Abstract
BackgroundThe preventive effects of antiretroviral treatment (ART) on onward transmission of HIV are a major reason for broadening eligibility for ART. In the WHO European Region, surveillance reveals substantial differences in access to ART across regions and sub-populations. We analysed self-reported data on ART and reasons for not taking ART from EMIS, a large Pan-European Internet survey among men-who-have-sex-with-men (MSM).MethodsRespondents from 38 European countries reported their last HIV test result and, if diagnosed with HIV, their treatment status, and reasons for not taking or having stopped ART from a 7 item multiple choice list and/ or answered an open-ended question to give other reasons. Responses were classified as fear of consequences, perceived lack of need, and ART inaccessibility based on factor analysis. Associations between not taking ART because of fear of consequences, and demographic, behavioural and contextual indicators were identified in a multivariable regression model.Results13,353 (7.7%) of 174,209 respondents had been diagnosed with HIV. Among them 3,391 (25.4%) had never received ART, and 278 (2.1%) had stopped taking ART. Perceived lack of need was by far the most common reason for not taking or stopping ART (mentioned by 3259 (88.8%) respondents), followed by fear of consequences (428 (11.7%)), and ART inaccessibility (86 (2.3%)). For all reasons, an East-West gradient could be seen, with larger proportions of men living in Central and Eastern Europe reporting reasons other than medical advice for not taking ART. A minority of men were reluctant to start ART independent of medical advice and this was associated with experiences of discrimination in health care systems.ConclusionsART is widely available for MSM diagnosed with HIV across Europe. Not being on treatment is predominantly due to treatment not being recommended by their physician and/or not perceived to be needed by the respondent.
Highlights
The introduction of combination antiretroviral therapy (ART) in 1996 had a substantial impact on HIV-related morbidity and mortality in all populations with access to treatment [1]
Responses were classified as fear of consequences, perceived lack of need, and antiretroviral treatment (ART) inaccessibility based on factor analysis
ART is widely available for MSM diagnosed with HIV across Europe
Summary
The introduction of combination antiretroviral therapy (ART) in 1996 had a substantial impact on HIV-related morbidity and mortality in all populations with access to treatment [1]. The CD4 cell count was established as a primary parameter to evaluate the need for ART, and international and European treatment guidelines recommended treatment initiation when approaching certain CD4 thresholds. Newer drugs had fewer side effects and improved adherence Both perceived treatment benefits and fewer side effects contributed to a shift towards earlier treatment initiation. Controversies about when to start ART have continued, with WHO guidelines recommending treatment at less than 500 CD4 cells, while the U.S and France have recently removed any CD4 criteria for treatment initiation [3,4,5]. Other European guidelines remain more conservative, waiting for better randomised controlled trials evidence for earlier treatment initiation [6,7,8]. We analysed self-reported data on ART and reasons for not taking ART from EMIS, a large Pan-European Internet survey among men-who-have-sex-with-men (MSM)
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