The everyday meaning and use of HIV 'undetectability' raises significant questions about the social and sexual significance of this state of viral suppression. We conducted in-depth, semi-structured interviews with 25 sexual minority men living in Vancouver, Canada, including men living with HIV. Interviews were audiorecorded, transcribed verbatim and analysed using grounded theory. Most participants understood being undetectable to signify that someone living with HIV is at a 'low,' 'lower,' or 'slim to no' risk of sexually transmitting HIV, as opposed to meaning 'uninfectious' or 'untransmittable'. Men discussed how undetectability was communicated in-person and online, including via sexual networking apps, and revealed how it is sometimes confused or conflated with another biomedical advance in HIV-prevention, namely pre-exposure prophylaxis (PrEP). HIV-negative men expressed significant scientific scepticism, a reluctance to incorporate a partner's low viral load or undetectable HIV status into their sexual decision-making, and an enduring fear associated with knowingly having sex with someone who is HIV-positive. We describe this as a form of untransmittable scepticism. While international campaigns have worked to communicate the scientific message that 'undetectable equals untransmittable' (U ¼ U), the sexual stigma attached to HIV remains durable among some gay, bisexual, queer and other men who have sex with men.

This study sought to identify the primary indicators for evaluating shelter assistance following natural disasters and then to develop a shelter evaluation instrument based on these indicators. Electronic databases and the 'grey' literature were scoured for publications with a relation to post-disaster shelter assistance. Indicators for evaluating such assistance were extracted from these publications. In total, 1,525 indicators were extracted from 181 publications. A preliminary evaluation instrument was designed from these 1,525 indicators. Shelter experts checked the instrument for face and content validity, and it was revised subsequently based on their input. The revised instrument comprises a version for use by shelter agencies (48 questions that assess 23 indicators) and a version for use by beneficiaries (52 questions that assess 22 indicators). The instrument can serve as a standardised tool to enable groups to gauge whether or not the shelter assistance that they supply meets the needs of disaster-affected populations.

ObjectivesIn British Columbia, Canada, syphilis is at record-high rates, with over 80% of cases in 2017 seen in gay, bisexual and other men who have sex with men (GBM). The syphilis epidemic is of particular concern for those living with HIV, since syphilis may lead to more serious complications in this population. We sought to explore syphilis-related knowledge and attitudes around biomedical prevention options for syphilis, with the goal of informing effective strategies to prevent syphilis.DesignWe conducted a qualitative study consisting of in-depth, individual interviews from December 2016 to June 2017. Our interviews focused on participants’ knowledge about syphilis and perceptions regarding syphilis pre-exposure prophylaxis (PrEP). Interviews were analysed using Grounded Theory.ParticipantsTwenty-five GBM were interviewed (64% white; median age: 43 years), including men living with HIV and/or with a history of syphilis.SettingVancouver, British Columbia.ResultsFive interrelated themes emerged. First, GBM were aware of the local syphilis epidemic. Second, syphilis-related knowledge differed according to syphilis and HIV serostatus. Third, competing ideas emerged regarding men’s concerns about syphilis. While our participants expressed concern about getting syphilis, they also described the importance of sexual pleasure. Fourth, many participants said that syphilis was not perceived to be alarming; preventing HIV infection remained a primary concern for many. Finally, while syphilis PrEP was appealing to those living with HIV or a prior syphilis diagnosis, others were concerned about antibiotic resistance, cost and side effects.ConclusionsOur participants organised their safer sex strategies around HIV, not syphilis. Although syphilis-related knowledge was relatively high among GBM living with HIV and those with a prior syphilis diagnosis, this knowledge did not appear to be related with safer sexual practices, such as increased condom use. This work highlights the importance of examining other potential prevention solutions, such as syphilis PrEP.