Mixed messages

Gay men increasingly accept HIV undetectable = untransmittable

Two gay men
Posed by models (Photo: Gustavo Peres from Pexels)

A new study concludes gay and bisexual men increasingly realize HIV undetectable = untransmittable (“U=U”). However, there’s still some way to go before everyone gets the message.

U=U means if someone is HIV-positive but medication has lowered the amount of HIV in their body to a level where it is consistently undetectable, there is zero risk of them transmitting the virus to sexual partners.

The study surveyed over 110,000 gay and bisexual men in the US. It took place between late 2017 and 2018. The results were published yesterday in the Journal of Acquired Immune Deficiency Syndrome (JAIDS).

It found that 53% of men said they believed the accuracy of U=U.

This was highest among men who are HIV-positive (84%), followed by HIV-negative men (54%). Those who didn’t know their status were less likely to accept the accuracy of U=U (just 39%).

In other words, those who have been tested, have spoken to a health counselor or have some knowledge of HIV, are understanding the science.

Related: What you stand to lose by not having sex with people with HIV

HIV-negative men on PrEP and those in serodiscordant relationships were also significantly more likely to accept that U=U.

This contrasts with a Canadian study from 2012-2015. That study found 94% of HIV negative men to be ‘skeptical’ or unaware of the U=U message. A New York study of 2016-2017 also found that only 30% of HIV negative men and those unaware of their status had faith in the U=U message.

This new study suggests the message is slowly getting out there. It’s not coincidental that the U=U campaign began to pick up gear from 2016 onwards.

The research was carried out by scientists at the City University of New York (CUNY). Participants answered sliding-scale questions such as: “What is the risk that an HIV+ man who is currently undetectable could transmit HIV sexually to his partner through topping?” and similarly through “Bottoming?”

Related: World’s first sperm bank open for HIV-positive donors

The authors say that although finding U=U is more widely accepted, too many gay and bi men still believe it to be “inaccurate.”

Jonathan Rendina, PhD, MPH, Assistant Professor, Department of Psychology, Hunter College, and the study’s lead author, said in a statement: “All published studies point to undetectable viral load as being the most effective method to date of preventing sexual HIV transmission, but most of our messaging has focused on the level of risk being zero rather than describing it in terms of effectiveness, which is the way we usually talk about condoms and PrEP.”

“Describing U=U as being ‘100% effective’ in protecting against HIV transmission may enhance acceptability among the groups who have been slower to accept the message to date.”

The study was welcomed by Dr Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) and one of the world’s leading experts on HIV.

“U=U has been validated repeatedly by numerous studies as a safe and effective means of preventing the sexual transmission of HIV,” Fauci said.

“The increased understanding and acceptance of U=U is encouraging because HIV treatment as prevention is a foundation of efforts to end the epidemic in the United States and around the world.”

Dr Rendina, told Queerty he wasn’t surprised by the study results, given how many organizations now promote the U=U message, including the CDC and NIAID: “If anything, I would have expected slightly higher acceptability – for example, there is still a sizeable proportion of men living with HIV who didn’t believe the science behind U=U.”

He says their data suggests most people hear about U=U via the media and social networks, rather than direct from health providers.

“[Which] highlights the important role providers play in successfully implementing this message.”

Does he think some people express uncertainty because they’re actually uncertain whether people are sticking to their medication?

“Within the questions about transmission risk, we asked people to imagine that their partner knew for sure that they were undetectable,” says Rendina. “So our hope is that this removed any effect of uncertainty about adherence.

“We do believe that there is at least some extent to which people might believe the science but not know if they can trust that their partners are durably suppressed, though we tried to rule out that uncertainty within this particular question.”