How Do Gay Serodiscordant Couples in Sydney, Australia Negotiate Undetectable Viral Load for HIV Prevention?

Philpot, Steven; Prestage, Garrett; Ellard, Jeanne; Grulich, Andrew E.; Bavinton, Benjamin R.

doi:10.1007/s10461-018-2247-6

Cited by 27 publications

(31 citation statements)

References 22 publications

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“…Although a majority of HIV-negative partners were aware of the concepts underlying U = U, there were some who had not heard the message, and many did not believe it. Our findings are comparable to a study conducted in Zambia and South Africa that reported that people were largely unfamiliar with the prevention benefits of HIV treatment [14] and with studies done among gay men who expressed reluctance for condomless sex even after viral suppression [12,13]. Awareness and acceptance of the additional HIV prevention benefit of ART needs to go beyond targeting HIV-positive partners; including HIV-negative partners in U = U discussions could provide motivation for HIV-positive people to adhere to ART.…”

Section: Discussionsupporting

confidence: 81%

“…Studies conducted with gay and bisexual men have found low awareness of treatment as prevention . Additionally, HIV‐negative people report reluctance about engaging in condomless sex with HIV‐positive partners even after viral suppression unless they are on pre‐exposure prophylaxis (PrEP) . Notably, there is a paucity of data from heterosexual couples and their providers especially in developing countries about their understanding of the U = U concept .…”

Section: Introductionmentioning

confidence: 99%

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“I just believe there is a risk” understanding of undetectable equals untransmissible (U = U) among health providers and HIV‐negative partners in serodiscordant relationships in Kenya

et al. 2020

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Introduction Sustained HIV viral suppression resulting from antiretroviral therapy (ART) eliminates the risk of HIV transmission, a concept popularly framed as Undetectable = Untransmittable (U = U). We explored knowledge and acceptance of information around the elimination of HIV transmission risk with ART (U = U) in Kenya. Methods Our qualitative study was conducted within a project evaluating the use of pre‐exposure prophylaxis (PrEP) integrated into ART care for HIV serodiscordant couples in public clinics in Kenya (the Partners Scale Up Project). From February 2017 to April 2019, we conducted semi‐structured key informant interviews with 83 health providers and in‐depth interviews with 61 HIV‐negative people in serodiscordant relationships receiving PrEP services. Transcripts were coded using thematic analysis. Results Health providers reported being aware of reduced risk of HIV transmission as a result of consistent ART use and used words such as “very low,” “minimal” and “like zero” to describe HIV transmission risk after viral suppression. Providers reported finding viral load results helpful when counselling clients about the risk of HIV transmission. Many lacked confidence in U = U and counselled on consistent condom use even after viral suppression while some expressed concerns that communicating this message to people living with HIV (PLHIV) would lead them to engage in multiple sexual relationships. Other providers reported that they did not counsel about the reduced risk of HIV transmission after viral suppression for fear of being blamed if HIV transmission occurred. HIV‐negative partners reported being informed about U = U by providers but they did not believe nor trust the message. Even after their partners achieved viral suppression, some HIV‐negative partners were unwilling to stop PrEP, while others indicated that they would use condoms if they stopped PrEP to be sure that they were protected from HIV. Conclusions Despite awareness that effective ART use eliminates HIV transmission risk, there is both a lack of in‐depth knowledge and conviction about the strategy among health providers and HIV‐negative partners in serodiscordant relationships. New strategies that go beyond communicating the science of U = U to consider the local social and clinical environments could maximize the effectiveness of U = U.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

“I just believe there is a risk” understanding of undetectable equals untransmissible (U = U) among health providers and HIV‐negative partners in serodiscordant relationships in Kenya

et al. 2020

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“…As such, the promotion of couple‐level and relationally driven interventions hold the potential to benefit serodiscordant couples by counteracting stigma and improving engagement in HIV care and viral suppression (Conroy et al 2016a, 2016b, Philpot et al . 2018, Rodríguez de los Reyes and González 2017). Here our findings provide evidence that the serodiscordant couples represented and already embraced this type of couple‐level approach.…”

Section: Discussionmentioning

confidence: 99%

The ‘normality’ of living as a gay serodiscordant couple in Sydney, Australia

Philpot

Persson

Prestage

et al. 2020

Sociology Health & Illness

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Serodiscordant couples are often understood through a discourse of HIV‐risk or researched in terms of the psychological stressors they face. However, due to antiretroviral treatments people living with HIV can achieve undetectable viral loads, which not only make them non‐infectious to partners, but allow them to think of their lives and relationships as safe and viable. These realisations mean that serodiscordant couples often embrace an HIV ‘normalisation’ discourse. In this article, we argue that this discourse of HIV ‘normalisation’ can overlook the more nuanced complexity of issues still faced by couples today, which reveal how their experiences of ‘normal’ are sometimes challenged and are not necessarily ‘normal’. Utilising semi‐structured interviews with 21 gay men in serodiscordant relationships in Sydney, Australia, we draw on the concept of ‘home’ life to explore how men engage with discourses of normalisation to describe and enact their relationships. We argue that although HIV is managed well enough to be insignificant in the context of home life, experiences or anticipation of stigma in public often remind couples that they are yet to be considered ‘normal’ socially.

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“…Although all HIV‐positive study participants had their VL tested at baseline, it should be noted that Thai guidelines state that VL testing should commence at least six months after ART initiation , which may partially account for the lower levels of knowledge among HIV‐negative partners of their HIV‐positive partner's VL test results. If couples decide to rely on TasP within relationships, they should be encouraged to discuss VL results openly with each other to ensure that decisions are being made with the best possible information . This may particularly be the case in Thailand, where higher proportions of HIV‐negative partners did not know their partner's VL test results or had “not correct” perceptions.…”

Section: Discussionmentioning

confidence: 99%

Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries

et al. 2019

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Introduction There are few data about the range of strategies used to prevent sexual HIV transmission within gay male serodiscordant couples. We examined HIV prevention strategies used by such couples and compared differences between countries. Methods Opposites Attract was a cohort study of male serodiscordant couples in Australia, Brazil and Thailand, from May 2014 (Australia) or May 2016 (Brazil/Thailand) to December 2016. At visits, HIV‐positive partners had viral load (VL) tested; HIV‐negative partners reported sexual behaviour and perceptions of their HIV‐positive partner's VL results. Within‐couple acts of condomless anal intercourse (CLAI) were categorized by strategy: condom‐protected, biomedically protected (undetectable VL and/or pre‐exposure prophylaxis [PrEP]), or not protected by either (HIV‐negative partners engaging in insertive CLAI, receptive CLAI with withdrawal, or receptive CLAI with ejaculation). Results A total of 343 couples were included in this analysis (153 in Australia, 93 in Brazil and 97 in Thailand). Three‐quarters of HIV‐positive partners were consistently virally suppressed (<200 copies/mL) during follow‐up, and HIV‐negative partners had correct perceptions of their partner's VL result for 76.5% of tests. One‐third of HIV‐negative partners used daily PrEP during follow‐up. Over follow‐up, 73.8% of couples had CLAI. HIV‐negative partners reported 31,532 acts of anal intercourse with their HIV‐positive partner. Of these, 46.7% were protected by condoms, 48.6% by a biomedical strategy and 4.7% of acts were not protected by these strategies. Australian couples had fewer condom‐protected acts and a higher proportion of biomedically protected acts than Brazilian and Thai couples. Of the 1473 CLAI acts where the perceived VL was detectable/unknown and were not protected by PrEP (4.7% of all acts), two‐thirds (n = 983) were when the HIV‐negative partner was insertive (strategic positioning). Of the 490 acts when the HIV‐negative partner was receptive, 261 involved withdrawal and 280 involved ejaculation. Thus, <1% of acts were in the highest risk category of receptive CLAI with ejaculation. Conclusions Couples used condoms, PrEP or perceived undetectable VL for prevention in the majority of anal intercourse acts. Only a very small proportion of events were not protected by these strategies. Variation between countries may reflect differences in access to HIV treatment, education, knowledge and attitudes.

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How Do Gay Serodiscordant Couples in Sydney, Australia Negotiate Undetectable Viral Load for HIV Prevention?

Cited by 27 publications

References 22 publications

“I just believe there is a risk” understanding of undetectable equals untransmissible (U = U) among health providers and HIV‐negative partners in serodiscordant relationships in Kenya

“I just believe there is a risk” understanding of undetectable equals untransmissible (U = U) among health providers and HIV‐negative partners in serodiscordant relationships in Kenya

The ‘normality’ of living as a gay serodiscordant couple in Sydney, Australia

Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries

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