Gay and bisexual men's awareness and knowledge of treatment as prevention: findings from the Momentum Health Study in Vancouver, Canada

Abstract

IntroductionAwareness and knowledge of treatment as prevention (TasP) was assessed among HIV-positive and HIV-negative gay, bisexual and other men who have sex with men (GBMSM) in Vancouver, Canada.MethodsBaseline cross-sectional survey data were analyzed for GBMSM enrolled, via respondent-driven sampling (RDS), in the Momentum Health Study. TasP awareness was defined as ever versus never heard of the term “TasP.” Multivariable logistic regression identified covariates of TasP awareness. Among those aware of TasP, men's level of knowledge of TasP was explored through an examination of self-perceived knowledge levels, risk perceptions and short-answer definitions of TasP which were coded as “complete” if three TasP-related components were identified (i.e. HIV treatment, viral suppression and prevention of transmission). Information source was also assessed. Analyses were stratified by HIV status and RDS adjusted.ResultsOf 719 participants, 23% were HIV-positive, 68% Caucasian and median age was 33 (Interquartile range (IQR) 26,47). Overall, 46% heard of TasP with differences by HIV status [69% HIV-positive vs. 41% HIV-negative GBMSM (p<0.0001)]. In adjusted models: HIV-positive GBMSM were more likely to have heard of TasP if they were Canadian born, unemployed, not using party drugs and had higher CD4 counts; HIV-negative GBMSM were more likely to have heard of TasP if they were Caucasian (vs. Aboriginal), students, had higher education, a regular partner and multiple sexual partners. Among those aware of TasP 91% of HIV-positive and 69% of HIV-negative GBMSM (p<0.0001) felt they knew “a lot” or “a bit in general” about TasP; 64 and 41% (p=0.002) felt HIV treatment made the risk of transmission “a lot lower”; and 21 and 13% (p<0.0001) demonstrated “complete” TasP definitions. The leading information source was doctors (44%) for HIV-positive GBMSM and community agencies (38%) for HIV-negative GBMSM, followed by gay media for both populations (34%).ConclusionsNearly half of GBMSM in this study reported having heard of TasP, yet only 14% demonstrated complete understanding of the concept. Variations in TasP awareness and knowledge by HIV status, and key socio-demographic, behavioural and clinical factors, highlight a need for health communication strategies relevant to diverse communities of GBMSM in order to advance overall TasP health literacy.

Factors associated with perceived accuracy of the Undetectable = Untransmittable slogan among men who have sex with men: Implications for messaging scale‐up and implementation

“…However, one of the primary findings is that the majority of HIV‐negative and unknown‐status men view the message as being inaccurate, thus lowering the potential acceptability and efficacy of the message in reaching these audiences and having the intended effect. These findings were in line with prior international research on beliefs about TasP more generally in which researchers identified that the majority of HIV‐negative participants expressed disbelief or scepticism about the efficacy of TasP 24, 25, 26.…”

“…Compared to prior studies on TasP, the present findings do highlight the possibility that beliefs about TasP have increased in the past few years 24, 25, 26, which may be due in large part to the campaign to disseminate the Undetectable = Untransmittable message by the Prevention Access Campaign. It is worth noting that this study was conducted before this message received endorsement by major public health entities like the U.S. Centers for Disease Control and Prevention, and research is needed to explore the impact of these endorsements and the increased dissemination it is receiving on social media and its integration within sexual networking app profiles.…”

Gay Men’s Understanding and Education of New HIV Prevention Technologies in Vancouver, Canada

“…For example, while many quantitative studies provide data on rates of NPT awareness (Lachowsky et al, 2016; Lin et al, 2016), other studies show that large gaps may exist between levels of awareness and actual understanding (Carter et al, 2015). Effective implementation will necessarily require gay men to not just be aware of NPTs but also understand and apply these concepts, so shifting to a literacy lens in future research may reveal critical knowledge gaps that will need to be addressed in order to improve NPT implementation.…”

“…For example, rates of TasP awareness in Vancouver are nearly 50%, though assessment of participants’ deeper knowledge found that only 14% had a complete understanding of this strategy (Carter et al, 2015). Misconceptions can be prevalent and persistent, such as the conflation of PEP and PrEP and the characterization of PEP as a “morning after pill” (Nodin et al, 2008; Saberi et al, 2012; Waldo et al, 2000).…”

Increasing HIV Treatment Optimism but No Changes in HIV Risk Behavior Among Men Who Have Sex With Men in Vancouver, Canada

“…In British Columbia (BC), Canada, TasP was introduced in 2010 through a pilot project in Vancouver and expanded province-wide in 2012 [15] . Thus, MSM in Vancouver have been exposed to TasP messages for several years through clinicians, the media, and likely discussions with peers and community leaders [16] . A previous cross-sectional analysis from our group demonstrated that indeed, higher HIV treatment optimism was associated with risky sex and that HIV-positive MSM had much higher HIV treatment optimism scores than that of HIV-negative/unknown MSM [17] .…”