The impact of Undetectable=Untransmittable and viral suppression on condomless sex among mixed HIV-status couples in Canada
Bibliographic record
Abstract
INTRODUCTION/OBJECTIVES: Undetectable = Untransmittable (U = U) means that virally suppressed HIV-positive partners cannot transmit HIV. With advancements in HIV care and the increasing number of mixed HIV-status relationships, we quantified U = U agreement (agreeing/disagreeing that U = U is true) among people in mixed HIV-status relationships, assessed response concordance between partners, quantified the association between dyad-level U = U agreement and condomless sex, and estimated interaction effects of viral suppression. METHODS: A cross-sectional opportunistic and snowball sampled survey explored condom use, U = U agreement, viral suppression, sociodemographic/relationship characteristics, and sexual behavior among 306 participants (153 matched dyads) in mixed HIV-status relationships (2016-2018). Bivariate analyses identified sociodemographic/relationship characteristics associated with U = U agreement. Cohen's Kappa assessed response concordance between partners. Firth logistic regression estimated associations between dyad-level U = U agreement and condomless sex with effect modification by viral suppression. RESULTS: Of 293 responses to the U = U question, 53.2% agreed with U = U. Agreement was associated with younger age (p = 0.006) and shorter duration of HIV in relationships (p = 0.034). Concordance between partners was higher for factual questions (kappa>0.50) and lower for belief/decision-making questions (kappa<0.40). The predicted probability of always having condomless sex was 0.60 (95% CI:0.57,0.64) when dyads agreed with U = U and the HIV-positive partner was virally suppressed. The likelihood of always having condomless sex was low when the HIV-positive partner was not virally suppressed, whether or not dyads agreed with U = U (predicted probability range: 0.08;95% CI:0.06,0.11 to 0.25;95% CI:0.17,0.33), or when only one partner agreed with U = U (predicted probability range:0.02;95% CI:0.01,0.02 to 0.11;95% CI:0.07,0.15). CONCLUSIONS: Dyad-level U = U agreement, viral suppression, and views of both partners were key factors in mixed HIV-status couples' decisions to have condomless sex. Future representative studies among sexual identity and racialized minority sub-populations are needed to better understand how mixed HIV-status relationships receive and apply U = U messaging, with a focus on partner age and the duration of HIV within relationships.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.005 | 0.001 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".