Trends in Belief That HIV Treatment Prevents Transmission Among Gay and Bisexual Men in Australia: Results of National Online Surveys 2013–2019

Abstract

We have tracked belief in the effectiveness of HIV treatment as prevention (TasP) among Australian gay and bisexual men (GBM) since 2013. National, online cross-sectional surveys of GBM were conducted every 2 years during 2013–2019. Trends and associations were analyzed using multivariate logistic regression. Data from 4,903 survey responses were included. Belief that HIV treatment prevents transmission increased from 2.6% in 2013 to 34.6% in 2019. Belief in the effectiveness of TasP was consistently higher among HIV-positive participants than other participants. In 2019, higher levels of belief in TasP were independently associated with university education, being HIV-positive, using pre-exposure prophylaxis, knowing more HIV-positive people, being recently diagnosed with a sexually transmitted infection (STI) and use of post-exposure prophylaxis. Belief that HIV treatment prevents transmission has increased substantially among Australian GBM, but remains concentrated among HIV-positive GBM, those who know HIV-positive people, and GBM who use antiretroviral-based prevention.

Explicit Relationship Agreements and HIV Pre-exposure Prophylaxis Use by Gay and Bisexual Men in Relationships

“…Data were collected as part of the PrEPARE Project, a repeated, cross-sectional study of Australian GBM's attitudes to HIV prevention (Holt et al, 2022(Holt et al, , 2021a(Holt et al, , 2021bMacGibbon et al, 2021). This analysis focuses on the 2021 round: a national, online, cross-sectional survey of GBM conducted in April-June 2021 using Qualtrics software (Provo, UT).…”

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

“…However, importantly, participants were markedly less likely to report being afraid of transmitting HIV in 2018 compared to all other years. This is a critical finding, suggesting that participants in a post U = U climate were significantly less fearful of onward HIV transmission than participants in previous years; sitting in line with a shift in attitudes towards treatment as a means of prevention since 2012 [ 11 ], and even among a substantial proportion of HIV-positive men in casual sexual contexts [ 19 ].…”

“…However, U = U is part of a longer history of ART use in Australia and it is likely that 48% of PLHIV reporting confidence in use of ART as a prevention technology represents a significant change in the way PLHIV view ART relative to the pre-U = U period. Indeed, a multi-year study among exclusively gay and bisexual men in Australia demonstrated that belief in treatment as prevention markedly increased between 2013 and 2019—particularly among HIV positive men [ 11 ]. Qualitative work has similarly explored the reimagining of sexuality in the wake of treatment as prevention, with Persson [ 12 ] highlighting its potential to reframe sexual relationships among serodiscordant couples as both safe and legitimate, and lessening fears of onward transmission.…”

Attitudes Towards Treatment as Prevention Among PrEP-Experienced Gay and Bisexual Men in Australia

“…Other studies have found PrEP use among GBM to be associated with higher rates of CLAI with HIV-positive partners compared to HIV-negative GBM not using PrEP [19,20]. U = U is an ongoing global campaign [15], and there is evidence that belief in TasP is increasing among GBM [12]. Previous research has found PrEP-experienced GBM are more willing to have CLAI with a partner who has a UVL [18].…”