Recently diagnosed gay men talk about HIV treatment decisions
Ian Down A B C , Garrett Prestage A B , Kathy Triffitt A , Graham Brown B , Jack Bradley A and Jeanne Ellard A BA The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
B Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, Vic. 3000, Australia.
C Corresponding author. Email: idown@kirby.unsw.edu.au
Sexual Health 11(2) 200-206 https://doi.org/10.1071/SH13100
Submitted: 28 June 2013 Accepted: 30 October 2013 Published: 10 July 2014
Abstract
Background: In recent years, there has been increasing evidence that early initiation of antiretroviral therapy (ART) may provide health benefits for those infected with HIV. There has also been significant discussion about the role of HIV treatment in preventing onward transmission of the virus. Early provision and uptake of ART to people recently diagnosed with HIV could achieve both individual and public health outcomes. The success of such an initiative relies, in part, on the preparedness of those recently diagnosed with HIV to engage with the therapy. Methods: The HIV Seroconversion Study collects both quantitative and qualitative data from people in Australia who have recently been diagnosed with HIV. During 2011–2012, 53 gay or bisexual men recruited across Australia took part in semistructured interviews as part of the study. The men were asked about their knowledge and experience of, and their decisions about whether or not to commence, HIV treatment. Results: The interviews identified differing levels of knowledge about HIV treatments and divergent views about the health and prevention benefits of ART. For some, treatments provided a sense of control over the virus; others were apprehensive and distrustful, and preferred to resist commencing treatments for as long as possible. Conclusions: If early initiation of treatment is to be encouraged, appropriate measures must be in place to ensure recently diagnosed individuals have access to the appropriate information and the support they need to enable them to make informed choices and, if necessary, to address their fears.
Additional keywords: antiretroviral therapy, initiation, men who have sex with men, prevention, uptake.
References
[1] Rosengarten M, Imrie J, Flowers P, Davis MD, Hart GJ. After the euphoria: HIV medical technologies from the perspective of their prescribers. Sociol Health Illn 2004; 26 575–96.| After the euphoria: HIV medical technologies from the perspective of their prescribers.Crossref | GoogleScholarGoogle Scholar | 15283778PubMed |
[2] Persson A. Facing HIV: body shape change and the (in)visibility of illness. Med Anthropol 2005; 24 237–64.
| Facing HIV: body shape change and the (in)visibility of illness.Crossref | GoogleScholarGoogle Scholar | 16081335PubMed |
[3] Persson A, Newman C. Potency and vulnerability: troubled ‘selves’ in the context of antiretroviral therapy. Soc Sci Med 2006; 63 1586–96.
| Potency and vulnerability: troubled ‘selves’ in the context of antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 16713052PubMed |
[4] When To Start Consortium. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet 2009; 373 1352–63.
| Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies.Crossref | GoogleScholarGoogle Scholar | 19361855PubMed |
[5] Sax PE, Baden LR. When to start antiretroviral therapy – ready when you are? N Engl J Med 2009; 360 1897–9.
| When to start antiretroviral therapy – ready when you are?Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXlsVSlu7o%3D&md5=928aa5a462ce71b306d948008a88e670CAS | 19339713PubMed |
[6] Jain V, Deeks SG. When to start antiretroviral therapy. Curr HIV/AIDS Rep 2010; 7 60–8.
| When to start antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 20425559PubMed |
[7] Royce RA, Sena A, Cates W, Cohen MS. Sexual transmission of HIV. N Engl J Med 1997; 336 1072–8.
| Sexual transmission of HIV.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s3isVSqtw%3D%3D&md5=15596e7c8b8a1bc6808ca06999ede871CAS | 9091805PubMed |
[8] Law MG, Prestage G, Grulich A, Van de Ven P, Kippax S. Modelling the effect of combination antiretroviral treatments on HIV incidence. AIDS 2001; 15 1287–94.
| Modelling the effect of combination antiretroviral treatments on HIV incidence.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MzmsVygtw%3D%3D&md5=b6425fb69b957785e1a43e969ccf3fd9CAS | 11426074PubMed |
[9] Smith K, Powers KA, Kashuba AD, Cohen MS. HIV-1 treatment as prevention: the good, the bad, and the challenges. Curr Opin HIV AIDS. 2011; 6 315–25.
| 21646878PubMed |
[10] McCormick AW, Walensky RP, Lipsitch M, Losina E, Hsu H, Weinstein MC, et al The effect of antiretroviral therapy on secondary transmission of HIV among men who have sex with men. Clin Infect Dis 2007; 44 1115–22.
| The effect of antiretroviral therapy on secondary transmission of HIV among men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXltlGisrk%3D&md5=add61b98a3817d2df462e0c16b0edb75CAS | 17366461PubMed |
[11] Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365 493–505.
| Prevention of HIV-1 infection with early antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXhtVars7jF&md5=f28f0bc4d943ad7366817444e30a0eaeCAS | 21767103PubMed |
[12] Jia Z, Ruan Y, Li Q, Xie P, Li P, Wang X, et al Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study. Lancet 2013; 382 1195–203.
| 23206835PubMed |
[13] Kirby Institute. Opposites Attract study. Sydney: Kirby Institute; 2011. Available online at: http://www.oppositesattract.net.au [verified October 2013].
[14] University of Copenhagen. Partner Study. Copenhagen: University of Copenhagen; 2010. Available online at: http://www.partnerstudy.eu [verified October 2013].
[15] Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Rockville, MD: Department of Health and Human Services; 2013. Available online at: http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf [verified November 2013].
[16] Australasian Society for HIV Medicine (ASHM). ASHM renews calls for review of criteria on when to start HIV treatment. Sydney: ASHM; 2013. Available online at: http://www.ashm.org.au/images/Media%20Releases/2013/ASHM_MediaRelease_TasP_130218.pdf [verified November 2013].
[17] Australasian Society for HIV Medicine (ASHM). Initiating antiretroviral therapy in treatment-naïve patients. Sydney: ASHM; 2012. Available from: http://arv.ashm.org.au/arv-guidelines/initiating-art-in-treatment-naive-patients Date accessed November 2013. [verified November 2013].
[18] Gold RS, Ridge DT. “I will start treatment when I think the time is right”: HIV-positive gay men talk about their decision not to access antiretroviral therapy. AIDS Care 2001; 13 693–708.
| “I will start treatment when I think the time is right”: HIV-positive gay men talk about their decision not to access antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MnnsVKrug%3D%3D&md5=8ee9c87100c16bbab7591473b5262f99CAS | 11720640PubMed |
[19] Cooper V, Buick D, Horne R, Lambert N, Gellaitry G, Leake H, et al Perceptions of HAART among gay men who declined a treatment offer: preliminary results from an interview-based study. AIDS Care 2002; 14 319–28.
| Perceptions of HAART among gay men who declined a treatment offer: preliminary results from an interview-based study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38zgtVyrsA%3D%3D&md5=52582dc40840ff82250f0ed49e5ce0a6CAS | 12042077PubMed |
[20] Kremer H, Ironson G, Schneiderman N, Hautzinger M. To take or not to take: decision-making about antiretroviral treatment in people living with HIV/AIDS. AIDS Patient Care STDS 2006; 20 335–49.
| To take or not to take: decision-making about antiretroviral treatment in people living with HIV/AIDS.Crossref | GoogleScholarGoogle Scholar | 16706708PubMed |
[21] Falster K, Gelgor L, Shaik A, Zablotska I, Prestage G, Grierson J, et al Trends in antiretroviral treatment use and treatment response in three Australian states in the first decade of combination antiretroviral treatment. Sex Health 2008; 5 141–54.
| Trends in antiretroviral treatment use and treatment response in three Australian states in the first decade of combination antiretroviral treatment.Crossref | GoogleScholarGoogle Scholar | 18588779PubMed |
[22] The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia annual surveillance report 2012. Sydney, NSW: The Kirby Institute, University of New South Wales; 2012.
[23] de Wit J, Holt M, Treloar C. HIV/AIDS, hepatitis and sexually transmissible infections in Australia: annual report of trends in behaviour 2012 (monograph 6/2012). Sydney: National Centre in HIV Social Research, The University of New South Wales; 2012.
[24] NSW Ministry of Health. NSW HIV strategy 2012–2015: a new era. North Sydney: NSW Ministry of Health; 2012.
[25] Granich R, Gilks C, Dye C, De Cock K, Williams B. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 2009; 373 48–57.
| Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model.Crossref | GoogleScholarGoogle Scholar | 19038438PubMed |
[26] Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, et al Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med 2009; 360 1815–26.
| Effect of early versus deferred antiretroviral therapy for HIV on survival.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXlsVGmtrY%3D&md5=5d1cee2af16cf7c14b27bc6191c77a93CAS | 19339714PubMed |
[27] Mayer KH, Venkatesh KK. Antiretroviral therapy as HIV prevention: status and prospects. Am J Public Health 2010; 100 1867–76.
| Antiretroviral therapy as HIV prevention: status and prospects.Crossref | GoogleScholarGoogle Scholar | 20724682PubMed |
[28] Montaner JS, Hogg R, Wood E, Kerr T, Tyndall M, Levy AR, et al The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet 2006; 368 531–6.
| The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic.Crossref | GoogleScholarGoogle Scholar | 16890841PubMed |
[29] Wilson DP, Law MG, Grulich AE, Cooper DA, Kaldor JM. Relation between HIV viral load and infectiousness: a model-based analysis. Lancet 2008; 372 314–20.
| Relation between HIV viral load and infectiousness: a model-based analysis.Crossref | GoogleScholarGoogle Scholar | 18657710PubMed |
[30] Strauss AL. Qualitative analysis for social scientists. New York: Cambridge University Press; 1987.
[31] Race K. The undetectable crisis: changing technologies of risk. Sexualities 2001; 4 167–89.
| The undetectable crisis: changing technologies of risk.Crossref | GoogleScholarGoogle Scholar |
[32] Horne R, Cooper V, Gellaitry G, Date HL, Fisher M. Patients’ perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence: the utility of the necessity-concerns framework. J Acquir Immune Defic Syndr 2007; 45 334–41.
| Patients’ perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence: the utility of the necessity-concerns framework.Crossref | GoogleScholarGoogle Scholar | 17514019PubMed |
[33] Newman C, Persson A, Ellard J. ‘We just don’t know’: ambivalence about treatment strategies in the Australian community-based HIV media. Health 2006; 10 191–210.
| 16513660PubMed |
[34] Gregory R, Peters E, Slovic P. Making decisions about prescription drugs: a study of doctor–patient communication. Health Risk Soc 2011; 13 347–71.
| Making decisions about prescription drugs: a study of doctor–patient communication.Crossref | GoogleScholarGoogle Scholar |
[35] Beach MC, Duggan PS, Moore RD. Is patients’ preferred involvement in health decisions related to outcomes for patients with HIV? J Gen Intern Med 2007; 22 1119–24.
| Is patients’ preferred involvement in health decisions related to outcomes for patients with HIV?Crossref | GoogleScholarGoogle Scholar | 17514382PubMed |
[36] Mallinson RK, Rajabiun S, Coleman S. The provider role in client engagement in HIV care. AIDS Patient Care STDS 2007; 21 S77–84.
| The provider role in client engagement in HIV care.Crossref | GoogleScholarGoogle Scholar | 17563293PubMed |
[37] Currier JS, Baden LR. Getting smarter – the toxicity of undertreated HIV infection. N Engl J Med 2006; 355 2359–61.
| Getting smarter – the toxicity of undertreated HIV infection.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD28Xht1OrtbvF&md5=0b244b087b3de6a3047f87dd8fff4cdeCAS | 17135590PubMed |
[38] Smith MK, Powers KA, Muessig KE, Miller WC, Cohen MS. HIV treatment as prevention: the utility and limitations of ecological observation. PLoS Med 2012; 9 e1001260
| HIV treatment as prevention: the utility and limitations of ecological observation.Crossref | GoogleScholarGoogle Scholar | 22802740PubMed |
[39] Smith K, Powers KA, Kashuba AD, Cohen MS. HIV-1 treatment as prevention: the good, the bad, and the challenges. Curr Opin HIV AIDS. 2011; 6 315–25.
| 21646878PubMed |
[40] Nosyk B, Audoin B, Beyrer C, Cahn P, Granich R, Havlir D, et al Examining the evidence on the causal effect of HAART on transmission of HIV using the Bradford Hill criteria. AIDS 2013; 27 1159–65.
| Examining the evidence on the causal effect of HAART on transmission of HIV using the Bradford Hill criteria.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXpsFajsbk%3D&md5=1d323c77a18a5640cbb2838886e8e02bCAS | 23902921PubMed |
[41] Murray JM, Prestage G, Grierson J, Middleton M, McDonald A. Increasing HIV diagnoses in Australia among men who have sex with men correlated with the growing number not taking antiretroviral therapy. Sex Health 2011; 8 304–10.
| Increasing HIV diagnoses in Australia among men who have sex with men correlated with the growing number not taking antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 21851769PubMed |
[42] Wilson DP, Hoare A, Regan DG, Law MG. Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men. Sex Health 2009; 6 19–33.
| Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 19254488PubMed |
[43] Hull MW, Wu Z, Montaner JSG. Optimizing the engagement of care cascade: a critical step to maximize the impact of HIV treatment as prevention. Curr Opin HIV AIDS. 2012; 7 579–86.
| Optimizing the engagement of care cascade: a critical step to maximize the impact of HIV treatment as prevention.Crossref | GoogleScholarGoogle Scholar | 23076123PubMed |
[44] Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clinical Infectious Diseases. 2011; 52 793–800.
| 21367734PubMed |
[45] Gellaitry G, Cooper V, Davis C, Fisher M, Date HL, Horne R. Patients’ perception of information about HAART: impact on treatment decisions. AIDS Care 2005; 17 367–76.
| Patients’ perception of information about HAART: impact on treatment decisions.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M7pvFWqtQ%3D%3D&md5=09600bf4d28337931dd8b3295f864106CAS | 15832885PubMed |