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Perceptions of HIV treatment as prevention among African people in sero-discordant relationships

XIX International AIDS Conference, Washington D.C, 25 July 2012 (Poster).

Speakers: Adam Bourne, Catherine Dodds; Jabulani Chwaula; Peter Weatherburn

The concept of HIV ‘treatment as prevention’ has received significant attention in the fields of science and health promotion. However, there is little data about how individuals most likely to be involved in HIV exposure and transmission perceive and engage with the notion. As part of the Plus One study, we gained insight from 60 African people who are involved in HIV sero-discordant sexual relationships (where transmission risk is high) offering a valuable perspective on community-level understandings of treatment as prevention. The sample included 44 people with diagnosed HIV, and 16 whose most recent HIV test result was negative. In depth interviews explored: experiences of coming to terms with diagnosis and disclosure, management and perceptions of HIV transmission risk, communication strategies, and awareness and experience of HIV treatment as prevention. The notion that HIV transmission could be managed through any means other than condoms was viewed with suspicion and uncertainty by the majority of participants. Over half had not heard of treatment as prevention and most of the remainder would not rely on it to prevent HIV transmission. Some participants complained of the added complication of conflicting messages from the HIV sector regarding about what treatment as prevention involves and its efficacy. Consistent and coherent information is needed to inform those living with, or at risk of contracting HIV, as to the efficacy of utilising HIV treatment as prevention. Interventions need to take account of established perceptions of risk management with a view towards improving the acceptability of harm reduction approaches that may incorporate treatment as prevention as one component within a varied ‘HIV prevention toolbox’.