December 10, 2019
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Acceptance of U=U on the rise among sexual minority men

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A growing proportion of sexual minority men in the United States believe in the message that Undetectable = Untransmittable, also known as U=U, which holds that virally suppressed patients with HIV will not sexually transmit HIV to their partners, according to a recent study.

Previously, a 2016-2017 nationwide survey of more than 12,200 sexual minority men (SMM) found that less than 30% of participants who were HIV-negative — or whose status was unknown — perceived U=U to be accurate, compared with 64% of participants who had HIV, explained H. Jonathon Rendina, PhD, MPH, an assistant professor of psychology at Hunter College in New York City, and colleagues.

According to the new study, those rates have increased.

“This study was intended to build upon our previously published findings to look at how acceptability might have changed over time, given the data for the prior paper were collected before the CDC and [the National Institute of Allergy and Infectious Diseases (NIAID)] statements endorsing the U=U message,” Rendina told Healio.

“Additionally, in the prior paper, questions were raised as to whether we were able to disentangle the extent to which these findings were due to misunderstanding or nonbelief of the underlying science surrounding undetectable viral load and transmission vs. acceptability of the U=U message itself.”

Rendina and colleagues gathered data in an online cross-sectional survey from November 2017 through September 2018 from 111,747 SMM in the U.S. According to the study, participants answered questions about biomedical status, HIV and STI prevention behaviors, drug use, condomless anal sex and perceived accuracy of U=U.

According to Rendina, the survey revealed several key findings, including that the acceptability of U=U is on the rise, with 53.2% of the sample group perceiving U=U as accurate — the highest rates being among HIV-positive SMM (83.9%), followed by HIV-negative participants (53.8%).

“We saw substantially higher levels across HIV status groups than in the prior study conducted before the CDC and NIAID endorsements and observed a slight increase in average levels of acceptability for each additional month of data collection,” Rendina said.

According to the study, there also appear to be substantial misunderstandings regarding transmission risk, with findings suggesting these misunderstandings are likely to be strong drivers of acceptability of the U=U message.

“When we talk to people, we tend not to focus on base rates of risk, and instead focus on how effective various prevention options are at reducing those base rates, which we do frequently when we talk about the effectiveness of condoms and [pre-exposure prophylaxis (PrEP)]. However, until recently, most of the U=U messaging had been focused on the risk of transmission being zero or ‘effectively no risk,’ both of which still focus on base rates,” Rendina said.

“As such, our recommendation is to consider framing U=U in terms of its effectiveness, to mirror language people are used to seeing for PrEP and condoms and describe durable viral suppression as being 100% effective at reducing risk of HIV transmission.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.