HIV/AIDS Knowledge, Undetectable = Untransmittable (U = U) Messaging, and Condom Use Among Men Who Have Sex With Men...

This study aimed to examine how traditional HIV/AIDS knowledge interacts with awareness and trust in the undetectable = untransmittable (U = U) message, influencing condom use behaviors among men who have sex with men (MSM) in China.

A cross-sectional survey was conducted from October 2023 to May 2024 among 1,085 MSM participants in Zhejiang Province. Structured questionnaires assessed HIV/AIDS knowledge, U = U awareness, trust in U = U messaging, condom use self-efficacy, and reported condom use behaviors. Data were analyzed using multivariable linear regression and ordinal logistic regression models, with interaction terms included to assess moderating effects.

Both traditional HIV/AIDS knowledge and U = U-related variables independently predicted higher condom use self-efficacy and more consistent condom use. Significant interactions revealed that the positive association between traditional HIV/AIDS knowledge and condom use was weaker among MSM with higher awareness and trust in U = U. Trust in U = U emerged as a strong moderator, indicating that those who trusted U = U messaging were less likely to rely solely on traditional knowledge for condom use decisions. Additionally, higher condom use self-efficacy was significantly associated with increased frequency of condom use behaviors, highlighting the critical role of confidence in preventive practices.

The findings suggest that biomedical prevention messages like U = U should be integrated carefully with traditional HIV education to ensure complementary, rather than contradictory, messaging. Public health initiatives must enhance biomedical literacy, promote accurate understanding of U = U messaging, and address trust issues toward biomedical strategies within culturally specific contexts. To strengthen the effectiveness of prevention strategies, targeted interventions that bolster both biomedical and traditional HIV/AIDS knowledge are necessary. Limitations of this study include its cross-sectional design, reliance on self-reported behaviors, and inability to infer causality. Comprehensive, culturally tailored HIV prevention strategies are recommended for MSM populations in China.