Suboptimal Patient-Provider Communication About Undetectable = Untransmittable and HIV Transmission Risk in Australia and the US

Sarah K. Calabrese, Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA. skcalabrese@gwu.edu.
Martin Holt, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.
David A. Kalwicz, Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA.
Justino J. Flores, Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA.
Kaosisochukwu C. Onochie, Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA.
Benjamin R. Bavinton, Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Bridget Haire, Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Anthony K. Smith, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.
James MacGibbon, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.
Loren Brener, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.
Timothy R. Broady, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.
John Rule, National Association of People with HIV Australia, Newtown, NSW, Australia.
Bruce Richman, Prevention Access Campaign, New York, NY, USA.
Carla Treloar, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.

Document Type

Journal Article

Publication Date

7-3-2025

Journal

AIDS and behavior

DOI

10.1007/s10461-025-04783-y

Keywords

HIV; Health communication; Health personnel; Sexual and gender minorities; Sustained virologic response; Treatment as prevention (TasP); Undetectable = Untransmittable (U = U)

Abstract

The Undetectable = Untransmittable (U = U) campaign aims to raise global awareness that people living with HIV whose viral load is undetectable cannot sexually transmit HIV. Healthcare providers are uniquely positioned to disseminate the U = U message. Our study explored patient-provider communication about U = U and HIV risk from the perspectives of gay, bisexual, and other men living with HIV (MLHIV) and healthcare providers engaged in HIV treatment and prevention service delivery. We conducted 40 semi-structured interviews with key informants recruited through HIV community-based and professional organizations in Australia (n = 20) and the US (n = 20). Key informants included 20 MLHIV and 20 providers. Data were analyzed thematically. MLHIV were cisgender men aged 29-67 years (M[SD] = 52[13.1]). Providers were cisgender adults aged 30-65 years (M[SD] = 38[9.0]). MLHIV preferred that providers use clear and direct language to explain U = U. When prompted to explain U = U as they would to patients, 8 of 10 Australian and 4 of 10 US providers used language consistent with those preferences. MLHIV, especially US MLHIV, reported that their providers' explanation of the U = U message was often absent, ambiguous, or inaccurate in practice. Such suboptimal communication aligned with the skepticism about U = U and concerns about patient behavior (e.g., adherence) expressed by several providers in the study. Providers relayed multiple reservations regarding new World Health Organization recommendations about informing patients that low-level viremia (detectable viral load ≥ copies/mL) conferred "almost zero" risk. Many Australian and US providers would benefit from training developed in collaboration with people living with HIV to improve patient-provider communication about U = U and HIV transmission risk.

Department

Prevention and Community Health

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