Sexual Behaviors and Awareness of U=U in People Living with HIV Receiving Antiretroviral Treatment In Northern Thailand.

Sexual activities are perceived as risky behaviors among people living with HIV (PLWH), which leads to stigmatization. Today, effective treatment and the strengthened Undetectable=Untransmittable (U = U) message are supposed to be key in freeing PLWH from the fear of HIV transmission. We conducted a cross-sectional study in 2024 at four HIV clinics in Chiang Mai, Thailand. We enrolled PLWH aged ≥ 18 years who were receiving ART. We collected data through face-to-face interviews using structured questionnaires to assess sexual behaviors and U = U awareness. Logistic regression analyses were performed to identify factors associated with being sexually active. Among 404 study participants, with a median age of 46 years, 235 (58.2%) were sexually active in the past 12 months. While most participants, 335 (83.0%), agreed that PLWH can be sexually active, only 76 (18.8%) were aware of the U = U message. Of those who were aware of U = U, a lower proportion reported 100% condom use compared to those who were not, either with steady (37.0% vs. 63.5%) or casual partners (33.3% vs. 84.6%). Factors associated with being sexually active included being young adults or middle-aged, having a sexual debut age < 20 years, alcohol use, and having a monthly income > 10,000 baht but not U = U awareness. While perceiving their sexual right, our findings demonstrated a U = U awareness gap among PLWH. We support the need to strengthen communication, share messages with the public, and tailor sexual health counseling to match the unique sexual and reproductive needs of PLWH at different stages of life.