Perceived Accuracy of ‘Undetectable Equals Untransmittable’ (U = U) Affects Openness to HIV Serodifferent Partnering in Australia: National, Cross-Sectional Survey Results

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Abstract Background HIV pre-exposure prophylaxis (PrEP) and viral suppression to an undetectable level (“Undetectable=Untransmittable” or “U = U”) are highly effective at preventing sexual HIV transmission between serodifferent partners (partners with different HIV statuses). These advances may reshape patterns of serodifferent partnering. We assessed openness to sexual and romantic serodifferent partnering among gay, bisexual and queer men and non-binary people (GBQ+ people). Methods Data were from a national, online cross-sectional survey of GBQ+ people in Australia. Logistic regression examined characteristics associated with openness to serodifferent sexual partners among HIV-negative or untested/unknown status participants who were sexually active (Analysis 1); and openness to serodifferent romantic partners among the same group, excluding those already in a relationship (Analysis 2). Results Among 1,759 sexually active participants, 51% were open to serodifferent sexual partners. Among 884 participants not in a relationship, 57% were open to serodifferent romantic partners. In both analyses, perceiving ‘zero’ HIV transmission risk with an undetectable partner was strongly associated with openness (sexual: aOR = 2.99, 95%CI: 2.34–3.83; romantic: aOR = 2.63, 95%CI: 1.86–3.71). Knowing at least one person living with HIV was independently associated with openness in sexual (aOR = 2.15, 95%CI: 1.70–2.72) and romantic contexts (aOR = 1.88, 95%CI: 1.39–2.54). Current PrEP use was associated with sexual openness only (aOR = 1.38, 95%CI: 1.07–1.78). Conclusion and policy implications Perceiving zero HIV transmission risk with an undetectable partner and social proximity to people living with HIV are strongly associated with openness to serodifferent partnering. We recommend investment in programs that personalize or humanize the epidemic while strengthening confidence in U = U.