Friday, March 18, 2016

Implementation Challenges & Opportunities for HIV Treatment as Prevention (TasP) among Young Men in Vancouver, Canada

Despite evidence supporting the preventative potential of HIV Treatment as Prevention (TasP), scientific experts and community stakeholders have suggested that the success of TasP at the population level will require overcoming a set of complex and population-specific implementation challenges. For example, the factors that might influence decisions to initiate ‘early’ treatment have yet to be thoroughly understood; neither have questions about the factors that enhance or impede their ability to achieve long-term adherence to ARVs or the social norms regarding various treatment regimens been examined in detail. This knowledge gap may hamper opportunities to effectively develop public health practices that are informed by the various challenges and opportunities related to TasP implementation and scale up.

Drawing on 50 in-depth, individual interviews with young men ages 18–24 in Vancouver, Canada, this study examines young men’s perspectives regarding factors that might affect their engagement with TasP.

While findings from the current study indicate young men generally have a high receptiveness to TasP, our findings also identify key social and structural forces that will warrant ongoing consideration for TasP implementation. For example, participants described how an enhanced awareness regarding treatment (including awareness of the universal availability of treatment in Vancouver) would be a necessary, but not sufficient, condition to decide to endorse TasP. Their decisions about engaging in HIV care in the context of TasP (e.g., HIV testing, treatment initiation, long-term adherence) also appear to be contingent on their ability to negotiate or ‘balance’ the risks and benefits to themselves and others. The findings also offer insight into the complex and sometimes controversial narratives that continue to emerge regarding risk compensation practices in the context of TasP.

Based on the results of this study, we identify several areas that hold promise for informing the effective scale up of TasP, including new information regarding implementation adaptation strategies.

[sample of interview responses]

But I don’t know if that [information about HIV treatment and prognoses] makes me any less concerned about certain aspects of the disease just because I also know that it’s [treatment] expensive, and that definitely plays into me, ‘cause I know that if I needed to afford expensive medication, I just couldn’t right now. (#018)

You’re still fucked [in the event of an HIV diagnosis]. I don’t even know if it’s covered by MSP [Medical Services Plan, the provincial health care plan in the province of British Columbia]. I highly doubt it. So if you’re on welfare and you have HIV, I think you’re pretty fucking screwed. And I would not want to have to figure it out, either. (#041)

The person may feel like, ‘Well, you’re only making me undergo treatment because you just wanna protect those around me and decrease their chance of contracting the infection, as opposed to treating me and being concerned about me.’ So I can see the person viewing the measure as ‘all but me.’ (#001)

Full article at:

Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
Ontario HIV Treatment Network, Toronto, Canada

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