Changing Knowledge and Attitudes Towards HIV Treatment-as-Prevention and “Undetectable = Untransmittable”: A Systematic Review

Treatment-as-prevention (TasP) refers to the strategy of treating HIV-positive individuals with antiretroviral therapy (ART) to prevent sexual transmission of the disease to others. A landmark 2011 study by the HIV Prevention Trials Network that monitored transmission amongst mixed HIV status couples (in which one partner was HIV-positive and one HIV-negative) provided conclusive evidence that ART eliminates the risk of transmission in virally suppressed people living with HIV. Despite the positive implications this research has for millions of people living with HIV worldwide, major disparities remain in terms of knowledge, awareness and attitudes towards TasP.

In a new journal article published in AIDS and Behavior, Human Capital Initiative Core Faculty Member Jacob Bor and 13 coauthors conduct a systematic review of the scientific literature on TasP knowledge, awareness and attitudes in different populations around the world. Their review included 72 peer-reviewed studies published in English between January 1, 2008 and October 18, 2020. Four of the studies assessed the impacts of TasP information dissemination interventions, and almost all of the studies focused on populations of men who have sex with men and other sexual minorities. 

Main findings:

• Large gaps in knowledge and awareness of TasP remain globally, particularly in sub-Saharan Africa. 
• Acceptability of TasP as a prevention strategy generally increases as people learn more about its effectiveness. 
• Interventions that have disseminated information about TasP have had “beneficial impacts” on HIV testing, treatment adherence, viral suppression and stigma reduction. 

Ten years after the HIV Prevention Trials Network’s landmark study, TasP is the medical community’s best hope for stopping the spread of HIV. The review by Bor and coauthors demonstrates a direct link between increased knowledge of TasP and positive health outcomes.

Given that knowledge and awareness of TasP are currently less than universal as documented by Bor and coauthors, there is a clear need for important scientific discoveries to be coupled with thoughtful public information strategies in order to increase the general public’s awareness and ability to live better and healthier lives.