In April 2009, the CIHR Team for the Study of Acute HIV Infection in Gay Men helped to bring a new HIV testing technology, called the early HIV test, to Vancouver.
The early HIV test can diagnose HIV during the acute infection period, a time when most HIV tests cannot detect infection due to limitations in testing technology. The acute infection period refers to the initial weeks and months of HIV infection during which there are very high amounts of HIV in the body. The early HIV test can provide an HIV diagnosis as early as 10-12 days after HIV exposure. This test is also called the pooled nucleic acid amplification test (NAAT).
Our study team wanted to bring this test to Vancouver because research in other cities showed it has health benefits for people diagnosed with HIV by getting earlier access to treatment and care. This test also helps to reduce the number of times HIV is passed on as people who are diagnosed with HIV often change their behaviour when they know they may pass HIV on to others.
Working with our community partners, the CIHR Team for the Study of Acute HIV Infection in Gay Men conducted research to learn about how the availability of the early HIV test impacts men’s experiences of HIV testing. Our study team talked to two groups of men who used the early HIV test: those who received HIV-negative test results, and those who received HIV-positive test results. We talked to participants about HIV, as well as their overall health and wellbeing throughout the project.
Our team has now published two reports summarizing our findings. Here, we focus on the findings from the report, “Understanding the impact of HIV among recently diagnosed gay men in Vancouver”, which highlights our research with 25 men who tested HIV-positive. 13 men were diagnosed with an acute HIV infection, and 12 men were diagnosed within the first year of having HIV, but after the acute period. We will highlight some of the main themes from our research – men’s experiences of getting an HIV diagnosis, men’s accounts of the sexual encounters they believe led them to becoming HIV-positive, men’s sex lives after being diagnosed with HIV, and men’s experiences of sharing their HIV status.
During our research between April 2009 and March 2012, using the early HIV test led us to diagnose acute HIV infection in 25 men who would otherwise have been given an HIV-negative test result. Not all of these men participated in our study. However, the men who did join our study told us they had positive interactions with the person who gave them their HIV test results (see Figure 1). Participants in our study also shared that it was hard to absorb all of the information they were being given about HIV at the time they were diagnosed.
We asked men if they remembered a specific time when they believe they became HIV-positive.
Most men identified a specific sexual encounter in which they believe they got HIV, based on facts about HIV, and knowledge about their own sex lives. Most of our participants believed they were exposed to HIV when they were bottoming during anal sex without a condom. About one-third of the guys told us they used a condom for the first part of sex, but that it was taken off or it broke before their partner finished.
Many participants acknowledged the role they played in the sexual encounter that they believe led them to become HIV-positive. At the same time, these guys also told us that all partners involved in sex have some responsibility to prevent HIV/STI transmission.
There was a period of time after diagnosis where most participants told us they stopped having sex altogether. Men shared a few reasons to stop having sex, including concern about passing HIV on to others, a focus on adjusting to life with HIV, and concern about telling a partner about their HIV status. Most men started having sex again: some men began having sex again within a few weeks of diagnosis, while others waited for a much longer period. Participants told us they made decisions about starting to have sex using information about their viral load, as well as based on their relationship status.
Men told us that many of the decisions they made about sex were informed by the feeling of responsibility they had to prevent passing HIV to their partners after diagnosis. They told us that they were cautious about having sex, particularly during the acute HIV infection phase, and took steps to reduce the possibility of passing HIV to their partners. For many men, this meant not having certain types of sex until they had an undetectable viral load.
Participants also shared their decision-making process about sharing their HIV status with people in their lives. Overall, men told us they were cautious about sharing their HIV status, and told people on a “need-to-know” basis. Most participants said they were able to get support at diagnosis by sharing their HIV status with close friends, family, partners, and counselors. Some participants told us that they especially valued support from people who had already been through an HIV diagnosis.
Men shared that they did encounter HIV stigma and misinformation when telling people about their HIV diagnosis in some social and sexual contexts. These negative experiences were often difficult for our participants. Some participants also said they chose not to share their HIV status with certain people because they expected a negative reaction.
Our research showed us some things that are being done well within Vancouver’s gay men’s health providers and community organizations, and it also showed us areas where we can continue to do better before and after men are diagnosed with HIV. To learn more about what we found, visit the study website at www.acutehivstudy.com.