Authors
A. Tavelli (1), A. Cingolani (2), L. Cosmaro (3), S. De Benedittis (1), N. Frattini (4), G.V. Calvino (5), F.M. Fusco (6), A. Costantini (7), A. Di Biagio (8), B.M. Celesia (9), M. Guastavigna (10), M. Cernuschi (11),(4), D. Calzavara (11), A. Antinori (12), F. Von Schloesser (13), A. d’Arminio Monforte (1), on behalf of Icona Foundation Study Group
Affiliation
(1) ICONA Foundation, Milan, Italy, (2) Clinic of Infectious Diseases, Catholic University, Rome, Italy, (3) LILA ONLUS, Milan, Italy, (4) A.S.A. ONLUS, Milan, Italy, (5) ANLAIDS ONLUS NAZIONALE, Rome, Italy, (6) P.O. ‘D. Cotugno’, Azienda Ospedaliera dei Colli, Naples, Italy, (7) Clinical Immunology Unit, Azienda Ospedaliero Universitaria delle Marche - Università Politecnica delle Marche, Ancona, Italy, (8) Infectious Disease Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy, (9) Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy, (10) S.C. Malattie Infettive e Tropicali I, ASL Città di Torino, Amedeo di Savoia Hospital, Turin, Italy, (11) Milano Checkpoint ETS, Milan, Italy, (12) Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy, (13) NADIR Onlus, Rome, Italy
ABSTRACT
Background: The "undetectable equals untransmittable” (U=U) message should contribute to reduce stigma affecting PWH, who can live without the fear of transmitting HIV once they have reached undetectable HIV-RNA. Nevertheless, still many PWH are unaware of this concept. To spread the U=U message in Italy, an awareness campaign designed by the community ‘U=U-Impossibile sbagliare’ was launched in Sept 2023. This study aims to verify its impact among PWH by measuring the awareness of U=U and its association with self-stigma.
Methods: A survey was disseminated within the PWH of the ICONA network before (Jul-Sept2023) and after the launch of the campaign (Sept2023-March2024). It was accessible via web or Icona mobile app and consisted of the validated HIV Stigma Scale (12-items) and 3 questions on U=U (Do you know U=U? Do you think it is reliable? Did it change your life?). The domains of the stigma scale were 4: personalized stigma, disclosure concerns, concerns with public attitude, negative self-image. Scores varied from 3 to 12, with higher scores indicating higher stigma. The survey was anonymous and not designed to compare pre-/post results of same subject. Data on knowledge of U=U pre-and post-campaign were compared by logistic regression; association between U=U knowledge and HIV stigma was analyzed by linear regression. A logistic regression analysis was conducted to identify factors associated with lack of knowledge of U=U.
Results: A total of 820 PWH responded to the survey: 362 (44.1%) pre- and 458 post- start of campaign (55.9%). 333 (40.6%) PWH responded “No” and 487 (59.4%) “Yes” to the question on knowledge of U=U with no differences according to the period: 226 (62.4%) pre- vs 168 (56.6%) post-campaign knew about U=U (p=0.13) (Table 1). After adjusting for age, gender at birth, MSM, center, education and nation of birth, the marginal predicted probability of knowing U=U pre-campaign was 61.3% (95%CI 56.4%-66.3%) and 57.7% (52.3%-63.0%) post-campaign (p=0.32).
The HIV stigma domain with the highest score was related to disclosure concerns. There was no evidence for an association between knowledge of U=U and the HIV-stigma scale scores; the “concerns with public attitudes” domain was even higher for those who knew U=U (Table 2). Independent factors associated to lack of U=U knowledge were age > 40, being non-MSM, education below university level and not-knowing last HIV-RNA (Table3).
Conclusions: Still 40% of PWH do not know about U=U; it is essential that medical staff dedicate due time to inform their patients. The campaign did not result in an increased knowledge of U=U. Possible reasons relate to the lack of funds to promote the concept widely. In this setting, the spot intervention suggests the need for additional campaigns targeting people still unaware of this concept (those with lower educational level, older age and not MSM). Finally, HIV stigma is a multifactorial issue of which personal awareness of U=U is one -but not the only- driver.
Allegato: Slide presentate alla conferenza
Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS end Antiviral Research
