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How Do Gay Serodiscordant Couples in Sydney, Australia Negotiate Undetectable Viral Load for HIV Prevention?

Abstract

Many gay Australian serodiscordant couples are currently relying on an HIV-positive partner’s undetectable viral load (UVL) to practice condomless sex. For these couples, preventing HIV is often considered a mutual responsibility, yet they lack a formally endorsed strategy that helps them navigate ‘UVL for prevention’ (UfP) as a couple. Drawing on interviews with 21 Australian gay men representing 15 serodiscordant couples, we explored ‘the couple’ within serodiscordant HIV prevention. In learning to rely on UfP, couples were initially apprehensive as they navigated unfamiliar territory, but their concerns faded over time. Confidence in UfP was facilitated by repeated condomless sex without transmission, consistent test results, and being in a couple framed by trust, commitment, and familiarity. Gay male serodiscordant couples should be encouraged to negotiate clear, spoken ‘viral load agreements’ (VLAs) if they choose to rely on UfP.

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Acknowledgements

We would like to thank all participants in the study, staff in the participating clinics, laboratory staff, and staff in gay and HIV community organisations for supporting this research. The Kirby Institute receives funding from the Australian Government Department of Health and Ageing. The Kirby Institute is affiliated with the Faculty of Medicine, University of New South Wales. The Opposites Attract Study received unconditional research grants from the National Health and Medical Research Council, Australia; amfAR, the Foundation for AIDS Research, USA; ViiV Healthcare, UK, and Gilead Sciences, USA.

Opposites Attract Study Group

Andrew E. Grulich (Chief Investigator), Iryna B. Zablotska, Garrett P. Prestage, Fengyi Jin, Benjamin R. Bavinton (project leader), Beatriz Grinsztejn, Nittaya Phanuphak, David A. Cooper, Anthony Kelleher, Sean Emery, Christopher K. Fairley, David Wilson, Kersten K. Koelsch, Kathy Triffitt, Nicolas Doong, David Baker, Mark Bloch, David J. Templeton, Anna McNulty, Catherine Pell, Jennifer Hoy, Ban Kiem Tee, Richard Moore, Norm Roth, David Orth, Angie N. Pinto.

Funding

The Opposites Attract Study received unconditional research grants from the National Health and Medical Research Council, the American Foundation for AIDS Research, ViiV Healthcare, and Gilead Sciences. The Kirby Institute receives funding from the Australian Government Department of Health and Ageing. The Kirby Institute is affiliated with the Faculty of Medicine, University of New South Wales.

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Correspondence to Steven P. Philpot.

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All authors declare no conflict of interest.

Ethical Approval

All procedures involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approval was provided by the St Vincent’s Hospital Human Research Ethics Committee (HREC/11/SVH/170).

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Informed consent was obtained from all individual participants included in the study.

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Collaborators of the For the Opposites Attract study group are listed in “Acknowledgement”.

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Philpot, S.P., Prestage, G., Ellard, J. et al. How Do Gay Serodiscordant Couples in Sydney, Australia Negotiate Undetectable Viral Load for HIV Prevention?. AIDS Behav 22, 3981–3990 (2018). https://doi.org/10.1007/s10461-018-2247-6

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Keywords

  • Gay men
  • Serodiscordant couples
  • HIV prevention
  • Undetectable viral load
  • Treatment as prevention