Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT.
J Acquir Immune Defic Syndr. 2021 Oct 1;88(2):149-156. doi: 10.1097/QAI.0000000000002762.
BACKGROUND: Adherence to antiretroviral therapy (ART) and sustained HIV suppression virtually eliminate HIV transmission, eg, having an undetectable viral load renders HIV untransmittable (U=U). Owing to the greatly reduced likelihood of HIV transmission when viral load is undetectable, we studied one behavioral ramification of adopting a U=U prevention strategy-not disclosing HIV status to sex partners. SETTING: Cisgender men recruited through community outreach in the state of Georgia, USA. METHODS: We examined HIV status disclosure to sex partners among 345 young (median age = 29 years) men receiving ART. Data were collected using computerized interviews, daily sexual behavior surveys over 28 days, unannounced pill counts for ART adherence, urine tests for drug use and urogenital health, and blood samples for HIV viral load. RESULTS: One in 3 participants (34%) engaged in condomless anal/vaginal intercourse with an HIV-negative/unknown HIV status partner over 28 days. Average ART adherence was 76%, and one in 5 men had detectable HIV viral loads. Men who engaged in condomless sex with undisclosed partners demonstrated significantly less HIV disclosure to family and friends and had fewer enacted stigma experiences. Hierarchical regression models showed that endorsing U=U as a personal HIV prevention strategy predicted undisclosed condomless sex over and above substance use, HIV stigma experiences, disclosure to family and friends, ART adherence, and HIV viral load. CONCLUSIONS: Interventions are needed to improve ART adherence and assist men living with HIV in their decisions to disclose HIV status to sex partners.
背景：抗逆转录病毒疗法（ART）的依从性和持续的 HIV 抑制几乎可以消除 HIV 的传播，例如，病毒载量无法检测到会使 HIV 无法传播（U=U）。由于病毒载量不可检测时 HIV 传播的可能性大大降低，我们研究了采用 U=U 预防策略的一个行为后果——不向性伴侣透露 HIV 状况。
地点：美国佐治亚州通过社区外展招募的顺性别男性。
方法：我们调查了 345 名接受 ART 治疗的年轻（中位年龄=29 岁）男性向性伴侣透露 HIV 状况的情况。使用计算机化访谈、28 天的每日性行为调查、ART 依从性的未宣布药丸计数、尿液检测药物使用和泌尿生殖健康以及 HIV 病毒载量的血液样本收集数据。
结果：1/3 的参与者（34%）在 28 天内与 HIV 阴性/未知 HIV 状况的伴侣发生了无保护的肛交/阴道交。平均 ART 依从性为 76%，五分之一的男性有可检测到的 HIV 病毒载量。与未透露伴侣发生无保护性行为的男性向家人和朋友透露 HIV 状况的比例明显较低，经历的耻辱感也较少。层次回归模型表明，将 U=U 作为个人 HIV 预防策略，预测了未透露的无保护性行为，这超过了物质使用、HIV 耻辱感体验、向家人和朋友的透露、ART 依从性和 HIV 病毒载量的影响。
结论：需要干预措施来提高 ART 依从性，并帮助感染 HIV 的男性做出向性伴侣透露 HIV 状况的决定。
J Acquir Immune Defic Syndr. 2021-10-1
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