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

Authors

Sarah K. Calabrese, Department of Psychological and Brain Sciences, George Washington University, Washington, DC.
Myra A. Zaheer, Department of Psychological and Brain Sciences, George Washington University, Washington, DC.
Justino J. Flores, Department of Psychological and Brain Sciences, George Washington University, Washington, DC.
David A. Kalwicz, Department of Psychological and Brain Sciences, George Washington University, Washington, DC.
Xen Modrakovic, Department of Psychological and Brain Sciences, George Washington University, Washington, DC.
Sharanya Rao, Department of Psychological and Brain Sciences, George Washington University, Washington, DC.
John F. Dovidio, Department of Psychology, Yale University, New Haven, CT; and.
Maria Cecilia Zea, Department of Psychological and Brain Sciences, George Washington University, Washington, DC.
Lisa A. Eaton, Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT.

Document Type

Journal Article

Publication Date

7-1-2024

Journal

Journal of acquired immune deficiency syndromes (1999)

Volume

96

Issue

3

DOI

10.1097/QAI.0000000000003417

Abstract

BACKGROUND: Scientific evidence indicates that HIV viral suppression to an undetectable level eliminates sexual transmission risk ("Undetectable=Untransmittable" or "U=U"). However, U=U messaging has been met with skepticism among sexual minority men (SMM) and others. In this survey-based experiment, we manipulated messaging about HIV risk and examined reactions and perceived message accuracy among US SMM. METHODS: SMM living with HIV (n = 106) and HIV-negative/status-unknown SMM (n = 351) participated in an online survey (2019-2020). Participants were randomly assigned to 1 of 3 messaging conditions, which varied by level of HIV sexual transmission risk associated with an undetectable viral load (No Risk [U=U]/Low Risk/Control). Participants reported reactions, message accuracy, and reasons for perceiving inaccuracy. We coded open-response data (reactions and reasons) into conceptual categories (eg, "Enthusiasm"). We compared reactions, accuracy ratings, and reasons by condition and serostatus. RESULTS: In the No Risk Condition, common reactions were Enthusiasm (40.0%), Skepticism/Disagreement (20.0%), and Agreement (19.4%), reactions common to comparison conditions. A higher percentage of HIV-negative/status-unknown participants (24.1%) expressed Skepticism/Disagreement in the No Risk Condition compared with other conditions (3.2%-9.7%). Participants living with HIV were more likely than HIV-negative/status-unknown participants to perceive the message as accurate in all conditions. In the No Risk Condition, common reasons for perceiving inaccuracy were Risk Misstated (46.1%), Oversimplified/Caveats Needed (17.1%), and Personal Unfamiliarity/Uncertainty (14.5%), reasons common to comparison conditions. Across conditions, 10.3% of participants attributed message inaccuracy to undetectable being misdefined. CONCLUSION: Most SMM reacted favorably to U=U messaging. However, many-especially HIV-negative/status-unknown SMM-expressed skepticism. Interventions are needed to enhance U=U understanding and acceptance.

APA Citation

Calabrese, Sarah K.; Zaheer, Myra A.; Flores, Justino J.; Kalwicz, David A.; Modrakovic, Xen; Rao, Sharanya; Dovidio, John F.; Zea, Maria Cecilia; and Eaton, Lisa A., "Messaging About HIV Transmission Risk When Viral Load Is Undetectable: Reactions and Perceived Accuracy Among US Sexual Minority Men" (2024). GW Authored Works. Paper 5370.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5370

Department

School of Medicine and Health Sciences Student Works