{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000039,"version":"4.0.1"},"reference-count":45,"publisher":"CSIRO Publishing","issue":"3","license":[{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"vor","delay-in-days":806,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["155346"],"award-info":[{"award-number":["155346"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Our objective was to understand what gay, bisexual, and queer men (GBQM) who had experience using pre-exposure prophylaxis (PrEP) thought about the \u2018Undetectable equals Untransmittable\u2019 (U=U) message and how it informed their sexual decision-making over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted annual longitudinal qualitative interviews (2020\u201322) with 17 current or former PrEP users as part of a mixed-methods implementation science study examining barriers and facilitators to PrEP awareness, access, and adherence. Over 3\u00a0years, 47 interviews were conducted with GBQM in Ontario, Canada. Interviews were transcribed verbatim and coded in NVivo following reflexive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants\u2019 sexual health decision-making was informed by their confidence in biomedical HIV prevention and the person taking medication (i.e. themselves using PrEP versus a real\/imagined person living with HIV (PLHIV)). Longitudinal narratives of U=U clustered around four overarching themes: (1) U=U confidence (i.e. increasing trust in U=U irrespective of their PrEP use); (2) PrEP confidence (i.e. accounts of self-reliance and PrEP as sufficient HIV protection); (3) combination confidence (i.e. trusting U=U and PrEP as a package); and (4) partner confidence (i.e. potential \u2018distrust\u2019 of U=U due to uncertainties about partners\u2019 medication adherence). Overall, men described increased sex with PLHIV over time, including some participants who, during earlier interviews, said they would \u2018never be comfortable\u2019 with serodifferent sexual partners.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>GBQM\u2019s use of PrEP shaped how they thought about U=U and sex with PLHIV. Although many GBQM embraced treatment as prevention\/U=U as significant to their sexual lives, longitudinal analysis revealed its varied and uneven adoption across participants and time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/sh23015","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T20:04:00Z","timestamp":1685563440000},"page":"223-231","source":"Crossref","is-referenced-by-count":19,"title":["Gay, bisexual, and queer men\u2019s confidence in the Undetectable equals Untransmittable HIV prevention message: longitudinal qualitative analysis of the sexual decision-making of pre-exposure prophylaxis users over time"],"prefix":"10.1071","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9032-3959","authenticated-orcid":true,"given":"Daniel","family":"Grace","sequence":"first","affiliation":[{"name":"ADalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emerich","family":"Daroya","sequence":"additional","affiliation":[{"name":"ADalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Gaspar","sequence":"additional","affiliation":[{"name":"ADalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Wells","sequence":"additional","affiliation":[{"name":"BSchool of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hull","sequence":"additional","affiliation":[{"name":"CDepartment of Medicine, University of British Columbia, Vancouver, BC, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Lachowsky","sequence":"additional","affiliation":[{"name":"BSchool of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darrell H. 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