Individual coping by HIV-positive people with non-infectiousness due to successful antiretroviral therapy

Abstract

Background: Antiretroviral therapy (ART) surpresses the viral load of HIV under a detectable level and reduces the risk of HIV transmission. Consenting HIV discordant partners who do not have other sexually transmitted infections (STIs) can have safer sex without condoms if the HIV-positive partner is on effective ART for at least six months and regularly checked. The protective effect is comparable to the use of condoms. This effect was first openly communicated in 2008 by the Swiss Federal Commission on Aids-related issues and subsequently adapted by Deutsche AIDSHilfe e.V. (DAH). The subject led to assumptions about a theoretical decline in protective behavior, but also to a possible reduction of HIV-stigma. This study focuses on the behavioral and psychosocial effects of non-infectiousness and individual coping. Methods: A qualitative study design with in-depth interviews and a hermeneutic phenomenological analysis approach was conducted. The heterogeneous sample contained 17 HIV-positive women and men who were diagnosed HIV-positive over the last 20 years and started ART between 1999 and 2013. Results: Eight categories associated with individual coping could be developed. The understanding and acceptance of non-infectiousness varied individually. In regard to the HIV regimen and HIV stigma, adjusting to life with HIV was a challenging experience for the participants and, in regard to their circumstances and the history of HIV, the process of accepting a non-infectious HIV corporeality was subject to dissonance between rationality and emotionality. Reduced internalized HIV stigma was indicated by less fear of HIV transmission and a regained sense of well-being. Half of the participants have practiced medical therapy as a protective method at least once, notwithstanding gender, age, cultural background or sexuality. Among men who have sex with men the importance of serosorting as a protective method and the relevance of STIs increased. Among women the possibility to have children was essential. A lack of information on non-infectiousness in the medical setting and a lack of awareness in society also became apparent. Outlook: As this is an explorative study, the results provide a framework for further research on this subject, especially in the context of HIV stigma. A rational and realistic instruction of People Living with HIV (PLHIV) within the medical setting and a raise of public awareness are recommended.