Antiretroviral Therapy Use, Viral Detectability and Fear of Onward Transmission Among People Living with HIV in Australia: Changes Between 1997 and 2018

Abstract

This paper examines how antiretroviral therapy (ART) use and fears towards the onward transmission of HIV have changed among people living with HIV (PLHIV) in Australia between 1997 and 2018. Participants were recruited as part of the HIV Futures study, a large cross-sectional survey of PLHIV in Australia, in 1997, 2003, 2012 and 2018 (total n = 3889). ART use, viral load detectability, and fear of onward HIV transmission were compared between years. Predictors of onward transmission fear were assessed among the 2018 subsample. While ART use within our sample decreased between 1997 and 2003, it subsequently increased to 97% in 2018. Self-reported viral load undetectability steadily increased over time, up to 88% in 2018. Notably, fewer PLHIV reported being fearful of transmitting HIV in 2018 compared to all other years. Being unfamiliar with the undetectable = untransmissible health movement, and having a detectable or uncertain viral load at last test, were significant predictors of being fearful of onward HIV transmission. Beyond the immediate medical considerations of HIV treatment, these results suggest that the undetectable = untransmissible movement may play a critical role in attenuating burdens experienced by PLHIV in Australia and that such messaging, in tandem with early and consistent ART use, should remain a salient feature of heath messaging among this population.

Communication and coordination of care for people living with HIV: a qualitative study of the patient perspective

“…This study has provided unique perspectives from PLHIV in regional Australia. The literature has historically underserviced this population, with many consumer-focussed studies being conducted in metropolitan areas [ 44 ]. Regional communities have unique healthcare needs due to differences in access to care, as well as societal and cultural differences [ 45 ].…”

People living with HIV who inject or have injected non‐prescription drugs: Evidence of substantial differences in health inequalities and experiences of clinical care

“…Indeed, poorer clinical satisfaction and social quality of life outcomes reported by this group may be related to worse physical health and more financial barriers; for example, by reducing the capacity for PLHIV to engage socially, to access services or engage with health information, decision making and care [45]. Moreover, financial insecurity and poorer physical health have been associated with suboptimal self‐reported social and health‐related quality of life among PLHIV in Australia [46]. Our findings indicate a need to improve the experiences of PLHIV with past IDU experiences and attenuate the unique health and well‐being inequalities experienced by them.…”

Messaging about HIV Transmission Risk When Viral Load Is Undetectable: Reactions and Perceived Accuracy among US Sexual Minority Men

“…Several potential psychosocial benefits of U=U messaging have been identified, such as alleviating fear of HIV transmission during sex, reducing HIV stigma, restoring a sense of normalcy for PLHIV, and enhancing comfort and equity within serodifferent relationships. [12][13][14][15][16][17] Additionally, U=U messaging can positively impact health behavior (eg, HIV testing). 18 Inaccurate messaging that suggests sexual transmission risk is still possible when a person has a sustained undetectable HIV viral load could fuel misinformation and untransmittable skepticism, a term coined by Grace et al 7 to describe "an apparent belief in the general premise of undetectability but a hesitancy or reservation to fully embrace the mentality that it means zero" (p. 11).…”

“…Several potential psychosocial benefits of U=U messaging have been identified, such as alleviating fear of HIV transmission during sex, reducing HIV stigma, restoring a sense of normalcy for PLHIV, and enhancing comfort and equity within serodifferent relationships. 12–17 Additionally, U=U messaging can positively impact health behavior (eg, HIV testing). 18…”