Resum
BACKGROUND: People living with HIV (PLHIV) are at higher risk of poor mental health such as depression and anxiety, partly because of fear of harming others and because of loneliness. Knowledge of not being infectious when having an undetectable viral load ('Undetectable=Untransmissible', or U=U) may have a positive impact on their mental health and quality of life. We sought to estimate the association of Undetectable=Untransmittable (U=U) knowledge and depression/anxiety and Internalized homonegativity among HIV-diagnosed MSM participating in the Latin-American MSM Internet Survey (LAMIS). METHODS: From January to May of 2018, 64,655 adult MSM from 18 Latin-American countries responded to an on-line questionnaire exploring sociodemographics, mental health metrics, and HIV-related knowledge and behavior. We used adjusted multivariable logistic regression to estimate the association between 'Undetectable=Untransmittable (U=U) knowledge' with two outcomes: 1. Presence of anxiety/depression (mild to severe symptoms) in the 4 items from the People Health Questionnaire (PHQ-4); 2. Higher internalized homonegativity, i.e. a score above the median score of the Short Internalized Homonegativity Scale (SIHS). U=U knowledge was assessed with knowing that 'a person with HIV who is on effective treatment (called undetectable) cannot transmit the virus to others during sex'.
RESULTS: Among all respondents, 10,265 (16%) reported diagnosed HIV. Among those, 74% (7566/10256) reported U=U knowledge; and 60% (4023/10166) had evidence of depression/anxiety (40% mild, 11% moderate, 9% severe). Among the 8824 respondents who answered the questions on IH, there was a median score of 1.14 points in the SIHS. After adjusting for sociodemographics and HIV-care related variables, U=U knowledge was negatively associated with both, presence of anxiety/depression symptoms (PR=0.91; 95%-CI:0.88'0.95) and a higher internalized homonegativity score (PR=0.79; 95%-CI:0.76'0.83). CONCLUSIONS: Our findings support that U=U knowledge is one of the factors having a positive impact on mental health outcomes among HIV-diagnosed MSM. Its promotion across Latin-America should be reinforced by HIV health services. Future studies should assess the impact of U=U knowledge on related outcomes such as HIV-stigma perception and quality of life.
