RESEARCH PAPER
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Understanding differences in knowledge and behaviors among men who have sex with men (MSM), men who have sex with women (MSW), and women, is critical to tailor HIV treatment. We investigated these differences among an international sample of people living with HIV (PLHIV) in 25 countries.

Methods:
Data came from the 2019 Positive Perspectives Study, an online convenience sample of PLHIV in 25 middleand high-income countries. Participants were categorized as MSM (n=1018), MSW (n=479), or women (n=696), based on self-classified gender and sexual orientation. Descriptive and multivariable analyses were performed (p<0.05).

Results:
Mean age was 43.4 years among MSM, 36.6 among MSW, and 41.0 among women. Overall, 24.2% [116/479] of MSW reported suboptimal health on all four domains assessed (sexual/mental/physical/overall), significantly higher than MSM (18.0% [183/1018], p=0.005), but similar to women (22.8% [159/696], p=0.585). Overall, the median number of reasons reported for missing HIV medication ≥1 time in the past month was 7, 2, and 1 for MSW, women, and MSM, respectively. The percentage reporting viral suppression among MSW (57.0% [273/479]) was significantly lower compared to both MSM (89.2% [908/1018], p<0.001), and women (62.8% [437/696], p=0.046). Yet, MSW were the least comfortable discussing with providers concerns about transmitting disease (MSW=42.8% [205/479]) vs MSM (70.3% [716/1018], p <0.001), or women (58.0% [404/696], p<0.001). The percentage of all MSW who considered having children a priority at time of starting treatment (30.5% [146/479]) was 1.4 times higher compared with women (22.6% [157/696], p=0.002) but about 6 times higher than MSM (5.4% [55/1018], p<0.001). Within multivariable analyses, being told of ‘Undetectable = Untransmittable’ by healthcare providers was positively associated with optimal sexual health among MSM in high-income countries (AOR=1.52; 95% CI: 1.01–2.32), MSM in middle-income countries (AOR=2.89; 95% CI: 1.57–5.32) and women in middleincome countries (AOR=1.29; 95% CI: 1.04–1.60), but not among MSW in either middle- or high-income countries.

Conclusions:
Compared with MSM, women and especially MSW had greater unmet need – a previously unrecognized gap. Relatively low rates of viral suppression among MSW have implications for HIV transmission to women via heterosexual contact. Acknowledging these differences when planning and administering care can help address disparities.

ACKNOWLEDGEMENTS
Data analysis and medical writing was supported by Zatum LLC.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. E. Castellanos and B. Allan report personal fees from ViiV Healthcare during the conduct of the study, and personal fees from ViiV Healthcare outside the submitted work. N. Van de Velde reports grants from ViiV Healthcare and GlaxoSmithKline outside the submitted work. G. M. Corbelli reports personal fees from ViiV Healthcare during the conduct of the study, and personal fees from ViiV Healthcare and HIV Vaccine Trials Network outside the submitted work. W.D. Hardy reports personal fees from ViiV Healthcare, during the conduct of the study; and personal fees from ViiV Healthcare, Advisory Boards, Merck, and from Gilead Sciences, outside the submitted work. P. de los Rios and B. Young report grants from ViiV Healthcare during the conduct of the study, as well as outside the submitted work. A. Eremin and C. Okoli report personal fees from ViiV Healthcare, during the conduct of the study. P. de los Rios, C. Okoli, B. Young, M. Muchenje and N. Van de Velde are employees of ViiV Healthcare.
FUNDING
This work was sponsored by ViiV Healthcare.
AUTHORS' CONTRIBUTIONS
CO, PD, BY and NV conceptualized the study. All authors contributed to the study design, analyses, drafting of the manuscript, and substantial revisions. All authors gave final approval for the manuscript to be submitted for publication.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
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