Study Examines Global HIV Transmission Trends

Treatment as prevention (TasP) is a powerful tool in the international effort to end HIV transmissions. A new paper titled “Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents” outlines the findings from the HPTN063 study, which estimated the frequency and predictors of numbers of HIV transmissions and bacterial sexually transmitted infection (STI) acquisition among sexually active HIV-positive individuals in care from three representative global settings.

Dr. Steven Safren, Affiliated Investigator at Fenway Health and Professor of Psychology at University of Miami, served as the HPTN063 study Chair and Dr. Kenneth Mayer, Medical Research Director of The Fenway Institute, served as Co-Chair.  Dr. Matthew Mimiaga, Senior Research Scientist and Director, Epidemiology and Global Health Research at Fenway, served as study Co-Investigator.

“TasP is seen as an effective public health tool to curb the HIV epidemic. However, managing chronic HIV infection comes with different life complications, and people living with HIV need more than just ART prescriptions to manage the different aspects of their care,” explained Dr. Safren. 

The study estimates that, among HIV positive patients in HIV care who disclose some level of difficulty with consistent condom use, for every 100 people living with HIV there are 3.81 estimated HIV transmissions. Looking at only heterosexual women and men who have sex with men (MSM) from the same sample population, researchers found a 22.4% incidence of bacterial STI.

The data suggests that in relation to individual potential for transmitting HIV, a number of psychosocial factors came into play, including depression, mental health, quality of life, fear of the consequences of HIV disclosure, and various cultural beliefs.

“This study found that most people in care were not likely to transmit HIV, but a small subset that did not have the virus suppressed on medication and reported condomless sex could potentially transmit HIV,” Safren said. “Moreover, a larger minority – close to one in four – had a new sexually transmitted infection over the course of the one year study. These findings highlight the importance of addressing the reasons for medication non-adherence, such as depression, alcohol use, and other difficulties, and ongoing screening for bacterial STIs for HIV-infected patients in care.”

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