can produce an equal reduction in HIV transmission, a strategy called TasP. Empirical research has focused on the efficacy of TasP, but there remains a degree of inconsistency in the findings to support the notion that undetectable equals untransmittable among HIV-infected individuals.
The popular slogan “undetectable = untransmittable” has led to increased awareness of HIV testing, prevention and treatment. Although beliefs surrounding this message are mixed, what can be identified is that certain groups can greatly benefit from educational programs and tools focused on increasing their knowledge about HIV infection and decreasing potential negative judgments and stigma than can affect those with HIV.
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