Abstract
ObjectiveAssess the acceptability of HIV treatment as prevention and early antiretroviral treatment among gay and bisexual men in Australia and any changes in attitudes over time.MethodsNational, online, cross-sectional surveys of gay and bisexual men were repeated in 2011 and 2013. Changes in attitudes to HIV treatment over time were assessed with multivariate analysis of variance. The characteristics of men who agreed that HIV treatment prevented transmission and thought that early treatment was necessary were identified with multivariate logistic regression.ResultsIn total, 2599 HIV-negative, untested and HIV-positive men participated (n = 1283 in 2011 and n = 1316 in 2013). Attitudes changed little between 2011 and 2013; most participants remained sceptical about the preventative benefits of HIV treatment. In 2013, only 2.6% of men agreed that HIV treatment prevented transmission; agreement was associated with being HIV-positive, having an HIV-positive regular partner, and having received HIV post-exposure prophylaxis. In contrast, 71.8% agreed that early antiretroviral treatment is necessary; younger men were more likely and HIV-positive men and participants with HIV-positive partners were much less likely to agree with this.ConclusionsPromoting the individual health benefits of HIV treatment rather than its preventative benefits remains more acceptable to Australian gay and bisexual men.
Highlights
The idea of using antiretroviral treatment (ART) as a form of HIV prevention has gained considerable prominence since the results of the HPTN 052 randomised controlled trial showed that ‘early’ treatment and sustaining an undetectable viral load dramatically reduced HIV transmission between serodiscordant heterosexual partners [1,2]
While international treatment guidelines have gradually shifted to embrace the early initiation of ART, it is far from clear whether this approach will be effective in curbing HIV transmission in countries that already report relatively high levels of HIV testing and treatment uptake [6]
We examined a standard set of demographic variables, variables that we have previously found to be associated with HIV risk and interest in antiretroviral-based prevention [11], and factors that reviews suggested might be associated with interest in TasP and early HIV treatment [7,8]
Summary
The idea of using antiretroviral treatment (ART) as a form of HIV prevention (treatment as prevention or TasP) has gained considerable prominence since the results of the HPTN 052 randomised controlled trial showed that ‘early’ treatment (initiating ART above 350 CD4 cells/mm3) and sustaining an undetectable viral load dramatically reduced HIV transmission between serodiscordant heterosexual partners [1,2]. The recommendation that ART should be initiated early has recently gained additional support in a subsequent analysis of the HPTN 052 data, which showed that patients who received early treatment experienced significantly fewer HIV-related clinical events [5]. There has been a notable lack of research on the acceptability of the TasP approach to affected communities [7,8]. This raises questions about how and effectively TasP can be implemented if levels of community support and interest are not well understood [9]
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