Work

The HIV-treatment-as-prevention adoption cascade among U.S. men and gender-minority individuals who have sex with men

Year: 2026

Type: preprint

Abstract: HIV treatment can suppress viral load and prevent transmission between sex partners, a strategy known as treatment as prevention (TasP). TasP is key for ending the HIV epidemic, and it is important to understand its adoption among priority populations. We examined the TasP adoption cascade using cross-sectional survey data from 1443 U.S. men and transgender, gender-nonconforming, and nonbinary individuals who reported having sex with men. Most participants (82.4%; n = 1189/1443) reported prior awareness of TasP, but only 52.6% of them (n = 625/1189) perceived it as effective at preventing HIV transmission. Of those, 83.8% (n = 524/625) indicated being willing to rely on TasP, among whom 30.2% (n = 158/524) reported having recently done so. Among participants aware of TasP, we compared those who perceived it as effective to those who did not. Participants who did not have HIV and never used PrEP were less likely to agree with TasP’s effectiveness than those who had used PrEP or had HIV. Those who had learned about TasP from a sex partner or who had a partner of different HIV status were more likely to perceive it as effective. TasP promotion appears to have achieved broad awareness, but future efforts should aim at increasing the understanding of its effectiveness, especially among those not connected to HIV-related services, organizations, or communities. Public Health Significance TasP is an important tool to end the HIV epidemic. Examining stages of its adoption can inform tailored promotion among priority populations. In our study, many participants were aware of TasP, but fewer perceived it as effective. Monitoring uptake over time will allow for responsive promotion strategies as attitudes continue to evolve.

Source: medRxiv

DOI: 10.64898/2026.01.19.26344396

Authors: Étienne Meunier, Daniel Sauermilch

Institutions: New York City Department of Health and Mental Hygiene, Long Island University

Language: English

Topic: HIV/AIDS Research and Interventions

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funder: National Institute on Minority Health and Health Disparities