義大利對 U=U 準確性的認識和信念之間的脫節

資料來源：Krishen Samuel / 2022 年 6 月 20 日 /aidsmap / 財團法人台灣紅絲帶基金會編譯

 

圖片：Lega Italiana per la Lotta contro l’Aids (LILA) 的 U=U 活動海報。

 

一項意大利全國性調查發現，四分之三的愛滋病毒感染者聽說過「檢測不到 = 無法傳播」 (U=U)，而接受調查的愛滋病毒陰性者中只有不到一半聽說過。很多傳染病醫生都知道U=U。然而，在所有抽樣組中，所有聽說過 U=U 的參與者都沒有完全相信它的完全準確性。

背景

「檢測不到 = 無法傳播」 (U=U) 對許多 HIV 感染者來說是一個改變生活的概念。然而，研究顯示它並不總是廣為人知——尤其是在那些沒有感染愛滋病毒的人中。當它為人所知時，人們往往不相信它的準確性。

先前在澳大利亞對 HIV 陰性男同性戀者進行的研究發現，依靠無法檢測到的病毒載量來預防 HIV，他們感到不舒服，而美國的一項大型研究發現，雖然 80% 以上的 HIV 感染者認為 U=U 是準確的，但近一半在抽樣的 HIV 陰性男同性戀者中，以及那些不知道自己感染狀態的男同性戀者中，都不認為 U=U 準確。

研究

羅馬聖心天主教大學的 Antonella Cingolani 博士及其同事在線上調查了 1,121 名參與者，其中 634 人是 HIV 陰性者，他們從事無套性行為。大多數是 40 歲以下 (73%)、男性 (68%) 和受過大學教育 (62%)。他們大多是同性戀或雙性戀（65%），並且在過去一年中報告了中位數為兩個性伴侶。沒有報告與 PrEP 相關的數據。

參與的 397 名愛滋病毒感染者的年齡分佈各不相同，只有 31% 的人年齡小於 40 歲，38% 的人年齡大於 50 歲。他們主要是男性（82%），三分之二以上是同性戀或雙性戀。大約 40% 的愛滋病毒感染者接受過大學教育。不到一半的人感染愛滋病毒超過十年（47%），而 28% 的人感染愛滋病毒的時間不到五年。絕大多數 HIV 感染者的病毒載量檢測不到（95%）。雖然他們報告過去一年的性伴侶數量與 HIV 陰性個體相同，但 39% 的 HIV 感染者報告有一個穩定的 HIV 陰性性伴侶，只有 6% 的 HIV 陰性群體報告有一個HIV感染者作為穩定的性伴侶。

90 名傳染病醫生也參與其中，其中大多數為 40 歲以下（54%）和女性（59%）。在治療愛滋病毒感染者的 73 名醫生中，大約一半的愛滋病毒管理感染者不到 100 名，而 30% 的管理愛滋病毒感染者超過 400 名。雖然大多數 (53%) 的愛滋病毒管理經驗不到 10 年，但有四分之一多一點擁有超過 20 年的經驗。

U=U 意識、對準確性和影響的感知

詢問所有參與者是否聽說過 U=U。那些回答說他們已經收到了關於他們對概念準確性的信念的後續問題；此響應的範圍可以從 1（完全不準確）到 4（完全準確）。雖然 92%、75% 和 47% 的醫生、愛滋病毒感染者和愛滋病毒陰性者分別聽說過 U=U，但 80% 的愛滋病毒感染者和知道的醫生認為它是完全準確的，而只有67% 的 HIV 陰性者也這麼說。雖然 59% 的 HIV 陰性參與者表示 U=U 完全或部分改變了他們對與 HIV 感染者發生性關係的態度，但其餘的人表示它幾乎沒有影響或沒有影響。

大多數 HIV 感染者報告由於 U=U 而生活得到改善：72% 的人報告他們的性生活有所改善，而 57% 的人報告說與 HIV 相關的恥辱感有所減少。

超過一半的 HIV 感染者表示他們的醫生已經告知了他們有關 U=U 的信息，而 21% 的人表示在就診時沒有提及，28% 的人只是在詢問有關 U=U 的信息後才進行討論。雖然 33% 的 HIV 感染者被他們的醫生告知如果無法檢測到他們可以進行無保險套性行為，但 40% 的人被告知必須使用安全套。

儘管醫生和愛滋病毒感染者來自同一中心，但仍存在一些差異。例如，超過三分之二的醫生認為他們花了足夠的時間來解釋 U=U，17% 的醫生表示他們花了很多時間來解釋這個概念。大多數 (61%) 認為他們的患者理解這個概念。然而，只有 39% 的人報告說擁有與 U=U 相關的特定材料，例如小冊子和海報。大多數醫生 (63%) 報告說每年進行兩次病毒載量測試，82% 的醫生報告說 U=U 的知識不會影響病毒載量測試的頻率。

與 U=U 知識相關的因素

中年 HIV 感染者，例如 40-50 歲的人，聽說 U=U 的可能性是 40 歲以下的人的一半（調整優勢比 (AOR) 0.46，95% 信賴區間 (CI) 0.24-0.89 ）。與較高的 U=U 意識相關的因素包括男性 (AOR 2.42, 95% CI 1.30–4.50) 和接受治療超過五年 (AOR 2.62, 95% CI 1.30–5.28)。與在其他地方聽說過的人相比，那些從社區組織或醫院聽說過 U=U 的人相信它完全準確的可能性是後者的兩倍。

「有80% 的 HIV 感染者和知道 U=U 的醫生認為它是完全準確的，但只有 67% 的 HIV 陰性者這麼說」。

對於 HIV 陰性人群，40-50 歲的人更有可能聽說過 U=U（AOR 4.51，95% CI 2.69-7.57）。如果他們在前一年有超過 50 個性伴侶（AOR 3.52，95% CI 1.14-10.86）亦是；而那些沒有接受過大學教育的人（AOR 0.49，95% CI 0.33-0.71），並且不經常檢測 HIV (AOR 0.37, 95% CI 0.22–0.60) ，則不太可能聽說過它。受過更多教育、在社區環境中聽說過 U=U ，並且有伴侶感染 HIV 的 HIV 陰性個體更有可能相信它是準確的。

在醫生中，參與照護 HIV 感染者的人聽說過 U=U 的可能性高出近 15 倍（OR 14.8，95% CI 2.57–85.1）。

結論

作者總結說：「目前的研究顯示，愛滋病毒感染者和醫生對信息 U=U 的準確性的認識和感知之間存在一些不一致，這顯示社區對信息本身的信心仍然很低」。

「應該做出更多努力，在可能從有針對性的教育活動中受益的子群體中傳播 U=U 信息。本研究的結果顯示，即使在意大利，U=U 概念的傳播仍遠未普及和充分。在無保護性行為人群中傳播這一信息遠遠未能得到有效實施，應優先考慮增加知識、減少愛滋病毒恥辱感和增加愛滋病毒診斷的可及性」。

 

參考文獻：

Cingolani A 等人。意大利對檢測不到 = 不可傳播信息 (U=U) 準確性的認識和感知：來自愛滋病毒感染者、傳染病醫生和無保護性行為者的調查結果。 AIDS Care，2022 年 5 月 17 日線上發布。https://doi.org/10.1080/09540121.2022.2074960

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disconnect between awareness and belief in accuracy of U=U in Italy

Krishen Samuel / 20 June 2022 / aidsmap

 

U=U campaign posters by Lega Italiana per la Lotta contro l’Aids (LILA).

An Italian nationwide survey found that three-quarters of people living with HIV had heard about Undetectable = Untransmittable (U=U), while just under half of HIV-negative people surveyed had heard about it. A high number of infectious disease doctors were aware of U=U. However, in none of the groups sampled did all participants  who had heard of U=U fully believe in its complete accuracy.

Background

Undetectable = Untransmittable (U=U) has been a life-changing concept for many people living with HIV. However, research indicates that it is not always widely known – especially among those who are not living with HIV. When it is known, there is often disbelief regarding its accuracy.

Previous research with HIV-negative gay men in Australia found that they were uncomfortable relying on an undetectable viral load to prevent HIV, while a large US study found that while over 80% of men living with HIV perceived U=U as accurate, nearly half of the HIV-negative gay men sampled, as well as those who did not know their status, did not perceive U=U as accurate.

The study

Dr Antonella Cingolani from the Catholic University of the Sacred Heart in Rome and colleagues surveyed a total of 1,121 participants online, 634 of whom were HIV-negative people engaging in condomless sex. Most were younger than 40 (73%), male (68%) and university educated (62%). They were mostly gay or bisexual (65%) and reported a median of two sexual partners in the past year. No PrEP-related data were reported.

The age distribution of the 397 people living with HIV who participated differed, with only 31% being younger than 40 and 38% being older than 50. They were predominantly male (82%) and just over two-thirds were gay or bisexual. Approximately 40% of the people living with HIV were university educated. Just under half had lived with HIV for more than a decade (47%), while 28% had been living with HIV for less than five years. The vast majority of people living with HIV had undetectable viral loads (95%). While they reported the same number of past year sexual partners as the HIV-negative individuals, 39% of people living with HIV reported having a stable HIV-negative sexual partner, with only 6% of the HIV-negative group reporting having a person living with HIV as a stable sexual partner.

Ninety infectious disease doctors also participated, the majority of whom were younger than 40 (54%) and female (59%). Of the 73 doctors treating people living with HIV, about half had less than 100 patients living with HIV, while 30% had more than 400. While the majority (53%) had less than ten years of experience managing HIV, just over a quarter had more than 20 years of experience.

U=U awareness, perception of accuracy and impact

All participants were asked if they had heard of U=U. Those who responded that they had were presented with a follow-up question regarding their belief in the accuracy of the concept; this response could range from 1 (completely inaccurate) to 4 (completely accurate). While 92%, 75% and 47% of doctors, people living with HIV and HIV-negative people had heard about U=U respectively, 80% of people living with HIV and doctors who were aware believed it to be completely accurate, while only 67% of HIV-negative people said the same. Although 59% of HIV-negative participants indicated that U=U totally or somewhat changed their attitude towards sex with someone living with HIV, the remainder stated that it had little or no effect.

Most people living with HIV reported life improvements because of U=U: 72% reported an improvement in their sex lives, while 57% reported a reduction in HIV-related stigma.

Just over half of people with HIV indicated that their doctors had informed them about U=U, while 21% stated that it was not mentioned during medical visits and 28% only had the discussion after asking for information on U=U. While 33% of people living with HIV were told by their doctor that they could have condomless sex if they are undetectable, 40% were told that condoms were necessary.

Despite the doctors and people living with HIV coming from the same centres, there were some discrepancies noted. For instance, over two-thirds of doctors felt that they spent enough time explaining U=U, with 17% indicating that they took a great deal of time to explain the concept. Most (61%) felt that their patients understood the concept. However, only 39% reported having specific materials related to U=U, such as pamphlets and posters. Most doctors (63%) reported performing viral load tests twice a year, and 82% reported that knowledge of U=U did not impact upon the frequency of viral load testing.

Factors associated with U=U knowledge

Middle-aged people living with HIV, for example those aged 40-50 were half as likely to have heard of U=U than those younger than 40 (Adjusted Odds Ratio (AOR) 0.46, 95% Confidence Interval (CI) 0.24–0.89). Factors associated with a higher likelihood of U=U awareness included being male (AOR 2.42, 95% CI 1.30–4.50) and being on treatment for more than five years (AOR 2.62, 95% CI 1.30–5.28). Those who had heard about U=U in from a community organisation or at their hospital were twice as likely to believe that it was completely accurate, compared to those who had heard it elsewhere. 

“80% of people living with HIV and doctors who were aware of U=U believed it to be completely accurate, while only 67% of HIV-negative people said the same.”

For HIV-negative people, those aged 40-50 were much more likely to have heard about U=U (AOR 4.51, 95% CI 2.69–7.57). This was also the case if they had had more than 50 sexual partners in the previous year (AOR 3.52, 95% CI 1.14–10.86), while those who did not have university-level education (AOR 0.49, 95% CI 0.33–0.71) and did not test frequently for HIV (AOR 0.37, 95% CI 0.22–0.60) were less likely to have heard about it. HIV-negative individuals who were more educated, had heard about U=U in a community setting, and had a partner living with HIV were more likely to believe that it was accurate.

Among doctors, those involved in the care of people living with HIV were nearly 15 times more likely to have heard of U=U (OR 14.8, 95% CI 2.57–85.1). 

Conclusion

“The present study showed some inconsistency between awareness and perception of accuracy of the message U=U in people living with HIV and physicians suggesting that there is still low confidence in the community regarding the message itself,” the authors conclude.

“More efforts should be implemented to spread the U=U message among subgroups who might benefit from targeted educational campaigns. The results of the present study suggest how even in Italy the dissemination of the U=U concept is still far from being universal and adequate. Dissemination of the message among people who have unprotected sex is far from being efficaciously implemented and should represent a priority for increasing knowledge, decreasing HIV stigma and increased access to HIV diagnosis.”

References

Cingolani A et al. Awareness and perception of accuracy of the Undetectable = Untransmittable message (U=U) in Italy: results from a survey among PLWHA, infectious-diseases physicians and people having unprotected sex. AIDS Care, published online 17 May 2022.

https://doi.org/10.1080/09540121.2022.2074960