Awareness and use of Undetectable=Untransmittable (U=U) among gay, bisexual, and other men who have sex with men in five Asian countries: results of the Asia Pacific MSM internet survey

Title

Awareness and use of Undetectable=Untransmittable (U=U) among gay, bisexual, and other men who have sex with men in five Asian countries: results of the Asia Pacific MSM internet survey

Presenter

Benjamin Bavinton

Authors

B. Bavinton * (1), A. Hill (2), N. Amos (2), S.H. Lim (3), T. Guadamuz (4), N. Kaneko (5), M. Holt (6), A. Bourne (2)

Institutions

(1) University of New South Wales, Kirby Institute, Sydney, Australia, (2) La Trobe University, Australian Research Centre in Sex, Health and Society, Melbourne, Australia, (3) University of Malaya, Kuala Lumpur, Malaysia, (4) Mahidol University, Bangkok, Thailand, (5) Nagoya City University, Nagoya, Japan, (6) University of New South Wales, Centre for Social Research in Health, Sydney, Australia

BACKGROUND: The global Undetectable=Untransmittable (U=U) campaign informs people that a person living with HIV who is on antiretroviral therapy (ART) with undetectable viral load (UVL) cannot sexually transmit HIV. However, the extent of U=U awareness among gay, bisexual, and other men who have sex with men (GBM) in many Asian countries is unclear.
METHODS: An online cross-sectional survey targeting GBM in Indonesia, Japan, Malaysia, Thailand, and Vietnam was conducted from May 2020'January 2021. Factors independently associated with U=U awareness were determined by multivariable logistic regression, stratified by HIV status.
RESULTS: We recruited 15,872 participants (Indonesia=1,342; Japan=7,452; Malaysia=849; Thailand=1,566; Vietnam=4,663). Overall, 6.8% were HIV-positive, 46.2% HIV-negative, and 47.0% of unknown-status. Overall, 35.9% were aware of U=U, 44.8% had never heard of it prior to the survey, and 19.3% were not sure. U=U awareness varied by country (Indonesia=27.6%; Japan=41.1%; Malaysia=39.3%; Thailand=33.4%; Vietnam=30.2%; p<0.001) and by HIV status (HIV-positive=75.5%; HIV-negative=43.8%; unknown-status=22.4%; p<0.001). Among HIV-positive men, factors independently associated with U=U awareness included: university education (p=0.014); reporting any condomless anal intercourse (CLAI; p=0.004); currently being on ART (p<0.001); having UVL at last test (p<0.001); and having fewer experiences of sexuality-related stigma (p=0.002). Among non-HIV-positive men, U=U awareness was associated with: being older (p=0.002); being 'out' to more people (p<0.001); university education (p=0.003); identifying as gay (p=0.009); reporting sex with >10 male partners in the previous year (p=0.001); having an HIV test in the previous year (p<0.001); and currently taking PrEP (p<0.001). Of 4,707 men reporting CLAI with a regular partner in the previous 12 months, 30.4% had used UVL to prevent HIV transmission (HIV-positive men=75.2%; non-HIV-positive men=25.1%; p<0.001). Among 1,797 men reporting CLAI with casual partners, 22.8% reported using UVL to prevent transmission (HIV-positive men=70.2%; HIV-negative men=17.2%; p<0.001).
CONCLUSIONS: Two-thirds of GBM were not aware that U=U and one-quarter of HIV-positive men lacked this awareness. While a large proportion of HIV-positive men used UVL to prevent transmission when having CLAI, this was uncommon among non-HIV-positive men. Such a situation significantly challenges the ability of GBM to utilise proven safer-sex options and diminishes opportunities to disrupt pervasive stigma experienced by people living with HIV.

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