Negative attitude towards MSM living with HIV tied to low knowledge, worry about HIV

Ignorance and fear of HIV both contribute significantly to the negative attitudes towards men who have sex with men (MSM) living with the virus, suggests a study presented at the 24th International AIDS Conference (AIDS 2022) in Montreal, Canada.

However, “[f]indings around openness about one's sexuality indicate an intersectional effect of anti-LGBTQ-stigma and HIV-stigma,” according to the researchers, led by CF Sjöland of the Karolinska Institutet, Global Public Health, in Stockholm, Sweden.

Furthermore, “[t]he association between the antistigma campaign and less negative attitudes suggest that targeted campaigns are effective and necessary, even in the era of Undetectable=Untransmittable (U=U) and among well-informed MSM,” they added.

This study examined the negative attitudes towards MSM living with HIV among self-reported HIV-negative MSM, as well as the determinants in terms of sociodemographics, openness about one’s sexuality, and knowledge or worry about HIV. The researchers also assessed the impact of a 2020‒2021 antistigma campaign, which sought to challenge traditional prejudices against MSM and inform about U=U, on such negative attitudes.

In 2021, an online survey was administered to MSM living in Sweden, which recruited participants via convenience sampling on popular gay dating and social media sites. A total of 1,287 respondents participated in the study, of whom 1,142 (89 percent) reported being HIV-negative, for which indices were created of negative attitudes towards MSM living with HIV and knowledge or worry about HIV.

Finally, the researchers inputted potential determinants of negative attitudes into a multivariable logistic regression model.

Based on the survey results, negative attitudes about HIV among respondents correlated with lower knowledge of HIV (odds ratio [OR], 2.5, 95 percent confidence interval [CI], 2.0‒3.3) and more worry (OR, 1.8, 95 percent CI, 1.4‒2.3), after adjusting for confounders such as age, city of residence, and university education. [AIDS 2022, abstract 11355]

On the other hand, openness about one’s sexuality independently contributed to having less negative attitude towards MSM living with HIV (OR, 0.4, 95 percent CI, 0.3‒0.5). Exposure to the 2020‒2021 antistigma campaign also resulted in less negative attitudes (OR, 0.7, 95 percent CI, 0.6‒0.9).

“MSM make up 32 percent of people living with HIV (PLHIV) in Sweden, with >95 percent of PLHIV on antiretroviral treatment (ART) and undetectable viral load,” the researchers said. “Despite high awareness of U=U, negative attitudes remain toward MSM living with HIV, including in social, sexual, and romantic relationships.”

From an Asian perspective, nearly two out of three MSM and about one in four HIV-positive men lacked awareness of U=U, based on the results of another study presented at the AIDS 2022 conference in Canada. [AIDS 2022, abstract 4869]

Many HIV-positive men used undetectable viral load (UVL) to prevent transmission when having condomless anal intercourse, but this was not common among non-HIV-positive men.

“Such a situation significantly challenges the ability of [MSM] to utilize proven safer-sex options and diminishes opportunities to disrupt pervasive stigma experienced by PLHIV,” the authors said.