Rob Stephenson1, Anna Bratcher2, Matthew J Mimiaga3,4,5,6, Robert Garofalo7,8, Marco A Hidalgo9,10, Samuel Hoehnle7,8, Patrick S Sullivan11. 1. Department of Systems, Population and Leadership, The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI. 2. Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA. 3. Center for Health Equity Research, School of Public Health, Brown University, Providence, RI. 4. Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI. 5. Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. 6. The Fenway Institute, Fenway Health, Boston, MA. 7. Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 8. Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL. 9. Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 10. Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA; and. 11. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Abstract
BACKGROUND: Among men who have sex with men, there is now clear evidence that the risk of HIV transmission through condomless sex when the HIV-positive partner is virally suppressed is effectively zero. However, an understanding of the accuracy of reporting of viral load among serodiscordant same-sex male couples is missing from the literature. SETTING: This analysis uses data from the baseline sample of Stronger Together, a randomized controlled efficacy trial of an innovative dyadic intervention to enhance antiretroviral therapy adherence for HIV serodiscordant male couples in 3 US cities (Atlanta, Boston, and Chicago). METHODS: Biomarker-confirmed and self-reported measures of viral load were used to assess the accuracy of self-report of viral suppression. In this descriptive analysis, the percentage of men who inaccurately reported being virally suppressed is compared across demographic, relationship, and HIV care characteristics. RESULTS: Results confirm those of other recent studies that have shown relatively high levels of inaccuracy in reporting of viral suppression. Although 72.5% of men could accurately report their viral load status, 20% reported that they were virally suppressed when they did not have a biomarker-confirmed measure of viral suppression. CONCLUSION: These results highlight the need to provide interventions to men who have sex with men living with HIV to support access to care and ensure current knowledge of viral load and to continue to support primary prevention of HIV through condom use and pre-exposure prophylaxis. For couples, particularly serodiscordant male couples, interventions that can teach the couple how to collaborate to achieve and maintain viral suppression for the positive partner are an urgent and pragmatic programmatic priority that can equip couples with the knowledge required to correctly implement U = U strategies.
BACKGROUND: Among men who have sex with men, there is now clear evidence that the risk of HIV transmission through condomless sex when the HIV-positive partner is virally suppressed is effectively zero. However, an understanding of the accuracy of reporting of viral load among serodiscordant same-sex male couples is missing from the literature. SETTING: This analysis uses data from the baseline sample of Stronger Together, a randomized controlled efficacy trial of an innovative dyadic intervention to enhance antiretroviral therapy adherence for HIV serodiscordant male couples in 3 US cities (Atlanta, Boston, and Chicago). METHODS: Biomarker-confirmed and self-reported measures of viral load were used to assess the accuracy of self-report of viral suppression. In this descriptive analysis, the percentage of men who inaccurately reported being virally suppressed is compared across demographic, relationship, and HIV care characteristics. RESULTS: Results confirm those of other recent studies that have shown relatively high levels of inaccuracy in reporting of viral suppression. Although 72.5% of men could accurately report their viral load status, 20% reported that they were virally suppressed when they did not have a biomarker-confirmed measure of viral suppression. CONCLUSION: These results highlight the need to provide interventions to men who have sex with men living with HIV to support access to care and ensure current knowledge of viral load and to continue to support primary prevention of HIV through condom use and pre-exposure prophylaxis. For couples, particularly serodiscordant male couples, interventions that can teach the couple how to collaborate to achieve and maintain viral suppression for the positive partner are an urgent and pragmatic programmatic priority that can equip couples with the knowledge required to correctly implement U = U strategies.
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