Knowledge of U=U is Increasing But Public Awareness Remains a Challenge

Undetectable equals Untransmittable (U=U) is an important concept that has been validated by science. U=U simply means that people living with HIV whose virus is completely suppressed cannot sexually transmit the virus to an HIV-negative partner.

Knowledge of the U=U campaign has been increasing, but previous studies conducted during 2012-17 have demonstrated that the proportion of gay and bisexual men who have sex with men (GBMSM) who are aware of U=U remains low.

In 2018, a team of investigators conducted a survey among GBSMSM to determine whether the U=U messaging is being more widely disseminated and resulting in a change in the landscape.

Findings from the survey were presented in a poster session at IDWeek 2019.

Survey data was collected between April and August of 2018. The data included demographic information, HIV status, information on antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) use, and beliefs and opinions regarding HIV transmission.

The investigators recruited 969 GBMSM through dating apps to complete a 96-question survey and analyzed data from 678 of the individuals. Among the participants the average age was 43 years, 65% of participants were white, 15% were black and 15% reported that they were living with HIV. Of the individuals living with HIV, 92% reported being on ART. For the 85% who did not have HIV, 39% reported that they were on a PrEP regimen.

Only 24% of respondents strongly agreed that a person with an undetectable viral load cannot transmit HIV to an HIV-uninfected person. Among HIV-negative GBMSM, 33% of those on PrEP agreed with the statement and 12% of those not on PrEP agreed. Among the individuals who were living with HIV, 42% agreed.

The investigators used multivariable logistic regression to explain correlates of strong agreement with U=U, using age, level of education, race, relationship status, cumulative number of sexual partners, condom use with most recent anal sex, HIV status, PrEP use, and attitudes about living with HIV.

The team found that variables associated with strong agreement with U=U included: living with HIV (AOR [adjusted odds ratio] = 1.63, p < .001), PrEP use (AOR = 2.85, p < .001), most recent encounter’s condom use (AOR = 2.22, p = .003), and having a positive attitudes about living with HIV (AOR= 1.93, p < .001).

Based on these findings, the study investigators conclude that U=U awareness seems to be improving among GBMSM, with HIV-negative individuals making the most progress. However, they note that the challenge is now public awareness and indicate that education around the campaign and the efficacy of PrEP may lead to reduced guilt about HIV transmission and reduce HIV stigma.

The abstract, Awareness of U=U Among Gay and Bisexual Men who have Sex with Men, was presented in a poster session on Friday, October 4, 2019 at IDWeek 2019 in Washington DC.