HIV-positive Gay Men Research Articles

Adapting Amidst Vulnerability: An Interpretative Phenomenological Analysis Study on Gay Men Living With HIV.

HIV represents a "biographical disruption", interrupting the continuity of life and fostering a sense of vulnerability. The transition of HIV into a chronic condition, coupled with extended life expectancy, necessitates significant lifestyle adjustments, making adaptation and navigation through uncertainties essential. Interpretative phenomenological analysis was used to investigate the lived experiences and adaptation processes of gay men in Greece who are living with HIV. Semi-structured interviews were conducted with seven HIV-positive gay men, recruited from two Greek NGOs that support individuals living with HIV. Investigator triangulation was used to interpret textual material, heightening credibility and reducing bias, thereby enhancing the findings' reliability. The analysis identified a superordinate theme, "Being Vulnerable Enough: Negotiating Uncertainties and Adapting in the HIV Experience", which encompasses three themes: "The Moment of Division: Fear, Uncertainty, and Vulnerability after an HIV Diagnosis", "Grief and Negotiation: Navigating Daily Life Through the Lens of Loss", and "Reclaiming Self: Shaping 'My HIV Identity' to Fit on My Terms". The initial shock of HIV diagnosis introduces a sense of vulnerability, with participants confronting fear, despair, and grief over the loss of health and the disruption of their anticipated life flow. Being vulnerable enough enables individuals to adapt to life with HIV by managing uncertainties through creating certainties with small daily decisions, in a non-linear, ongoing process of negotiation and reassessment, without the need to eliminate all uncertainties.

Changing characteristics of HIV-positive gay and bisexual men's relationships in the era of biomedical prevention.

To assess changes in personal and relationship characteristics among HIV-positive Australian gay and bisexual men (GBM) as rates of antiretroviral therapy (ART) and knowledge and confidence regarding the effectiveness of viral suppression in preventing HIV transmission have increased. Repeated behavioural surveillance of GBM recruited from venues, events, and online in seven Australian states and territories. HIV-positive participants were included. Trends in demographics, HIV treatment, and relationship characteristics were assessed with binary and multivariable logistic regression. A total of 3,643 survey responses (2016-2020) were included. Over time, HIV-positive GBM became less likely to identify as gay or report an Anglo-Australian ethnicity. The average length of time since HIV diagnosis increased and the frequency of attending HIV-related clinical appointments decreased. There were no changes in the reported number of recent sex partners or proportion reporting regular male partners over time. Among HIV-positive GBM in relationships, the proportion reporting HIV-positive partners decreased, and the proportion reporting HIV-negative partners increased. Levels of condomless sex with regular partners increased over time, however, this was concentrated among HIV-positive GBM in serodiscordant relationships. Findings suggest that increased accessibility and trust in biomedical prevention strategies have contributed to broader relationship and sexual opportunities for HIV-positive GBM in Australia. Our findings suggest future health promotion activities could highlight the social and relationship benefits of to further promote the effectiveness of treatment as prevention to further increase trust in it as an HIV prevention strategy among GBM.

I Am More than HIV: A Qualitative Exploration of Factors That Can Strengthen Resilience Among HIV-Positive Gay Men in Australia

IntroductionHIV-positive gay men continue to experience stigma related to sexual orientation and HIV status. Although resilience toward such stressors can be achieved, limited Australian research exists that examines how resilience is strengthened toward these dual stigmas.MethodsA total of 20 men from Melbourne, Australia, participated in semi-structured interviews between March and October 2019 to explore ways in which they manage such stigmas.ResultsReflexive thematic analysis identified two primary themes: (1) “intrapersonal control,” which relates to individual mind set and lifestyle changes that participants utilized to strengthen resilience; (2) “systemic change,” which includes participants’ needs for better public health messaging. Findings show resilience was enhanced when proactive approaches to sexual orientation, HIV health appraisal, lifestyle changes, and social support were made. Further, outdated HIV awareness campaigns and a lack of current messaging regarding HIV transmission in the wider community were identified as inhibiting resilience development and promoting stigma among gay men.ConclusionThe results from this study show ways that Australian gay men strengthen their resilience through both intrapersonal (e.g., self-awareness, reappraisal, and self-efficacy) and external resources (e.g., education and public awareness) and how health care providers and social policy makers could better support the men to achieve this.Social-Policy ImplicationsFindings suggest that targeted public health responses are required to compliment the advances made in biomedicine and viral suppression.

Mental health correlates of HIV-related resilience among older gay men living with HIV/AIDS in New York City: The GOLD studies

Introduction: Older adults represent the greatest proportion of people living with HIV/AIDS (PLWHA) in the U.S. and sexual minority men continue to be disproportionally impacted. As PLWHA age, they face multiple mental and psychosocial health challenges that may impact their overall health and well-being. Resilience may act as a buffer against these challenges. Method: Associations between HIV-related resilience and mental health endorsements were examined among older HIV-positive gay men in New York City. Result: Multivariate analyses indicate those with higher levels of HIV-related resilience were more likely to have lower levels of PTSD and substance dependence and were also more likely to feel financially secure. Conclusion: While further research will help better understand the role resilience has on overall health and well-being of older gay PLWHA, utilizing this perspective can yield important insights that can be used to shift toward strengths-based service and programmatic approaches for this population.

Assessing the Factor Structure and Psychometric Properties of the HIV-Related Resilience Screener: The GOLD Studies.

People who are 50 and older constitute the majority of those living with HIV/AIDS (PLWHA) in the US. Aging PLWHA face myriad biopsychosocial health challenges related to HIV/AIDS and the aging process. Resilience may act as a buffer to the negative impact of these challenges however measuring it among PLWHA has been inconsistent, so the HIV-Related Resilience Screener (HIV-RRS) was developed. Data for the present study are drawn from 250 sociodemographically diverse HIV-positive gay men ages 50-69 in NYC. Tests of reliability and validity were conducted, and an Exploratory Factor Analysis indicated a three-factor model was the most parsimonious solution. Items were examined for their underlying relationships and labeled: adaptive coping, optimism, and effective coping. The total HIV-RRS yielded a Cronbach's α of 0.84. Convergent and face validity were established using psychosocial and physical outcomes. The HIV-RRS is a psychometrically sound instrument to assess resilience among older HIV-positive gay men.

Comparison of four assays for human papillomavirus detection in the anal canal

ObjectiveAnal cancer is preceded by high-risk human papillomavirus (HRHPV) infection, predominantly HPV16. No HPV assay is licenced for use in anal screening. We aimed to determine the sensitivity and specificity of four anal canal swab HPV assays to predict high-grade squamous epithelial lesions (HSIL). MethodsIn a cohort of Australian HIV-positive and negative gay and bisexual men, we compared the sensitivity and specificity of detection of 13 anal HRHPV genotypes by Linear Array (LA), Cobas 4800, EuroArray, and Anyplex II HPV28 (+ and ++ cut offs), compared their ability to predict prevalent anal HSIL, and compared anal canal HRHPV detection with HRHPV isolated from HSIL using laser capture microdissection (LCM). ResultsA total of 475 participants had baseline results available for all four assays (166, 35.0% HIV positive), and 169 participants had a diagnosis of cytological and/or histological HSIL. The HPV16 and any HRHPV detection were highest with Anyplex II HPV28 (+) (156, 32.8% 95% CI 28.6–37.2 and 359, 75.6%, 95% CI 71.5–79.4, respectively). For detection of concurrent HSIL and HPV16, the assay sensitivity was similar, ranging from 49.1%, 95% CI 41.4–56.9 (Anyplex II HPV28 ++) to 55.0%, 95% CI 47.2–62.7 (Anyplex II HPV28 +). For concurrent HSIL and any HRHPV detection, EuroArray was more specific than Anyplex II HPV28 (+) (45.9% 95% CI 40.2–51.7 vs 36.7%, 95% CI 31.3–42.4, p = 0.021) and had comparable specificity with Anyplex II HPV28 (++) (45.9% vs 47.2%, 95% CI 41.5–53.0, p = 0.75). All assays had high sensitivities for predicting HPV16 detected on LCM (92.5–97.5%). Anyplex II HPV28 and EuroArray were significantly more sensitive than LA for lesions caused by non-HPV16 HRHPV types on LCM. DiscussionAnyplex II HPV28 and EuroArray detected more non-16 HRHPV genotypes than LA. Increasing the Anyplex II HPV28 cutoff improved specificity without compromising sensitivity for detection of concurrent HSIL.

“After 25 years of democracy we are still stigmatized and discriminated against…”: Health care experiences of HIV positive older black gay men in a township in South Africa

Older gay black men living with HIV and AIDS have been and continue to be an invisible part of the research landscape in South Africa, with the focus being on the younger LGBTQI+ cohort. Furthermore, aging and health care concerns of this population are ‘swept under the carpet’ due to stigmatization and homophobia. This qualitative study explored the aging and health-care experiences of older gay black men in a selected township in the Cape Metropole, with the purpose of finding strategies to deal with their real life concerns. The first author utilized in-depth interviews with 15 participants, 10 of which were a sample of self-identified gay men, aged between 43-77 and drawn from a selected township in the Cape Metropole in South Africa. Five health professionals working at the local clinic were also interviewed. Interviews were audio-recorded in the language of the participants (isiXhosa) and transcribed verbatim. They were then translated from isiXhosa to English before a thematic analysis was undertaken. One of the key findings of the study was that health-care professionals, particularly nurses at a local clinic, are stigmatizing older black men who are living with HIV and AIDS. This is exacerbated by the rejection by their families and the death of their life partners which leads to isolation, loneliness and depression. Due to comorbidities, COVID-19 has led to some participants passing away. Training of health-care professionals should be prioritized by social workers and workshops should be held in the township to educate families of older LGBTQI+ people on their aging concerns.

Non-prescription drug use among HIV positive gay and bisexual men in Australia: A latent class analysis and comparison of health and well-being.

Establishing typologies of drug use among gay and bisexual men who have sex with men (GBMSM) who are living with HIV, as well as differences in health outcomes between them, is important in addressing health inequalities within this population. We sought to determine how use of non-prescription drugs is clustered for these individuals and to establish differences in their broader health and well-being, including STI diagnosis, mental health, and physical health. We examined past-year drug use reported by 747 GBMSM in Australia as part of the HIV Futures 8 survey, a large cross-sectional survey of people living with HIV. We tested between two and five latent class models of specific drug use and conducted cross-class comparisons of past-year STI diagnosis and self-reported mental and physical health. We identified four distinct drug use typologies: 'chemsex-related use', 'minimal use', 'analgesic and sedative use', and 'diverse use'. The 'chemsex use' and 'diverse use' classes had a markedly higher likelihood of STI diagnosis relative to the other two classes, while the 'analgesic and sedative use' class reported markedly poorer physical and mental health scores than the other classes. While GBMSM living with HIV in Australia have higher rates of drug use compared to other GBMSM, and the general population, our analysis indicates that patterns of drug use are not uniform within this group. Specific patterns of drug use are related to distinct health inequalities, and this should be accounted for when addressing the needs of men who use drugs differently.

The Paradoxes of PrEP: Rejection, Reluctancy, and Novel Gay Identities in Biomedical HIV Prevention in Serbia

This article explores the different ways in which gay men in Serbia perceive PrEP as a novel method of HIV prevention. In the article, I draw on data from my research on PrEP use among thirty gay men in Belgrade. The use of PrEP is still very low amongst gay communities in Serbia due to their rejection of PrEP and due to the stigma around PrEP use. In Serbia, the social significance of PrEP relates to HIV status disclosure on gay social/dating media. Paradoxically, on gay dating sites, the signifier "PrEP" blurs the line between HIV positive gay men – who have achieved undetectable HIV status through a potent ARV therapy – and those HIV negative gay men who use PrEP as a preventative tool against HIV transmission. In the article, I will argue that a new form of gay identity has emerged on gay dating apps in Serbia – "undetectable, on PrEP." This new identity emerges from confusion in HIV risk assessment. The use of PrEP has been seen as a marker to denote someone’s HIV negative status and to protect them from HIV transmission. However, some gay men with an undetectable HIV status would like to be regarded as HIV negative even though they are not, and thus they use the signifier "on PrEP" to highlight their desire to claim an HIV negative status. PrEP has many symbolic valences: from HIV status disclosure to assumed promiscuity. As I will argue, while the health paradigm is of utmost importance for Serbian gay men, internalized stigma additionally drives the low uptake of PrEP amongst gay communities in Serbia, thus contributing to the confusion regarding PrEP use and the overall approach to HIV prevention. This article finds that those respondents who accept PrEP without stigma or confusion regarding their HIV status are also more willing and ready to recommend using PrEP to other gay men.

Forging Resilience to HIV/AIDS: Personal Strengths of Middle-aged and Older Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV/AIDS.

HIV-positive gay, bisexual, two-spirit, and other men who have sex with men (MSM) have exhibited significant resilience to HIV/AIDS in Canada since the start of the epidemic. Since 2012, most of the research that has been conducted on resilience to HIV/AIDS has utilized quantitative methods and deficits-based approaches, with a preferential focus on the plight of young MSM. In order to address apparent gaps in research on HIV/AIDS resilience, we conducted a community-based participatory research qualitative study that utilized a strengths-based approach to examine the perspectives and lived experiences of HIV-positive, middle-aged and older MSM on their individual attributes that helped forge their HIV/AIDS resilience. We conducted 41 semistructured interviews with diverse, HIV-positive, middle-aged and older MSM from Central and Southwestern Ontario, Canada. From our thematic analysis of our interviews, we identified four themes, which represented personal strengths that fostered resilience to HIV/AIDS: (a) proactiveness, (b) perseverance, (c) having the right mindset, and (d) self-awareness with self-control. This article discusses the importance of these personal strengths to fostering HIV/AIDS resilience, and how community-based resources could potentially lessen the need to muster such personal strengths, or alternatively, cultivate them.

Risk of HIV Transmission Through Sexual Activities: A Survey among Hiv-Positive Gay Men in Jember, Indonesia

Introduction: Prevention of HIV transmission can be done through safe sexual activities. It can occur if HIV-positive gay men or men who sex men (MSM) did not have sex with men or use a condom. Objective: This study aimed to identify the preventive behavior of HIV transmission through sexual activities among HIV-positive gay men. Methods: This study used a quantitative design with a descriptive exploratory approach. One hundred and one HIV-positive gay men were collected by using purposive sampling following this study. Data were collected by a questionnaire of preventive behavior of HIV transmission through sexual behavior and analyzed with an exploratory, descriptive approach. Results: Almost all MSM still have sex (96%) after they have been diagnosed HIV-positive, and most do not always use a condom (74.3%). Conclusions: Sexual prevention behavior in MSM is still low and it can increase new HIV cases. Efforts are needed against HIV transmission among the gay men population by adequate information to enhance condom use awareness and commitment when they have the same sexual activities.

The Biomedical Closet? Undetectability among HIV-positive Gay Men in India

ABSTRACT The discourse of Undetectability, referring to the effect of HIV viral suppression on forward sexual transmission, is at the heart of the current paradigm of Treatment-as-Prevention and is invested with hopes of eliminating stigma. But ethnographic examination of the way HIV-positive gay and bisexual men in four major Indian cities experience Undetectability reveals a more complicated picture. Rather than resolve the problem of HIV stigma, Undetectability enables new ways of managing it, including ethical non-disclosure in the face of social danger. This reveals three paradoxes inherent in the universalism of Treatment-as-Prevention and its reliance on biomedical solutions.

Primary and secondary supportive partnerships among HIV-positive and HIV-negative middle-aged and older gay men.

This study describes the primary and secondary partnerships of aging gay men participating in the Understanding Patterns of Healthy Aging Among Men Who Have Sex with Men substudy of the Multicenter AIDS Cohort Study and examines differences in the prevalence of these relationship structures by HIV status while adjusting for age, education, and race/ethnicity. Relationships were compared within the following structural categories: “only a primary partnership”, “only a secondary partnership”, “both a primary and secondary relationship”, or “neither a primary nor secondary relationship”. There were 1,054 participants (51.9% HIV negative/48.1% HIV positive) included in the study. Participants had a median age of 62.0 years (interquartile range: 56.0–67.0) and most reported being non-Hispanic white (74.6%) and college educated (88.0%). Of the 1,004 participants with available partnership status data, 384 (38.2%) reported no primary or secondary partnerships, 108 (10.8%) reported secondary-only partnership, 385 (38.3%) reported primary-only partnership, and 127 (12.6%) reported both primary and secondary partnerships. Of participants who reported primary partnerships only, the prevalence rates (PRs) were lower among those 62 years and older, HIV positive, black non-Hispanic and Hispanics. Of participants who reported only having a secondary partnership, the PRs were higher among those 62 years and older and HIV positive. Of participants who did not report having either a primary or secondary partnership, the PRs were higher among those 62 years and older, HIV positive, and black non-Hispanic compared with their respective referent groups. There was no significant difference in PRs of having both primary and secondary partnerships by age category, HIV status, race/ethnicity, and education. This study aimed to fill a knowledge gap in the literature regarding both primary and secondary supportive partnerships among aging HIV-positive and HIV-negative gay men.

Looking Ahead: Intersecting Influences on Older Gay Men Living With HIV

Older HIV-positive gay men live at the intersection of multiple inequalities—with cascading effects on their present and future lives. This qualitative study explored how they plan for their future, with a focus on Advance Care Planning—the process of reflecting/communicating preferences and values for future health and end-of-life care. Seven French-speaking gay men aged 55+ in Montreal, Canada participated in a focus group that was audio-recorded, transcribed and thematically analyzed in four steps. Findings suggest the intersection of sexual orientation and HIV-positive status exacerbated self-disclosure issues; the further addition of age led to preoccupation with day-to-day living and rendered these men vulnerable to social isolation. These tensions not only interfered with their capacities to talk about future care, but also created barriers to thinking about future care. These findings describe the multiple layers and compounding consequences of inequality among older gay men living with HIV.

Can HIV-positive gay men become parents? How men living with HIV and HIV clinicians talk about the possibility of having children.

It is now established that people living with HIV who have an undetectable viral load and adhere to antiretroviral treatment cannot transmit HIV to their sexual partners. Previous research has shown that ‘being undetectable’ changes how HIV‐positive gay men experience their sex lives. But how does it affect gay men’s reproductive behaviours? And what influence does it have on views about parenthood at a time when gay fatherhood has become more socially accepted and publicly visible? Drawing on qualitative interviews with patients and clinicians at four HIV clinics in London, we identify differences in how interviewees talked about the possibility of having children for HIV‐positive men. Both groups, unprompted, frequently referred to sperm washing as a method enabling safe conception. However, whereas clinicians talked about sperm washing as an historical technique, which is no longer necessary, patients spoke of it as a current tool. The men rarely mentioned being undetectable as relevant to parenthood and, when prompted, some said that they did not fully understand the mechanics of HIV transmission. Our findings offer new insights into how biomedical knowledge is incorporated into people’s understandings of living with HIV, raising important questions about how the meanings of being undetectable are communicated.

Innovating the Study of Context: Using a Qualitative Study on Subjugation and Resistance to Explore the Utility of Foucauldian Governmentality as a Framework for Enriching Situational Analyses

Situational analysis has, as an emerging poststructuralist approach to grounded theory, recently grown in use across a diverse range of disciplines and substantive areas. In this paper, we consider the complementarity of Foucauldian governmentality as a theoretical framework for supporting and enriching situational analyses. Our work is based on the findings of a recent study, informed by situational analysis, in which we interviewed 27 HIV-positive (n=16) and HIV-negative (n=11) gay men ages 50 and over about their health care experiences, and used these data to examine processes of subjugation and resistance reflected in their accounts. Drawing on our analytical process, we consider the utility of governmentality in identifying salient discursive forces within a situation of interest, in theorizing how contextual factors operate on and influence the experiences of key actors in a field of inquiry, and in generating insight on fluid uses of power within an area under examination.

Catholic Family Ties: Sustaining and Supporting HIV-Positive Canadian Gay Men’s Faith, Mental Health, and Wellbeing

Research has documented that sexual minorities and people living with HIV/AIDS have successfully used religious coping to help them overcome life challenges related to their sexual orientation and HIV status, including religious struggles surrounding their faith brought about by stigma and discrimination that have historically been promoted by organized religion. Research has also documented how sexual minorities and people living with HIV/AIDS have utilized family support as a vital resource for effectively coping with life challenges associated with homophobia, heterosexism, and HIV stigma, which have historically been perpetuated in certain family and faith dynamics. The aim of the community-engaged, qualitative study described in this article was to examine the synergistic effects of religious coping and family support, particularly in the context of Catholic family ties, as a unified mechanism for supporting HIV-positive gay men in the face of religious struggles and other life challenges. Confidential, semi-structured interviews were conducted with nine HIV-positive, gay men from the Greater Toronto Area of Ontario, Canada, to obtain their perspectives on how and why their Catholic family ties have helped support them through their religious struggles and other life challenges. Utilizing a modified Grounded Theory approach, interview data were collected and analyzed until data saturation was achieved. The findings and lessons learned from the study’s analysis are discussed in this article, which elaborates on the unique synergy of religious coping and family support as interconnected mechanisms that could be of significant value for supporting HIV-positive gay men experiencing religious struggles and other life challenges.

The Disparities in Mental Health between Gay and Bisexual Men Following Positive HIV Diagnosis in China: A One-Year Follow-Up Study.

This study aimed to determine the change in mental health (depression and anxiety) among HIV-positive gay and bisexual men (GBM) one year after diagnosis and the disparities in trajectories of mental health between them. The potential factors contributing to the disparities were also investigated. This was a one-year follow-up study focusing on the mental health of newly diagnosed HIV-positive individuals. Participants rated their depression, anxiety, stress, and social support levels at baseline and one year later. Information on the utilization of mental healthcare and the initiation of antiretroviral therapy (ART) after diagnosis was collected at one-year follow-up. A total of 171 and 87 HIV-positive gay and bisexual men, respectively, completed two-time points surveys in this study. The depressive and anxiety symptoms experienced by HIV-positive GBM improvement one year after diagnosis. These improvements tended to be smaller in gay participants. Other factors including mental health care utilization and ART status during the one-year follow-up period, changes in social stress scores and objective social support scores were also associated with the changes in depression and anxiety, and all these factors, except for change in objective support, were found to be statistically different between HIV-positive GBM. Special attention should be given to the mental health of HIV-positive gay men. Promoting HIV-positive gay men to assess to mental health services and ART may be important for these populations to improve mental health. Enhancing social support and reducing stress levels may also be necessary for the vulnerable HIV-positive sexual minority groups.

Evaluating translation of HIV-related legal protections into practice: a qualitative assessment among HIV-positive gay, bisexual, and other men who have sex with men in Manila, Philippines

ABSTRACT Legal protections for people living with HIV (PLHIV) are important for protecting human rights, yet little research has examined how laws translate into awareness and understanding for key populations. The Philippines has recently revised their legal protections for PLHIV in response to its growing HIV epidemic, where HIV-positive gay, bisexual and other men who have sex with men bear the majority of cases. We present findings from interviews with 21 HIV-positive gay, bisexual and other men who have sex with men in Manila, Philippines regarding awareness, understanding, and needs regarding HIV-specific legal protections at the time just before new revisions to the omnibus HIV law were passed. Overall, there was no standardized way participants became aware of legal protections; few became aware through healthcare providers, while most learned through online resources, social media, and advocacy organizations. However, even after learning about HIV-specific legal protections, many found the law too complex to understand or did not understand how to use such protections. This led participants to preemptively take action to avoid HIV-related discrimination, even if they were protected by law. Participants demonstrated a strong desire for interventions and policies to improve legal awareness and understanding for PLHIV, government officials, and private businesses. This research demonstrates the value of increasing awareness and understanding in policy-specific interventions designed to improve quality of life for PLHIV. Interventions centered around legal protections are currently underdeveloped, providing a strong opportunity to integrate such interventions in existing practice or as stand-alone tools to decrease perceived stigmatization.

“Not a walking piece of meat with disease”: meanings of becoming undetectable among HIV-positive gay, bisexual and other men who have sex with men in the U = U era

ABSTRACTGay, bisexual and other men who have sex with men (GBMSM) represent a key population disproportionately affected by HIV in various settings. While past studies have investigated how individuals negotiated their identities following their diagnoses of HIV, an emerging area of inquiry considers the implications of viral suppression, or becoming undetectable, on identity and well-being in an undetectable = untransmittable (U = U) era. We conducted 24 in-depth interviews with a purposively recruited sample of GBMSM living with HIV in Singapore. Interviews were analyzed through inductive thematic analysis. Participants viewed viral suppression as a clinical objective, and contrasted this with becoming undetectable as an identity and aspiration. Many participants saw becoming undetectable as a turning point for them post-diagnosis, and expressed a sense of achievement upon attaining the status. Participants shared that being undetectable was associated with several positive outcomes in coming to terms with their HIV-positive diagnoses that signified achievements in health, personal and social responsibilities, as well as equity in romantic and sexual relationships. The results of this study highlight the importance of becoming undetectable and its potential impact on the quality of life for GBMSM living with HIV.