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Campbell DM, Dubé K, Cowlings PD, Dionicio P, Tam RM, Agarwal H, Stockman JK, Auerbach JD, Sauceda JA, Conroy AA, Johnson MO. "It comes altogether as one:" perceptions of analytical treatment interruptions and partner protections among racial, ethnic, sex and gender diverse HIV serodifferent couples in the United States. BMC Public Health 2022; 22:1317. [PMID: 35810288 PMCID: PMC9270765 DOI: 10.1186/s12889-022-13528-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Most HIV cure-related studies involve interrupting antiretroviral treatment to assess the efficacy of pharmacologic interventions - also known as analytical treatment interruptions (ATIs). ATIs imply the risk of passing HIV to sexual partners due to the loss of undetectable HIV status. There has been a notable lack of attention paid to perceptions of ATIs among racial, ethnic, sex and gender minorities, and HIV serodifferent couples. These populations are among those most impacted by HIV in the United States. Future HIV cure research paradigms should equitably include considerations from these groups. METHODS From August - October 2020, we conducted in-depth interviews with 10 racial, ethnic, sex, and gender minority HIV serodifferent couples in geographically diverse regions of the United States to understand their perspectives about ATIs and partner protection measures to prevent secondary HIV transmissions because of participation in ATI studies. We used framework analysis to analyze the qualitative data. RESULTS Of the 10 couples recruited, four identified as a gay couple, two as a gay and bisexual couple, two as a heterosexual couple, one as a gay and queer couple, and one as a queer couple. We found that HIV serodifferent couples in our study viewed ATIs as contradicting HIV treatment adherence messages. Couples expressed discomfort around ATIs in HIV cure research. They were concerned with the return of HIV detectability and worried ATIs might result in secondary HIV transmission. Participants were strongly in favor of using a range of partner protection measures during ATIs that included PrEP, HIV risk reduction counseling, and alternatives for penetrative sex practices. Couples also recommended that sex partners be consulted or involved as part of ATI trials. CONCLUSIONS Our findings highlight new potential opportunities and strategies to mitigate risk of HIV transmission during ATIs among key groups historically under-represented in HIV cure research. Findings also underscore the relational aspects of ATI trials. We provide preliminary considerations for planning ATI trials with diverse HIV serodifferent partners. Future studies should continue to explore these issues among other types of partnerships, cultures, and socio-cultural settings.
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Affiliation(s)
- Danielle M. Campbell
- grid.254041.60000 0001 2323 2312Charles R. Drew University of Medicine and Science (CDU), 1731 East 120th Street, Los Angeles, CA 90059 USA ,Joint Doctoral Program in Public Health, University of California, San Diego/San Diego State University, 9500 Gilman Drive, La Jolla, CA 92093 USA ,grid.266100.30000 0001 2107 4242Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA.
| | - Portia D. Cowlings
- grid.254041.60000 0001 2323 2312Charles R. Drew University of Medicine and Science (CDU), 1731 East 120th Street, Los Angeles, CA 90059 USA ,grid.261833.d0000 0001 0691 6376Graduate School of Education and Psychology, Department of Education, Pepperdine University, 6100 Center Drive, Los Angeles, CA 90045 USA
| | - Patricia Dionicio
- Joint Doctoral Program in Public Health, University of California, San Diego/San Diego State University, 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Rowena M. Tam
- Joint Doctoral Program in Public Health, University of California, San Diego/San Diego State University, 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Harsh Agarwal
- grid.10698.360000000122483208UNC Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599 USA
| | - Jamila K. Stockman
- grid.266100.30000 0001 2107 4242Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Judith D. Auerbach
- grid.266102.10000 0001 2297 6811San Francisco (UCSF) Department of Medicine, Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - John A. Sauceda
- grid.266102.10000 0001 2297 6811San Francisco (UCSF) Department of Medicine, Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Amy A. Conroy
- grid.266102.10000 0001 2297 6811San Francisco (UCSF) Department of Medicine, Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Mallory O. Johnson
- grid.266102.10000 0001 2297 6811San Francisco (UCSF) Department of Medicine, Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
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