Undetectable=Untransmittable Perception and Its Association with Sexual Risk Behaviors and Potential Physical and...

Undetectable = Untransmittable (U=U) is the scientific consensus that people living with HIV (PLWH) who maintain an undetectable viral load cannot sexually transmit HIV to others. This study aimed to explore the status of PLWH's perception of U=U (including knowledge, attitude, and acceptance) and the relationships with their sexual behaviors and potential physical and psychological benefits (satisfaction of health, depression, self-stigma, quality of life, ART adherence, viral load and CD4+ cell level).

We analyzed data from 730 PLWH aged 18 years or older from the outpatient clinic at the Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, between October 2021 and January 2022. Data were collected using a structured, anonymous, paper-based questionnaire. It gathered information on U=U perception, sexual risk behaviors, potential physical and psychological benefits and socio-demographic and clinical characteristics. To examine associations between U=U perception and sexual risk behaviors and potential physical and psychological benefits, for categorical outcome variable, multiple logistic regression was adopted for the CD4+ cells and HIV viral load level; for count outcome variable, generalized linear model (GLM) with Poisson regressor was used for sexual risk behaviors; and since all the other response variables were skewed, GLM with Gamma regressor was used.

The mean age of the participants was 33.6 years (SD = 10.8). Majority (95.1%) of the participants were male and initiated ART (97%). Nearly half had bachelor's degree or higher (45.6%) and were identified as homosexuality (48.5%). More than half heard U=U (63.8%) and perceived U=U accurate (57.4%), however only 13.6% had a comprehensive understanding of U=U and 19.9% accepted U=U as a strategy for HIV prevention. The acceptance level of U=U was positively correlated with increased unprotected sexual behaviors [β(95% CI)=0.21(0.045,0.365); P<0.05)]. The U=U perception was not related to depression, antiretroviral therapy adherence, self-stigma and perceived quality of life. We only found that less U=U knowledge was associated with the detectable [β(95% CI)=0.69(0.503,0.903); P<0.05)] or unavailable viral load [β(95% CI)=0.68(0.0528,0.884); P<0.01)], and unavailable CD4+ cell counts was more like to less U=U knowledge [β(95% CI)=0.62(0.395,0.959); P<0.05)]. Furthermore, those with unavailable viral data exhibited a more negative attitude towards U=U [β(95% CI)=0.79(0.635,0.977); P<0.05)]. In addition, lower level of U=U acceptance was related to the unavailable CD4 cell counts [β(95% CI)=0.67(0.474,0.940); P<0.05)].

This study suggests that PLWH have not fully reaped the benefits of U=U. Further research is necessary to explore strategies for promoting clear and accurate information about U=U and for effectively communicating the personal and societal benefits of U=U to PLWH.