Skip to main content

Advertisement

SpringerLink
Log in

Attitudes and Beliefs About HIV Treatment as Prevention Among People Who are Not Engaged in HIV Care, 2018–2019

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Treatment as prevention (TasP) is an effective HIV prevention strategy. Our objectives were to explore TasP attitudes and beliefs among people with HIV (PWH) who are not engaged in care and to examine attitudes and beliefs by selected characteristics. We sampled PWH who had participated in the Medical Monitoring Project (MMP), a structured interview survey, from June 2018–May 2019 to participate in 60-minute semi-structured telephone interviews. We obtained sociodemographic and behavioral quantitative data from the MMP structured interview. We used applied thematic analysis to analyze the qualitative data and integrated the qualitative and quantitative data during analysis. Negative attitudes and beliefs, especially skepticism and mistrust, about TasP were pervasive. Only one participant who identified as female, was not sexually active, and had not heard of TasP held positive attitudes and beliefs about TasP. TasP messages should use clear and unambiguous language, address mistrust, and reach people who are not engaged in medical care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

Not applicable.

Code Availability

Not applicable.

References

  1. HIV Treatment as prevention. https://www.hiv.gov/tasp. Updated June 17, 2022. Accessed July 20, 2022.

  2. Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375:830–9. https://doi.org/10.1056/NEJMoa1600693

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Bavinton BR, Pinto AN, Phanuphak N, et al. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study. Lancet HIV. 2018;5(8):e438–47. https://doi.org/10.1016/S2352-3018(18)30132-2

    Article  PubMed  Google Scholar 

  4. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81. https://doi.org/10.1001/jama.2016.5148

    Article  PubMed  Google Scholar 

  5. Cambiano RA, Bruun T, Vernazza P, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. The Lancet. 2019;393(10189):2428–38.

    Article  Google Scholar 

  6. Prevention Access Campaign. https://preventionaccess.org/about-introduction/. Accessed January 17, 2023.

  7. Matacotta J, Rosales-Perez F, Carillo C. HIV preexposure prophylaxis and treatment as Prevention — beliefs and access barriers in men who have sex with men (MSM) and transgender women: a systematic review. J Patient-Centered Res Reviews. 2020;7(3):265–74.

    Article  Google Scholar 

  8. Glan K, Rimer BK, Viswanath K, editors. Health Behavior and Health Education: theory, Research, and practice. 4th ed. San Francisco, Ca: Jossey-Bass; 2008.

    Google Scholar 

  9. Rendina JH, Talan AJ, Cienfuegos-Szalay J, Carter JA, Shalhav O. Treatment is more than prevention: perceived personal and social benefits of undetectable = untransmittable messaging among sexual minority men living with HIV. AIDS Patient Care STDS. 2020;34(10):444–51. https://doi.org/10.1089/apc.2020.0137

    Article  PubMed  PubMed Central  Google Scholar 

  10. Card K, Armstrong H, Lachowsky N, et al. Belief in treatment as prevention and its relationship to HIV status and behavioral risk. J Acquir Immune Defic Syndr. 2018;77(1):8–16. https://doi.org/10.1097/QAI.0000000000001557

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bor J, Fischer C, Modi M, et al. Changing knowledge and attitudes towards HIV Treatment-as-Prevention and “Undetectable = Untransmittable”: a systematic review. AIDS Behav. 2021;25(12):4209–24. https://doi.org/10.1007/s10461-021-03296-8

    Article  PubMed  PubMed Central  Google Scholar 

  12. Grace D, Nath R, Parry R, Connell J, Wong J, Grennan T. ‘… if U equals U what does the second U mean?’: sexual minority men’s accounts of HIV undetectability and untransmittable scepticism. Culture, Health, & Sexuality. 2021;23(9): 1270–1286. https://doi.org/10.1080/13691058.2020.1776397

  13. Meanley S, Connochie D, Bonett S, Flores D, Bauermeister J. Awareness and perceived accuracy of undetectable = untransmittable: a cross-sectional analysis with implications for treatment as prevention among young men who have sex with men. Sex Transm Dis. 2019;46(11):733–6. https://doi.org/10.1097/OLQ.0000000000001048

    Article  PubMed  PubMed Central  Google Scholar 

  14. Siegel K, Meunier E. Awareness and perceived effectiveness of HIV Treatment as Prevention among men who have sex with men in New York City. AIDS Beh. 2019;23(7):1974–83. https://doi.org/10.1097/QAI.0000000000001557

    Article  Google Scholar 

  15. Meunier E, Siegel K, Sundelson A, Schrimshaw E. Stages of adoption of “treatment as Prevention” among HIV-Negative men who have sex with men who engage in Exchange Sex. AIDS Patient Care STDS. 2020;34(9):380–91. https://doi.org/10.1089/apc.2020.0062

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rendina H, Parsons J. Factors associated with perceived accuracy of the undetectable = untransmittable slogan among men who have sex with men: implications for messaging scale-up and implementation. J Int AIDS Soc. 2018;21(1):e25055. https://doi.org/10.1002/jia2.25055

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rendina JH, Cienfuegos-Szalay J, Talan A, Scott Jones S, Jimenez RH. Growing acceptability of undetectable = untransmittable but widespread misunderstanding of transmission risk: findings from a very large sample of sexual minority men in the United States. J Acquir Immune Defic Syndr. 2020;83(3):215–22. https://doi.org/10.1097/QAI.0000000000002239

    Article  PubMed  PubMed Central  Google Scholar 

  18. Newman C, de Wit J, Persson A, Holt M, Slavin S, Kidd M, et al. Understanding concerns about treatment-as-Prevention among People with HIV who are not using antiretroviral therapy. AIDS and Behav. 2015;19(5):821–31. https://doi.org/10.1007/s10461-014-0959-9

    Article  CAS  Google Scholar 

  19. Carneiro P, Westmoreland D, Patel V, Grov C. Awareness and acceptability of undetectable = untransmittable among a U.S. national sample of HIV-negative sexual and gender minorities. AIDS Beh. 2021;25(2):634–44.

    Article  Google Scholar 

  20. Beer L, Johnson CH, Fagan JL, et al. A national behavioral and clinical surveillance system of adults with diagnosed HIV (The Medical Monitorign Project): protocol for an annual cross-sectional interview and medical record abstraction survey. JMIR Rese Protoc. 2019;8(11):e15453. https://doi.org/10.2196/15453

    Article  Google Scholar 

  21. Padilla M, Gutierrez M, Fagan J. Using semistructured telephone interviews to collect qualitative data from people with HIV who are not in medical care: implementation study. JMIR Res Protoc. 2022;11(11):e40041. https://doi.org/10.2196/40041

    Article  PubMed  PubMed Central  Google Scholar 

  22. Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. 3rd ed. Thousand Oaks, CA: SAGE Publications, 2017. https://books.google.com/books?hl=en&lr=&id=BXEzDwAAQBAJ&oi=fnd&pg=PP1&ots=UkzbHnjvoz&sig=pdEZVXGw66CUfaAWTtJiYlj3JZo#v=onepage&q&f=false. Accessed August 10, 2022.

  23. Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs-principles and practices. Health Serv Res. 2013;48(6 Pt 2):2134–56. https://doi.org/10.1111/1475-6773.12117

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sauermilch D, Siegel K, Hoppe T, Roth G, Meunier E. Attitudes towards HIV-positive status disclosure among U = U-aware sexual and gender minority individuals in the USA: a consensual qualitative research approach. Sex Res Social Policy. 2022;1–13. https://doi.org/10.1007/s13178-022-00710-1

  25. Ending the HIV Epidemic in the U.S. (EHE). Centers for Disease Control and Prevention. Updated June 13., 2022. https://www.cdc.gov/endhiv/treat.html. Accessed July 20, 2022.

  26. Kalichman SC, Kalichman MO, Easton LA. Undisclosed HIV status to sex partners and its unintended consequences in the era of undetectable = untransmittable. J Acquir Immune Defic Syndr. 2021;88(2):149–56. https://doi.org/10.1097/QAI.0000000000002762

    Article  PubMed  Google Scholar 

  27. Okoli C, Van de Velde N, Richman B, et al. Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries. Sex Trans Infect. 2021;97(1):18–26. https://doi.org/10.1136/sextrans-2020-054551

    Article  Google Scholar 

  28. Hascher K, Jaiswal J, Lorenzo J, et al. ‘Why aren’t you on PrEP? You’re a gay man’: reification of HIV ‘risk’ influences perception and behavior of young sexual minority men and medical providers. Cult Health Sex. 2021;1–15. https://doi.org/10.1080/13691058.2021.2018501

  29. Calabrese SK, Mayer KH, Marcus JL. Prioritising pleasure and correcting misinformation in the era of U = U. Lancet HIV. 2021;8(3):e175–80. https://doi.org/10.1016/S2352-3018(20)30341-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Schwartz J, Grimm J. Investigating the content of #UequalsU on Twitter. Health Commun. 2021;1–9. https://doi.org/10.1080/10410236.2021.2006395

  31. Rivera AV, Carillo SA, Braunstein SL. Prevalence of U = U awareness and its association with anticipated HIV stigma among low-income heterosexually active black and latino adults in New York City, 2019. AIDS Patient Care STDS. 2021;35(9):370–6. https://doi.org/10.1089/apc.2021.0070

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank MMP-Qual participants and project area staff. We acknowledge the contributions of the Clinical Outcomes Team and Behavioral and Clinical Surveillance Branch at CDC. We also acknowledge Brittani Carter, Shana Green, Susi McGhee, Ehryn Ortega, and Ansley Lemons-Lyn for their contribution to data collection, transcription, and coding. This project was supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and the Centers for Disease Control and Prevention.

Funding

Funding for the Medical Monitoring Project is provided by the Centers for Disease Control and Prevention.

Author information

Authors and Affiliations

  1. Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Mabel Padilla, Mariana Gutierrez, Mohua Basu & Jennifer Fagan

  2. DHAP/NCHHSTP/CDC, 1600 Clifton Road NE MS E-46, 30333, Atlanta, GA, USA

    Mabel Padilla

Authors
  1. Mabel Padilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mariana Gutierrez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohua Basu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer Fagan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors made substantial contributions to the analysis and interpretation of the data, revised the manuscript critically, approved the version to be published, and are accountable for all aspects of the work. Data collection was performed by Jennifer Fagan and Mabel Padilla. Data analysis and interpretation were performed by all co-authors. The first draft of the manuscript was written by Mabel Padilla and all authors substantially commented on prior iterations of the manuscript.

Corresponding author

Correspondence to Mabel Padilla.

Ethics declarations

Conflict of Interest

The authors declare no conflicts of interest. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethics Approval

MMP data collection is part of routine public health surveillance and was determined to be non-research.

Consent to Participate

Informed consent was obtained for all participants.

Consent for Publication

Not applicable.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Padilla, M., Gutierrez, M., Basu, M. et al. Attitudes and Beliefs About HIV Treatment as Prevention Among People Who are Not Engaged in HIV Care, 2018–2019. AIDS Behav 27, 3122–3132 (2023). https://doi.org/10.1007/s10461-023-04032-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-023-04032-0

Keywords

Search

Navigation