Familiarity with, perceived accuracy of, and willingness to rely on Undetectable=Untransmittable (U=U) among gay and bisexual men in Australia: results of a national cross-sectional survey
James MacGibbon
A * , Benjamin R. Bavinton B , Timothy R. Broady A , Jeanne Ellard C , Dean Murphy B D , Sarah K. Calabrese E , David A. Kalwicz F , Dash Heath-Paynter G , Angus Molyneux H , Cherie Power E , Andrew Heslop I , John de Wit A J and Martin Holt A
+ Author Affiliations
- Author Affiliations
A Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia.
B Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
C Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia.
D Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Vic., Australia.
E New South Wales Ministry of Health, Sydney, NSW, Australia.
F Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA.
G Health Equity Matters, Sydney, NSW, Australia.
H ACON, Sydney, NSW, Australia.
I Positive Life NSW, Sydney, NSW, Australia.
J Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands.
Sexual Health 20(3) 211-222 https://doi.org/10.1071/SH23050
Submitted: 6 March 2023 Accepted: 1 June 2023 Published: 28 June 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: The Undetectable=Untransmittable (U=U) message has been promoted since it was demonstrated that viral suppression through HIV treatment prevents sexual transmission between serodiscordant partners (HIV treatment as prevention). Our study assessed familiarity with, perceived accuracy of, and willingness to rely on U=U in a national sample of gay and bisexual men in Australia.
Methods: We conducted a national, online cross-sectional survey in April–June 2021. Eligible participants were gay, bisexual and queer men and non-binary people who lived in Australia. Logistic regression was used to identify factors associated with familiarity, perceived accuracy and willingness to rely on U=U (by having condomless sex with a partner with HIV who has an undetectable viral load).
Results: Of 1280 participants, most were familiar with U=U (1006/1280; 78.6%), the majority of whom believed U=U was accurate (677/1006; 67.3%). Both familiarity and perceived accuracy were higher among participants living with HIV, followed by pre-exposure prophylaxis (PrEP) users, HIV-negative participants not taking PrEP, and untested/unknown status participants. Knowing at least one person living with HIV, among other factors, was associated with familiarity and perceived accuracy of U=U; and familiarity was associated with perceived accuracy. Among participants familiar with U=U, less than half were willing to rely on U=U (473/1006; 47.0%). Familiarity with U=U and knowing at least one person living with HIV were associated with willingness to rely on U=U, among other factors.
Conclusions: We found familiarity with U=U was associated with perceived accuracy and willingness to rely upon it. There is an ongoing need to educate gay and bisexual men (particularly HIV-negative men) about U=U and its benefits.
Keywords: attitudes, Australia, biomedical HIV prevention, gay and bisexual men (GBM), HIV prevention, HIV undetectability, men who have sex with men (MSM), treatment as prevention (TasP).
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