Gay men’s attitudes towards and perceptions of viral load and treatment as prevention Question What are gay men’s attitudes towards and perceptions of viral load and treatment as prevention? Key Take-Home Messages

 Findings from recent studies (1-3) have highlighted the potential for antiretroviral therapy to prevent HIV by reducing an HIV-positive person’s viral load.  Prevention experts are concerned that active promotion of “treatment as prevention” may undermine the benefits of widespread antiretroviral use by contributing to treatment optimism and increasing risk behaviours (4).  The limited number of studies over the past five years suggest that treatment-related beliefs of reduced infectivity could lead to an increase in sexual risk-taking (5;6), particularly among HIV-positive gay men who believed that undetectable viral loads reduced HIV transmission (5).  Some studies found that HIV-positive gay men who had undetectable viral loads were more likely to engage in unprotected anal intercourse, but other studies did not find the same association (5;7-10). Differences were associated with one’s own/partner’s HIV status, and type of partnership.  HIV sero-concordant partners (i.e., both HIV-positive) were more likely than sero-discordant partners (i.e., one partner HIV-positive and one HIVnegative) to discuss viral load when making decisions about whether to engage in unprotected anal intercourse (10).  The literature highlighted significant differences in sero-discordant partners’ understanding of viral load and in their decisions to use condoms (8).