GRANT M. GALLAGHER
Evidence has established that people living with HIV who achieve and maintain an undetectable viral load through antiretroviral therapy cannot sexually transmit the virus to other people with HIV. This fact, encapsulated in the slogan Undetectable = Untransmittable or U = U, is now a cornerstone of HIV prevention strategies and stigma reduction.
Researchers from Hunter College and the City University of New York have published the results of a new survey in the Journal of Acquired Immune Deficiency Syndrome, which documented the growing acceptability among men of sexual minorities with the premise that U = U, but with a widespread overestimation of the risk of transmission.
The results were obtained over a 10-month period from November 2017 to September 2018. The study population was reached through advertisements placed on online sites such as social media and dating apps, which directed them to a survey.
Participants reported their HIV status as positive, negative, or unknown. Participants with negative or unknown HIV status were asked if they were currently prescribed PrEP, and participants who reported living with HIV were asked if their most recent viral load test was undetectable, detectable, or unknown.
The responses were used to form 5 groups: HIV negative/unknown on PrEP, HIV negative not on PrEP, unknown HIV status on PrEP, undetectable HIV positive, and detectable or unsafe HIV positive.
Participants were asked about recreational drug use, casual male sexual partners, the month they completed the survey, perceived accuracy of U=U, and perceived risk of transmission with an undetectable partner.
A total of 111,747 men provided all the necessary data on measurements relevant to the study, which constitutes the analytical sample.
53.8% of HIV-negative men, 39% of men with unknown status, and 83.9% of HIV-positive men found a perceived accuracy of U = U.
Recent recreational drug use and recent casual sex were associated with greater perceived accuracy.
Only 10% of the total sample perceived the risk of transmission as 0 when an undetectable sexual partner was active, and a slightly higher 14% perceived this risk of transmission when the undetectable partner was receptive. Among those who perceived U = U as completely accurate, however, the proportions were 31% and 39%, respectively.
"The current results echo previous studies showing that men who reported more risky behaviors and greater commitment to HIV treatment and prevention were more likely to believe in the accuracy of U = U," the authors wrote.
The results indicate a growing acceptance of U = U. A study in 2016-17 showed that only 30% of HIV-negative and unknown status participants reported that the message was accurate.
The authors of the 2017-2018 survey suggested a shift from risk reduction frameworks to protection enhancement frameworks.
"In other words, describing U=U as '100% effective' in protecting against HIV transmission may improve acceptability among groups that have been slower to accept the message to date," the report's authors said.
From: https://www.contagionlive.com/news/survey-of-sexual-minority-men-documents-growing-acceptability-of-uu