The Expected Impact of HIV Post-Treatment Control and HIV Elimination on Quality of Life, Sexual Satisfaction, and Stigma Among People With HIV and Key Populations

The Expected Impact of HIV Post-Treatment Control and HIV Elimination on Quality of Life, Sexual Satisfaction, and Stigma Among People With HIV and Key Populations | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Expected Impact of HIV Post-Treatment Control and HIV Elimination on Quality of Life, Sexual Satisfaction, and Stigma Among People With HIV and Key Populations Kim Romijnders, Franco Romero, Amy Matser, Myrthe Verburgh, Maartje Dijkstra, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4311908/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 May, 2025 Read the published version in Communications Medicine → Version 1 posted You are reading this latest preprint version Abstract Objective This study explored the expected impact of two hypothetical HIV cure scenarios on quality of life (QoL), sexual satisfaction, and stigma among people with HIV (PHIV) and key populations (i.e., partners of PHIV, family members, friends and other contacts, and MSM without HIV) in the Netherlands. Design A cross-sectional survey was conducted among PHIV and key populations in the Netherlands from October 2021 until June 2022. Methods QoL, sexual satisfaction, and stigma were assessed with an online survey to compare participants’ current situation and for two hypothetical HIV cure scenarios: HIV post-treatment control (PTC), where HIV is suppressed without the need for ongoing antiretroviral treatment (ART), but the viral reservoir is expected to persist, and HIV elimination, where HIV is completely removed from the body. Results PHIV (n=222) expected improved QoL and sexual satisfaction, as well as reduced stigma compared to their current situation following both PTC and elimination. Key populations (n=495) similarly expected improvements for both HIV cure scenarios, except no expected improvement was found for QoL following PTC. The expected impact of a cure on QoL, sexual satisfaction, and stigma varied by age. Participants aged between 18 and 34 years expected greater improvement following both cure scenarios compared to older participants. Conclusion Both PHIV and key populations without HIV expect an HIV cure to have a positive impact on QoL, sexual satisfaction, and stigma. This impact is expected not only for HIV elimination but also for HIV PTC, the development of which appears more feasible. Health sciences/Diseases/Infectious diseases/HIV infections Health sciences/Diseases/Infectious diseases/Viral infection HIV cure survey quality of life key populations Figures Figure 1 Figure 2 Introduction Antiretroviral therapy (ART) has transformed the outlook of HIV from a fatal to a manageable chronic disease 1 . Despite these advancements, HIV continues to significantly impact the quality of life (QoL), sexual satisfaction, and stigma experienced by people with HIV (PHIV) and key populations (e.g., partners of PHIV, family members, friends and other contacts, and MSM without HIV) 2,3 . Part of this impact stems from the lifelong dependency on ART 2,4 , which has been reported to result in emotional and physical distress, potentially diminishing QoL 2,4 . In the Netherlands, both PHIV and key populations are reported to experience lower QoL compared to the general Dutch population 5 . Additionally, PHIV may endure ongoing burdens post-diagnosis, including HIV-related stigmatization, feelings of guilt, challenges related to disclosing their HIV status, and negative impacts on interpersonal relationships 5 . These burdens are found to persist over time 2,6 . Among key populations, there is still substantial fear of HIV acquisition and experienced stigma related to sexual behavior 7 . These negative experiences among PHIV and key populations underscore the urgent need for improved biomedical interventions for HIV, including the development of a cure 2,8 . There appear to be seven confirmed cases of HIV cure 9,10 . While, a scalable HIV cure remains hypothetical, it may have the potential to improve experienced QoL, sexual satisfaction, and reduce stigma among both PHIV and key populations 2,11,12 . In line with the HIV cure target product profile, both PTC and HIV elimination may be considered curative interventions, each with distinct characteristics 8,13 . Previous research regarding an HIV cure primarily focused on the willingness of PHIV to participate in HIV cure trials 14 or qualitatively explored the expected impact of HIV cure on the lives of PHIV and key populations 2 . Firstly, qualitative research indicated that only a cure that completely eliminates HIV from the body was deemed a true cure 2,15,16 . Indeed, qualitative research conducted in Australia reported that PTC was not considered a cure for HIV because it would not alleviate worry about transmission, concerns for friends and family, stigma 16 . Secondly, it demonstrated that PHIV and key populations in the Netherlands perceived the ultimate impact of a cure for HIV to be the normalization of life 2,16 . Improvement was expected on three main themes: PHIV and key populations were hopeful that HIV cure would lead to improved QoL, sexual liberation and improved sexual satisfaction, and would reduce HIV-related stigma 2 . In contrast, qualitative research in other context and geographical settings implied that stigma towards marginalized groups may increase following HIV cure 17,18 . Finally, previous qualitative research indicated that prioritizing research to understand the potential impact of HIV cure strategies on the partners of PHIV, communities, and those vulnerable to HIV in general, such as MSM, contributes to implementation and dissemination of science and meaningful involvement of all those affected by HIV 12,19-21 . While qualitative research suggests the potential positive impact of an HIV cure on three main themes: general QoL 22 , sexual satisfaction 23 , and stigma 24 , for PHIV and key populations, it remains unclear whether this expectation of a potential impact is widely supported among these populations. To the best of our knowledge, the potential impact of an HIV cure on these dimensions has not been explored quantitatively. Our study uses a cross-sectional survey to quantify the expected impact of two different hypothetical HIV cure scenarios – HIV post-treatment control (PTC) and HIV elimination – on QoL, sexual satisfaction, and stigma among PHIV and key populations in the Netherlands. Methods This study involved a cross-sectional survey exploring the expected impact of two HIV cure scenarios on the QoL, sexual satisfaction, and stigma among PHIV and key populations vulnerable to HIV in the Netherlands. In our study, key populations were partners of PHIV, family members, friends and other contacts, and MSM without HIV 2,3 . Participants were eligible if they were Dutch or English-speaking, 18 years or older, living with HIV or belonging to key populations, and provided informed consent. The study was approved by the ethics committee of the University Medical Center Utrecht (UMC Utrecht): 20-546/C. Recruitment Participants were recruited between October 2021 and June 2022 from the Amsterdam Cohort Studies (ACS) 25 , the AGEhIV Cohort Study 26 , the infectious diseases outpatient clinic of the UMC Utrecht, the Dutch HIV Association 27 , Stichting ShivA 28 , Grindr 29 , and the Public Health Services of Amsterdam, Rotterdam, Zuid-Limburg, Groningen, Utrecht, Gelderland-East, and Brabant-South East. Based on sample size calculations, we aimed to include between 700 and 1000 participants to draw conclusions about a mean difference of 3 points in QoL as assessed on the visual analogue scale (VAS) of the EQ-5D (scores ranging from 0 to 100) before and after HIV cure (SD < 20, confidence level = 95%, power = 80%). Questionnaire Data were collected using REDCap electronic data capture tools hosted at the UMC Utrecht and the ACS 25 . Tailoring was used to ensure participants were only shown questions relevant to them. All items were asked three times, unless otherwise stated, to assess a participant’s current QoL, sexual satisfaction, stigma, and demographic characteristics (section I), expected QoL, sexual satisfaction, and stigma after PTC (section II), and expected QoL, sexual satisfaction, and stigma after elimination (section III). Participants who completed only section I or completed the survey in an unrealistically short time (< 5 min per section: PHIV n = 1; key populations n = 1) were excluded from the analyses. A cure for HIV Vignettes were used to present two hypothetical HIV cure scenarios: PTC and elimination. These vignettes were previously developed and tested for coherence and comprehensibility in a qualitative study involving 42 participants, which contains a complete description of the scenarios 2 . PTC entails the long-term suppression of HIV by the immune system without the necessity for ongoing HIV medication. However, in the event of PTC failure, HIV rebound may occur. HIV elimination refers to a scenario in which HIV, including its reservoir, is eliminated from the body. Following successful HIV removal, ongoing HIV medication is no longer required, but the possibility of reinfection remains. For each vignette, participants were asked about their QoL, sexual satisfaction, and stigma if the cure was available. Subsequently, participants were asked to express their preferences between PTC and elimination at the conclusion of the questionnaire (Q: You now read both descriptions of cure scenarios. Which of the treatment options would you prefer?). Additionally, research indicates that a scenario such as PTC, is more likely than complete HIV elimination 8,11,13,30-36 . This indicates that PHIV and key populations will not have a choice between PTC or HIV elimination as a new treatment option, and thus, participants of our survey were not offered a choice or comparison between cure scenarios. To accommodate the current state-of-the-art research on HIV cure, no comparisons were made in our analyses in QoL, sexual satisfaction, and stigma between PTC and HIV elimination. Participant characteristics The following characteristics were included: gender (male, female, and non-binary), age (categorized into 18 – 34 years, 35 – 54 years, and >= 55 years), level of education (categorized into low–middle and high 37 ), sexual orientation (LGBTQIA+ and straight), relationship status (single and in a relationship), migration background (Dutch and non-Dutch), HIV status (PHIV and key populations without HIV), and, if applicable, time since HIV diagnosis (in years). Changes in life after hypothetical HIV cure Based on themes explored during thematic analyses of qualitative interviews, we included five questions to directly assess the expected change in life after hypothetical HIV cure for internalized stigma, mental health, social activities, physical health, and overall QoL after PTC (section II) and elimination (section III) 2 . Changes in life were assessed using a 5-point Likert scale ranging from much worse (1) to much better (5) (e.g., “How would your quality-of-life change?”). Response on each item was categorized into worse (scores 1 – 2), equal (score 3), or improved (scores 4-5). QoL QoL was defined in our qualitative work as the perception of a position in life in relation to goals and expectations 2 . Participants were asked to rate their current QoL and QoL if the cure was available using the VAS of the EQ-5D. 22 The VAS measures general QoL ranging from the worst imaginable health (0) to the best imaginable health (100) the participant could imagine. Sexual satisfaction Sexual satisfaction was conceptualized through individual, interpersonal, and behavioral lenses, focusing respectively on personal satisfaction, partner interactions, and specific behaviors contributing to satisfaction 38 . Sexual satisfaction was assessed using the short version of the New Scale of Sexual Satisfaction (N-SSSS) 23 on a five-point Likert scale ranging from not at all satisfied (1) to extremely satisfied (5). The sum of the scores was computed for participants who had a sex partner in the past six months (scores ranged 12 – 60) 23 . HIV-related stigma HIV-related stigma, as perceived by people with HIV, encompasses negative attitudes, beliefs, and actions from others, as well as internalized feelings of shame and fear of disclosure. In this study, we focus on the public attitudes domain, which involves societal views and misconceptions about people living with HIV, significantly impacting their social interactions and quality of life 24,39 . To assess HIV-related stigma for the current situation (section I), we used the concerns with public attitudes towards PHIV subscale of the short version of the Berger HIV Stigma Scale (HSS) 24 . Scores ranged from strongly disagree (1) to strongly agree (4). The subscale was used in sections I, II and III (scores ranged from 4 – 16). Data analyses QoL, sexual satisfaction, and stigma scales were transformed to Z-scores. Descriptive statistics were used to describe demographic characteristics, current QoL, sexual satisfaction, and stigma in our study population. Analyses were performed separately for PHIV and key populations. Missing values were not imputed. We examined whether gender, age, time since HIV diagnosis, relationship status, and migration background were associated with QoL, sexual satisfaction, and stigma, using univariable linear regression analyses. To examine the expected impact of each cure scenario we used several methods. First, we examined the percentage of participants who expected their QoL to improve, remain the same, or worsen after each cure scenario on the internalized stigma, mental health, social activities, physical health, and overall QoL-items. Second, the expected change in QoL, sexual satisfaction, and stigma after PTC and elimination were examined separately for each outcome by comparing scores for the current situation and after each cure scenario using linear mixed models for both PHIV and key populations (i.e., twelve in total). In both groups, we examined whether expected changes were influenced by age (young vs middle and young vs old), education, relationship status, migration background and among PHIV also by gender (male versus female), time since HIV diagnosis and sexual orientation. Therefore, we added each characteristic and their interaction with the cure scenario in separate models (i.e., 78 in total). Finally, we explored HIV cure preferences by examining percentages of participants who preferred PTC and elimination. Statistical analyses were performed with SPSS, version 27 40 . Results Participant characteristics A total of 892 participants started the survey. Of these, 717 participants – including 222 PHIV and 495 participants from key populations – completed at least section I (i.e., current situation) and section II (PTC) of the questionnaire and were included in the analyses ( Table 1 ). A total of 648 participants completed all three sections. Among PHIV, 91% identified as male, 60% were highly educated, and the mean time since HIV diagnosis was 13.6 years. Among participants from key populations, 97% identified as male and 78% were highly educated. Table 1. Participant characteristics. PHIV (n = 222) Key populations (n = 495) Gender (n (%)) Male 201 (91%) 480 (97%) Female 18 (8%) 3 (1%) Non-binary 3 (1%) 12 (2%) Age in years (n (%)) 18 – 34 years 30 (14%) 158 (32%) 35 – 54 years 111 (50%) 250 (51%) >= 55 years 81 (36%) 87 (18%) Education A (n (%)) Low-middle 89 (40%) 108 (22%) High 133 (60%) 385 (78%) Sexual orientation (n (%)) LGBTQIA+ 197 (89%) 489 (99%) Straight 25 (11%) 6 (1%) Relationship status B (n (%)) Single 126 (58%) 344 (70%) Relationship 91 (42%) 124 (25%) Migration background C (n (%)) Dutch 190 (86%) 410 (83%) Non-Dutch Time since diagnosis in years (m (SD)) 31 (14%) 13.6 (9.4) 82 (17%) Current PrEP use among key populations (n (%)) No 345 (71.5%) Yes 150 (30.3%) Key population (n (%)) D Man who has sex with men 286 (91.4%) Partner has HIV 25 (7.8%) Community (family member, or friend has HIV) 5 (1%) Sex worker 6 (2%) Paid for sex 8 2%) Injected drugs 8 (2.5%) Currently experienced (section I) (m (SD)) QoL 73.9 (18.2) 78.9 (14.7) Sexual satisfaction 43.1 (10.6) 43.5 (9.0) Stigma 7.4 (2.3) 7.5 (1.9) A The International Standard Classification of Education was used to categorize education. 37 Among key populations two missings were observed. B Five and 27 missings were observed among PHIV and key populations, respectively. C Among PHIV one participant and among key populations four participants did not indicate their country of birth. D Multiple answers were provided, percentages do not add up to 100%. PHIV = people with HIV; LGBTQIA+ = Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and “+”all of the other identities not included in the short acronym; QoL = quality of life. Current QoL, sexual satisfaction, and stigma Table 2 reports the associations between participant characteristics and current QoL, sexual satisfaction, and stigma. PHIV older than 55 years experienced higher QoL than PHIV between 18 and 34 years old. PHIV between 35 and 54 years old and older than 55 years experienced less stigma than PHIV aged 18 – 34 years. Among key populations, participants between 35 and 54 years old experienced higher QoL than key populations between 18 and 34 years. In addition, key populations between 35 and 54 years old and older than 55 years perceived less stigma towards PHIV than participants aged 18 – 34 years. Table 2. Differences in current QoL, sexual satisfaction, and stigma by participant characteristics. QoL B (95% CI) Sexual satisfaction B (95% CI) A Stigma B (95% CI) PHIV (n = 222) Gender (male vs. female (ref)) 0.40 (-0.08; 0.89) -0.66 (-1.24; -0.08) * -0.26 (-0.74; 0.22) Age (35 – 54 years vs. 18 – 34 years (ref)) 0.37 (-0.06; 0.80) 0.21 (-0.28; 0.70) -0.53 (-0.92; -0.13) * Age (>=55 years vs. 18 – 34 years (ref)) 0.22 (0.004; 0.43)* 0.17 (-0.04; 0.38) -0.37 (-0.57; -0.16) * Education (high vs. low-middle (ref)) 0.20 (-0.08; 0.47) 0.02 (-0.29; 0.33) 0.05 (-0.22; 0.32) Sexual orientation (LGBTQIA+ vs. straight (ref)) 0.39 (-0.03; 0.81) -0.45 (-0.94; 0.03) -0.17 (-0.59; 0.25) Relationship status (single vs. relationship (ref)) -0.28 (-0.55; -0.01) * -0.05 (-0.36; 0.27) -0.15 (-0.42; 0.12) Migration background (Dutch vs. non-Dutch (ref)) -0.16 (-0.55; 0.23) 0.14 (-0.31; 0.59) -0.60 (-0.97; -0.23)* Time since diagnosis (per year increase) 0.003 (-0.01; 0.02) -0.02 (-0.04; -0.002) * -0.03 (-0.04; -0.01) * Key populations (n = 495) Age (35 – 54 years vs. 18 – 34 years (ref)) 0.25 (0.05; 0.45) * -0.01 (-0.25; 0.24) -0.62 (-0.80; -0.43) * Age (>=55 years vs. 18 – 34 years (ref)) 0.11 (-0.03; 0.24) -0.11 (-0.26; 0.04) -0.41 (-0.54; -0.29) * Education (high vs. low-middle (ref)) 0.15 (-0.06; 0.37) 0.07 (-0.19; 0.32) -0.11 (-0.32; 0.10) Relationship status (single vs. relationship (ref)) -0.04 (-0.25; 0.16) -0.27 (-0.50; -0.04) * 0.23 (0.03; 0.44) Migration background (Dutch vs. non-Dutch (ref)) 0.14 (-0.10; 0.37) 0.17 (-0.11; 0.44) -0.04 (-0.27; 0.20) Scores for QoL, sexual satisfaction, and stigma were transformed to Z-scores. The results were obtained using a univariate linear regression analysis. * Indicates a significant result. QoL = Scores for QoL measured with the VAS. 22 Sexual satisfaction was measured using the N-SSSS. 23 Stigma was measured using the Berger stigma scale. 24 A Sexual satisfaction was only computed for participants with a sex partner in the past six months: PHIV n = 159, key populations n = 361. QoL = quality of life; CI = confidence interval; PHIV = people with HIV; LGBTQIA+ = Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and “+”all of the other identities not included in the short acronym; e. Note: Differences in the current QoL, sexual satisfaction and stigma for gender and sexual orientation for key populations are not shown due to the low number of female and straight participants in the sample. Expected change in life after hypothetical HIV cure: internalized stigma, mental health, social activities, physical health, and overall QoL We measured whether PTC or elimination would worsen, not affect, or improve participants’ internalized stigma, mental health, social activities, physical health, and overall QoL using the expected change for QoL items ( Figure 1 a–d ). Across domains, improvements were expected by 52% to 70% of PHIV for both cure scenarios. For both cure scenarios, the most improvement was expected for the overall QoL (range 63 - 70% of PHIV), while the least improvement was expected for social activities (range 37 - 42% of PHIV). For key populations, improvements across domains were expected by 31% to 69% of participants. For both cure scenarios, the most improvement was expected for internalized stigma (range 61 - 69 % of key populations), while the least improvement was expected for physical health (range 31 - 36% of key populations). Expected change after cure: QoL, sexual satisfaction, and stigma scales The expected changes in QoL, sexual satisfaction, and stigma between the current situation and after PTC and elimination are shown in z-scores in Figure 2 a–c . PHIV expected significantly improved QoL (PTC: 0.37, 95% CI: 0.27 to 0.47; elimination: 0.57, 95% CI: 0.46 to 0.68) and sexual satisfaction (PTC: 0.32, 95% CI: 0.22 to 0.42; elimination: 0.54, 95% CI: 0.40 to 0.68), and reduced stigma (PTC: -0.11, 95% CI: -0.20 to -0.02; elimination: -0.19, 95% CI: -0.30 to -0.08) after PTC and elimination compared to the current situation. Key populations also expected improvements for both HIV cure scenarios on sexual satisfaction (PTC: 0.34, 95% CI: 0.25 to 0.43; elimination: 0.46, 95% CI: 0.36 to 0.56) and stigma (PTC -0.28, 95% CI: -0.36 to -0.20; elimination -0.61, 95% CI: -0.69 to -0.53). For QoL, expected improvement was found after elimination (0.17, 95% CI: 0.12 to 0.22) but not after PTC (0.02, 95% CI: -0.03 to 0.07) ( Figure 2 d–f ). Role of participant characteristics on expected change after cure We investigated the effect of participant characteristics on the expected change in QoL, sexual satisfaction, and stigma after PTC and elimination compared to the current situation in both groups. Of these 78 linear mixed models, five models showed a significant effect of age ( Supplementary file A, Figures 3–6, 11 ). For the other characteristics, few models showed a significant effect: one model showed an effect of gender, two models showed an effect of migration background, and one model showed an effect of relationship status on expected change ( Supplementary file A , figures 7–10). Models with an age effect showed that PHIV between 18 and 34 years expected more improvement in QoL and sexual satisfaction than PHIV aged 55 years and older after elimination. This group also expected a larger reduction in HIV-related stigma after both PTC and elimination ( Supplementary file A , Figures 3 – 6 ). For QoL and stigma, current differences between young and older PHIV were expected to become smaller, but for sexual satisfaction the current difference between young and older PHIV was expected to become larger. Participants between 18 – 34 years from key populations expected a larger reduction in HIV-related stigma after elimination than older people, resulting in a smaller difference between age groups after cure ( Supplementary file A , Figure 11 ). Preference of PTC versus elimination Finally, we assessed the preference of participants regarding PTC or elimination. Seventy-one percent of participants from PHIV and 88% of participants from key populations preferred elimination over PTC. Discussion To the best of our knowledge, this is the first study to quantitatively explore the expected impact of HIV cure scenarios on QoL, sexual satisfaction, and stigma, separately among PHIV and key populations. PHIV expected that both PTC and elimination would positively affect their QoL and sexual satisfaction, and would also reduce stigma. Similarly, key populations expected a positive impact following both scenarios, with the exception of no improvement in QoL following PTC. Similarly, many participants, both PHIV and key populations, expected positive changes in internalized stigma, mental health, social activities, physical health, and overall QoL. Additionally, the expected change in QoL, sexual satisfaction, and stigma resulting from an HIV cure varied by age. In general, participants expected improvement following a hypothetical cure for HIV on many domains, including internalized stigma, mental health, social activities, physical health, QoL, and sexual satisfaction. This expected positive impact on important domains aligns with findings regarding HIV elimination from qualitative research conducted among both PHIV and key populations 2,8,11,12,16,41–45 . However, regarding PTC, previous qualitative work from the Netherlands and Australia showed that PHIV and key populations did not consider PTC a cure for HIV as it would not alleviate burdens associated with HIV, such as worries about transmission and stigma 2,16 . Current state-of-the-art research indicates that long-term control of the viral reservoir, akin to PTC, is more likely than complete HIV elimination to become widely available 8,11,13,30–36 . Remarkably, our findings suggested a significant improvement not only for HIV elimination but also for the more achievable PTC curative strategy. We hypothesize that the expected impact of a cure for HIV may vary based on the characteristics of a cure, such as, viral rebound. In our PTC vignette, post-cure monitoring was added, and it was not possible to transfer HIV and monitoring was added. Potential cures for HIV may have characteristics that require more vigilance for PHIV, their partners, and communities which may influence QoL, sexual satisfaction, and stigma. We detected several age-related effects in this study. Firstly, among both PHIV and key populations, we found that older participants reported currently experiencing less stigma and higher QoL compared to their younger counterparts. The positive current outlook on QoL and stigma among older participants may be attributed to their general optimism and hope regarding a potential cure for HIV in the future 2,46 . While optimism is considered a personality trait, it can also be cultivated over time 46 . Additionally, the accumulated experience of life with HIV over the years may contribute to the more positive outlook among older PHIV regarding their current experiences related to QoL, sexual satisfaction, and stigma 47 . Older PHIV and key populations in our study may have experienced the burden of HIV before ART, which includes fear of HIV acquisition or transmission, the necessity of extensive medication, and associated side effects. Comparing their current situation with the past may have led to a more favorable perception of their present circumstances 6,12,48 . Furthermore, older PHIV and key populations may be more accustomed to life with HIV compared to younger participants, who have not experienced the HIV epidemic of the ‘80s and ‘90s firsthand 6,12,49 . Secondly, among both PHIV and key populations we identified several indications suggesting that participants between the ages of 18 and 34 expected greater improvements in QoL, sexual satisfaction, and more reduction in stigma following either PTC or HIV elimination compared to older participants. Smaller differences were ascertained in expected QoL, sexual satisfaction, and stigma between age groups after cure. These indications of greater expected improvement among participants aged 18 to 34 years may stem from an overestimation of the current influence of HIV on QoL, sexual satisfaction, and stigma. This hypothesis is supported by studies 49–55 that have demonstrated an overestimation of the consequences of HIV on QoL and stigma, as well as the perceived severity of living with HIV compared to the actual experiences of PHIV. Strengths and limitations This study is one of the first to quantitatively evaluate the potential impact of two hypothetical HIV cure scenarios in both PHIV and key populations. However, there are several limitations to consider. Firstly, the results are based on a context where biomedical interventions for HIV, such as ART and pre-exposure prophylaxis, are widely accessible. PHIV and key populations in our study reported high QoL scores and low levels of public stigma. Contextual differences may influence the perceived impact observed in our study. We recommend exploring the impact of an HIV cure in different geographical and cultural settings and on marginalized populations 2,16–19,21 . Secondly, our samples of PHIV and key populations, which were recruited through convenience sampling, may not be fully representative for all affected populations in the Netherlands. Our sample of PHIV was compared to the Dutch HIV Monitoring Report data 1,56 , showing similar age and time since diagnosis distributions: 50% aged 35–54 years and 36% over 55, with 60% diagnosed over 10 years ago in the Dutch population of PHIV. However, our sample had a higher proportion of individuals with a migration background (14% vs. 10%) and a lower proportion of women (8% vs. 19%) compared to the general PHIV population in the Netherlands 1 . In addition, our samples of PHIV and key populations, included mainly highly educated MSM. 1,53,57–59 . More research is needed to explore the impact of HIV cure strategies across diverse populations, such as women and straight PHIV, both with and without a migration background, as well as populations with low socioeconomic positions. Thirdly, our study may have attracted participants who are more hopeful about an HIV cure, potentially biasing the expected positive changes reported. However, existing research suggests that individuals with other chronic conditions often experience feelings of hopelessness, stress, fatigue, and despair 60–63 . Finally, due to numerous statistical tests, we focused on overall patterns rather than individual significant findings. We advise caution when interpreting single significant findings related to gender, migration background, and relationship status. Conclusion In conclusion, both PHIV and key populations generally expected a positive impact on QoL, sexual satisfaction, and stigma following either HIV PTC or elimination. Considering our current knowledge of HIV cure research, the development of an effective PTC scenario on a global scale appears much more feasible than achieving true elimination. Our data provide reassurance that people with and without HIV would nonetheless expect significant benefits from PTC, including a reduction in experienced stigma. Nevertheless, we believe further research is needed to explore the perceived impact of the characteristics of a PTC, such as viral rebound or continued monitoring, among PHIV, their sexual partners and other key populations. Declarations Author declaration statement The institution of M. F. Schim van der Loeff received study funding from GSK; he served on advisory boards of GSK and Merck. P.Reiss through his institution has received grant support from Gilead Sciences, ViiV Healthcare and Merck & Co. Ganna Rozhnova is an editorial board member of Communications Medicine . The other authors have no competing interests to disclose. Author contributions K.A.G.J.R: Conceptualization; Data collection; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Supervision; Validation; Writing - original draft; Writing - review & editing. F.R.G.: Data collection; Data curation; Writing - review & editing. A.M.: Data collection; Writing – review & editing. M.L.V.: Resources; Writing – review & editing. M.D.: Resources; Writing – review & editing. P.R.: Investigation; Resources; Writing - review & editing. M.E.K.: Data curation, Writing - review & editing. P.N.: Formal analysis; Methodology; Writing - review & editing. M.S.v.d.L.: Methodology; Writing - review & editing. M.B.: Conceptualization; Funding acquisition; Formal analysis; Methodology; Supervision; Writing - review & editing. G.R.: Conceptualization; Funding acquisition; Supervision; Investigation; Project administration; Resources; Writing - review & editing. Acknowledgement We gratefully acknowledge the participants who were willing to share their experiences with us. In addition, we are thankful for their valuable contribution to our recruitment to all staff of the Amsterdam Cohort Studies, the AGEhIV Cohort Study, the infectious diseases outpatient clinic of the University Medical Center Utrecht, Bertus Tempert and Renee Finkelflügel from the Dutch HIV Association. We gratefully acknowledge Gail Henderson, Holly Peay, Stuart Rennie, and Fred Verdult for their involvement during the initial stages of this study. The authors gratefully thank Peter Zuithoff for his expert statistical consultations on linear mixed models. Finally, we thank our collaborators on the Aidsfonds project P-52901 (Daniela Bezemer, Godelieve de Bree, Janneke Heijne, Sebastiaan Verboeket, Udi Davidovich, Sigrid Vervoort, Berend van Welzen, and Ard van Sighem) for helpful discussions. The authors gratefully acknowledge funding by the Aidsfonds Netherlands, grant number P-52901. Funding The authors gratefully acknowledge funding by the Aidsfonds Netherlands, grant number P-52901. Ethical approval The study was approved by the ethics committee of the University Medical Center Utrecht (UMCU): 20-546/C. Data availability statement Only the authors have access to the raw data quoted in this study due to confidentiality. Any reasonable request for access to material relating to the study can be made directly to the corresponding author, who will decide on information sharing on a case-by-case basis. Code availability Any reasonable request for access to SPSS syntaxes relating to the study can be made directly to the corresponding author, who will decide on information sharing on a case-by-case basis. References 1 van Sighem A.I. et al. HIV Monitoring Report 2022. Human Immunodeficiency Virus (HIV) Infection in the Netherlands., (Stichting hiv monitoring, Amsterdam, 2022). 2 Romijnders, K. et al. The perceived impact of an HIV cure by people living with HIV and key populations vulnerable to HIV in the Netherlands: A qualitative study. J Virus Erad 8 , 100066 (2022). https://doi.org/10.1016/j.jve.2022.100066 3 Noorman, M. A. J. et al. 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Enhancing meaningful involvement of people living with HIV and affected communities in HIV cure-focused science. J Virus Erad 6 , 100018 (2020). https://doi.org/10.1016/j.jve.2020.100018 36 Noorman, M. A. J. et al. The Importance of Social Engagement in the Development of an HIV Cure: A Systematic Review of Stakeholder Perspectives. AIDS Behav 27 , 3789-3812 (2023). https://doi.org/10.1007/s10461-023-04095-z 37 Centraal Bureau voor Statistiek (CBS). [International Standard Classification of Education (ISCED)]. 39 (Centraal Bureau voor Statistiek (CBS), Heerlen, 2018). 38 Mark, K. P., Herbenick, D., Fortenberry, J. D., Sanders, S. & Reece, M. A Psychometric Comparison of Three Scales and a Single-Item Measure to Assess Sexual Satisfaction. The Journal of Sex Research 51 , 159-169 (2014). https://doi.org/10.1080/00224499.2013.816261 39 Reinius, M. et al. Development of a 12-item short version of the HIV stigma scale. 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Enduring stigma and precarity: A review of qualitative research examining the experiences of women living with HIV in high income countries over two decades. Health Care Women Int 43 , 313-344 (2022). https://doi.org/10.1080/07399332.2021.1959589 49 Zimmermann, H. M. L. et al. The Burden of Living With HIV is Mostly Overestimated by HIV-Negative and Never-Tested Men Who Have Sex With Men. AIDS Behav 25 , 3804-3813 (2021). https://doi.org/10.1007/s10461-021-03281-1 50 Flint, A., Gunsche, M. & Burns, M. We Are Still Here: Living with HIV in the UK. Med Anthropol 42 , 35-47 (2023). https://doi.org/10.1080/01459740.2022.2139182 51 Namisi, C. P. et al. Stigma mastery in people living with HIV: gender similarities and theory. Z Gesundh Wiss 30 , 2883-2897 (2022). https://doi.org/10.1007/s10389-021-01480-7 52 Sarma, P., Cassidy, R., Corlett, S. & Katusiime, B. Ageing with HIV: Medicine Optimisation Challenges and Support Needs for Older People Living with HIV: A Systematic Review. Drugs Aging 40 , 179-240 (2023). https://doi.org/10.1007/s40266-022-01003-3 53 Stutterheim, S. E., Kuijpers, K. J. R., Waldén, M. I., Finkenflügel, R. N. N., Brokx, P. A. R., & Bos, A. Trends in HIV Stigma Experienced by People Living with HIV in the Netherlands: A Comparison of Cross‐Sectional Surveys Over Time. (2021). 54 Vaughan, E., Power, M. & Sixsmith, J. Experiences of stigma in healthcare settings by people living with HIV in Ireland: a qualitative study. AIDS Care 32 , 1162-1167 (2020). https://doi.org/10.1080/09540121.2020.1781761 55 Mahajan, A. P. et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS (London, England) 22 Suppl 2 , S67-S79 (2008). https://doi.org/10.1097/01.aids.0000327438.13291.62 56 Sighem, A. I. et al. Monitoring Report 2019., (Stichting HIV Monitoring, Amsterdam, 2019). 57 Stichting hiv monitoring. Jaarverslag 2023. (Stichting hiv monitoring, 2024). 58 Stutterheim, S. E., Bos, A. E. & Schaalma, H. P. HIV-related stigma in the Netherlands . (Aids Fonds, 2008). 59 Centraal Bureau voor Statistiek (CBS). [Society: numbers of level of education] , (2018). 60 Coyle, L. A. & Atkinson, S. Imagined futures in living with multiple conditions: Positivity, relationality and hopelessness. Soc Sci Med 198 , 53-60 (2018). https://doi.org/10.1016/j.socscimed.2017.12.022 61 Duggleby, W., Lee, H., Nekolaichuk, C. & Fitzpatrick-Lewis, D. Systematic review of factors associated with hope in family carers of persons living with chronic illness. Journal of Advanced Nursing n/a https://doi.org/https://doi.org/10.1111/jan.14858 62 Hirsch, J. K. & Sirois, F. M. Hope and fatigue in chronic illness: The role of perceived stress. J Health Psychol 21 , 451-456 (2016). https://doi.org/10.1177/1359105314527142 63 Kylma, J., Vehvilainen-Julkunen, K. & Lahdevirta, J. Hope, despair and hopelessness in living with HIV/AIDS: a grounded theory study. J Adv Nurs 33 , 764-775 (2001). https://doi.org/10.1046/j.1365-2648.2001.01712.x Additional Declarations Yes there is potential Competing Interest. The institution of M. F. Schim van der Loeff received study funding from GSK; he served on advisory boards of GSK and Merck. P.Reiss through his institution has received grant support from Gilead Sciences, ViiV Healthcare and Merck & Co. Ganna Rozhnova is an editorial board member of Communications Medicine. The other authors have no competing interests to disclose. Supplementary Files CommunicationsMedicine23April2024supplementaryfileA.pdf Cite Share Download PDF Status: Published Journal Publication published 03 May, 2025 Read the published version in Communications Medicine → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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stigma, mental health, social activities, physical health, and QoL after PTC or elimination. Panels a – b show the expected change among PHIV for PTC and elimination. Panels c – d show the expected change among key populations for PTC and elimination. PTC = post-treatment control. QoL = quality of life. Y-axes represent the following questions answered by participants: Internalized stigma: How would the degree to which you experience internalized stigma due to HIV change? Mental health: How would your mental health change? Social activities: How do you think that your social activities would change? Physical health: How would your general physical health change? QoL: How would your QoL change?\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4311908/v1/53e5f9ccbe68f1f374571206.png"},{"id":69848461,"identity":"672b5d99-f76e-4bd1-9a82-8b78111f02e1","added_by":"auto","created_at":"2024-11-25 21:22:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":63029,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eExpected change after cure: QoL, sexual satisfaction, and stigma scales. \u003c/strong\u003eY-axes represented the transformed Z scores of QoL, sexual satisfaction, and stigma scales. \u003csup\u003e*\u003c/sup\u003eAll mean scores are transformed to Z scores to enable interpretation of expected change. Scores for current QoL, sexual satisfaction, and stigma differ slightly due to respondents who did not fully complete the survey (i.e., only completed section I and II). Panels a-c show the expected change among PHIV for PTC and elimination. Panels d-f show the expected change among key populations for PTC and elimination. Error bars represent confidence intervals. QoL = Quality of life; PTC = post-treatment control; VAS = visual analogue scale; N-SSSS = New Scale of Sexual Satisfaction; HSS = Berger stigma subscale: concerns with public attitudes towards PHIV.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4311908/v1/8dab5bddb9186522f5f5265f.png"},{"id":81898202,"identity":"3302771a-d9e7-41fd-8a69-9a228f0bc699","added_by":"auto","created_at":"2025-05-04 07:06:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1498574,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4311908/v1/8c39fa47-a6b3-4a6e-97cb-2a7575aede68.pdf"},{"id":69848462,"identity":"490d4517-2080-4d7c-8713-60e31ab66609","added_by":"auto","created_at":"2024-11-25 21:22:01","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":334612,"visible":true,"origin":"","legend":"","description":"","filename":"CommunicationsMedicine23April2024supplementaryfileA.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4311908/v1/e14400aa8d64cf925d365455.pdf"}],"financialInterests":"\u003cb\u003eYes\u003c/b\u003e there is potential Competing Interest.\nThe institution of M. F. Schim van der Loeff received study funding from GSK; he served on advisory boards of GSK and Merck. P.Reiss through his institution has received grant support from Gilead Sciences, ViiV Healthcare and Merck \u0026 Co. Ganna Rozhnova is an editorial board member of Communications Medicine. The other authors have no competing interests to disclose.","formattedTitle":"\u003cp\u003eThe Expected Impact of HIV Post-Treatment Control and HIV Elimination on Quality of Life, Sexual Satisfaction, and Stigma Among People With HIV and Key Populations\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAntiretroviral therapy (ART) has\u0026nbsp;transformed\u0026nbsp;the outlook of HIV from a fatal to a manageable chronic disease\u0026nbsp;\u003csup\u003e1\u003c/sup\u003e.\u0026nbsp;Despite these advancements, HIV continues to significantly\u0026nbsp;impact the quality of life (QoL), sexual satisfaction, and stigma experienced by\u0026nbsp;people with HIV (PHIV) and key populations\u0026nbsp;(e.g., partners of PHIV, family members, friends and other contacts, and MSM without HIV)\u003csup\u003e2,3\u003c/sup\u003e.\u0026nbsp;Part of this impact stems from\u0026nbsp;the lifelong dependency on ART\u003csup\u003e2,4\u003c/sup\u003e,\u0026nbsp;which has been\u0026nbsp;reported to result in\u0026nbsp;emotional and physical distress,\u0026nbsp;potentially diminishing\u0026nbsp;QoL\u0026nbsp;\u003csup\u003e2,4\u003c/sup\u003e.\u0026nbsp;\u0026nbsp;In the Netherlands, both PHIV and key populations are reported to experience lower QoL compared to\u0026nbsp;the general Dutch population\u0026nbsp;\u003csup\u003e5\u003c/sup\u003e.\u0026nbsp;Additionally, PHIV may endure\u0026nbsp;ongoing\u0026nbsp;burdens\u0026nbsp;post-diagnosis,\u0026nbsp;including\u0026nbsp;HIV-related stigmatization, feelings of guilt,\u0026nbsp;challenges related to\u0026nbsp;disclosing\u0026nbsp;their\u0026nbsp;HIV\u0026nbsp;status, and negative impacts\u0026nbsp;on interpersonal\u0026nbsp;relationships\u0026nbsp;\u003csup\u003e5\u003c/sup\u003e.\u0026nbsp;These\u0026nbsp;burdens\u0026nbsp;are\u0026nbsp;found to persist over time\u0026nbsp;\u003csup\u003e2,6\u003c/sup\u003e.\u0026nbsp;Among key populations, there is still substantial fear of HIV acquisition and experienced stigma related to\u0026nbsp;sexual behavior\u0026nbsp;\u003csup\u003e7\u003c/sup\u003e.\u0026nbsp;These negative experiences among PHIV and\u0026nbsp;key populations\u0026nbsp;underscore\u0026nbsp;the\u0026nbsp;urgent\u0026nbsp;need for\u0026nbsp;improved biomedical interventions for HIV, including\u0026nbsp;the development of\u0026nbsp;a cure\u0026nbsp;\u003csup\u003e2,8\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere appear to be seven confirmed cases of HIV cure \u003csup\u003e9,10\u003c/sup\u003e. While, a scalable HIV cure remains hypothetical, it may have the potential to improve experienced QoL, sexual satisfaction, and reduce stigma among both PHIV and key populations \u003csup\u003e2,11,12\u003c/sup\u003e. In line with the HIV cure target product profile, both PTC and HIV elimination may be considered curative interventions, each with distinct characteristics \u003csup\u003e8,13\u003c/sup\u003e. Previous research regarding an HIV cure primarily focused on the willingness of PHIV to participate in HIV cure trials \u003csup\u003e14\u003c/sup\u003e or qualitatively explored the expected impact of HIV cure on the lives of PHIV and key populations \u003csup\u003e2\u003c/sup\u003e. Firstly, qualitative research indicated that only a cure that completely eliminates HIV from the body was deemed a true cure \u003csup\u003e2,15,16\u003c/sup\u003e. Indeed, qualitative research conducted in Australia reported that PTC was not considered a cure for HIV because it would not alleviate worry about transmission, concerns for friends and family, stigma \u003csup\u003e16\u003c/sup\u003e. \u0026nbsp;Secondly, it demonstrated that PHIV and key populations in the Netherlands perceived the ultimate impact of a cure for HIV to be the normalization of life \u003csup\u003e2,16\u003c/sup\u003e. Improvement was expected on three main themes: PHIV and key populations were hopeful that HIV cure would lead to improved QoL, sexual liberation and improved sexual satisfaction, and would reduce HIV-related stigma\u003csup\u003e2\u003c/sup\u003e. In contrast, qualitative research in other context and geographical settings implied that stigma towards marginalized groups may increase following HIV cure \u003csup\u003e17,18\u003c/sup\u003e. Finally, previous qualitative research indicated that prioritizing research to understand the potential impact of \u0026nbsp;HIV cure strategies on the partners of PHIV, communities, and those vulnerable to HIV in general, such as MSM, contributes to implementation and dissemination of science and meaningful involvement of all those affected by HIV \u003csup\u003e12,19-21\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eWhile qualitative research suggests\u0026nbsp;the potential positive impact of an HIV cure on three main themes: general QoL\u003csup\u003e22\u003c/sup\u003e, sexual satisfaction \u003csup\u003e23\u003c/sup\u003e, and stigma\u0026nbsp;\u003csup\u003e24\u003c/sup\u003e,\u0026nbsp;for PHIV and key populations, it remains\u0026nbsp;unclear whether this\u0026nbsp;expectation of\u0026nbsp;a potential\u0026nbsp;impact is widely supported among these populations.\u0026nbsp;To the best of our knowledge, the potential impact of an HIV\u0026nbsp;cure\u0026nbsp;on these dimensions has not been explored quantitatively. Our study uses a cross-sectional survey to quantify\u0026nbsp;the expected impact of two different hypothetical\u0026nbsp;HIV cure scenarios\u0026nbsp;\u0026ndash; HIV post-treatment control (PTC) and HIV elimination\u0026nbsp;\u0026ndash;\u0026nbsp;on QoL, sexual satisfaction, and stigma among\u0026nbsp;PHIV and\u0026nbsp;key populations\u0026nbsp;in the Netherlands.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study involved a cross-sectional\u0026nbsp;survey exploring the expected impact of two HIV cure scenarios on the QoL, sexual satisfaction, and stigma among PHIV and key populations vulnerable to HIV in the Netherlands. In our study, key populations were partners of PHIV, family members, friends and other contacts, and MSM without HIV\u0026nbsp;\u003csup\u003e2,3\u003c/sup\u003e. Participants were eligible if they were Dutch or English-speaking, 18 years or older, living with HIV or belonging to key populations, and provided informed consent. The study was approved by the ethics committee of the University Medical Center Utrecht (UMC Utrecht): 20-546/C.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eRecruitment\u003c/h2\u003e\n\u003cp\u003eParticipants were recruited between October 2021 and June 2022 from the Amsterdam Cohort Studies (ACS)\u0026nbsp;\u003csup\u003e25\u003c/sup\u003e, the AGEhIV Cohort Study\u0026nbsp;\u003csup\u003e26\u003c/sup\u003e, the infectious diseases outpatient clinic of the UMC Utrecht, the Dutch HIV Association\u0026nbsp;\u003csup\u003e27\u003c/sup\u003e, Stichting ShivA\u0026nbsp;\u003csup\u003e28\u003c/sup\u003e, Grindr\u0026nbsp;\u003csup\u003e29\u003c/sup\u003e, and the Public Health Services of Amsterdam, Rotterdam, Zuid-Limburg, Groningen, Utrecht, Gelderland-East, and Brabant-South East. Based on sample size calculations, we aimed to include between 700 and 1000 participants to draw conclusions about a mean difference of 3 points in QoL as assessed on the visual analogue scale (VAS) of the EQ-5D (scores ranging from 0 to 100) before and after HIV cure (SD \u0026lt; 20, confidence level = 95%, power = 80%).\u003c/p\u003e\n\u003ch2\u003eQuestionnaire\u003c/h2\u003e\n\u003cp\u003eData were collected using REDCap electronic data capture tools hosted at the UMC Utrecht and the ACS\u0026nbsp;\u003csup\u003e25\u003c/sup\u003e. Tailoring was used to ensure participants were only shown questions relevant to them. All items were asked three times, unless otherwise stated, to assess a participant\u0026rsquo;s current QoL, sexual satisfaction, stigma, and demographic characteristics (section I), expected QoL, sexual satisfaction, and stigma after PTC (section II), and expected QoL, sexual satisfaction, and stigma after elimination (section III). Participants who completed only section I or completed the survey in an unrealistically short time (\u0026lt; 5 min per section: PHIV n = 1; key populations n = 1) were excluded from the analyses.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eA cure for HIV\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eVignettes were used to present two hypothetical HIV cure scenarios: PTC and elimination. These vignettes were previously developed and tested for coherence and comprehensibility in a qualitative study involving 42 participants, which contains a complete description of the scenarios\u0026nbsp;\u003csup\u003e2\u003c/sup\u003e. PTC entails the long-term suppression of HIV by the immune system without the necessity for ongoing HIV medication. However, in the event of PTC failure, HIV rebound may occur. HIV elimination refers to a scenario in which HIV, including its reservoir, is eliminated from the body. Following successful HIV removal, ongoing HIV medication is no longer required, but the possibility of reinfection remains. For each vignette, participants were asked about their QoL, sexual satisfaction, and stigma if the cure was available. Subsequently, participants were asked to express their preferences between PTC and elimination at the conclusion of the questionnaire (Q: You now read both descriptions of cure scenarios. Which of the treatment options would you prefer?). Additionally, research indicates that a scenario such as PTC, is more likely than complete HIV elimination\u0026nbsp;\u003csup\u003e8,11,13,30-36\u003c/sup\u003e. This indicates that PHIV and key populations will not have a choice between PTC or HIV elimination as a new treatment option, and thus, participants of our survey were not offered a choice or comparison between cure scenarios. To accommodate the current state-of-the-art research on HIV cure, no comparisons were made in our analyses in QoL, sexual satisfaction, and stigma between PTC and HIV elimination.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eParticipant characteristics\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThe following characteristics were included: gender (male, female, and non-binary), age (categorized into 18 \u0026ndash; 34 years, 35 \u0026ndash; 54 years, and \u0026gt;= 55 years), level of education (categorized into low\u0026ndash;middle and high\u0026nbsp;\u003csup\u003e37\u003c/sup\u003e), sexual orientation (LGBTQIA+ and straight), relationship status (single and in a relationship), migration background (Dutch and non-Dutch), HIV status (PHIV and key populations without HIV), and, if applicable, time since HIV diagnosis (in years).\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eChanges in life after hypothetical HIV cure\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eBased on themes explored during thematic analyses of qualitative interviews, we included five questions to directly assess the expected change in life after hypothetical HIV cure for internalized stigma, mental health, social activities, physical health, and overall QoL after PTC (section II) and elimination (section III)\u0026nbsp;\u003csup\u003e2\u003c/sup\u003e. Changes in life were assessed using a 5-point Likert scale ranging from much worse (1) to much better (5) (e.g., \u0026ldquo;How would your quality-of-life change?\u0026rdquo;). Response on each item was categorized into worse (scores 1 \u0026ndash; 2), equal (score 3), or improved (scores 4-5).\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eQoL\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eQoL was defined in our qualitative work as the perception of a position in life in relation to goals and expectations\u0026nbsp;\u003csup\u003e2\u003c/sup\u003e. Participants were asked to rate their current QoL and QoL if the cure was available using the VAS of the EQ-5D.\u003csup\u003e22\u003c/sup\u003e The VAS measures general QoL ranging from the worst imaginable health (0) to the best imaginable health (100) the participant could imagine.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eSexual satisfaction\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eSexual satisfaction was conceptualized through individual, interpersonal, and behavioral lenses, focusing respectively on personal satisfaction, partner interactions, and specific behaviors contributing to satisfaction\u0026nbsp;\u003csup\u003e38\u003c/sup\u003e. Sexual satisfaction was assessed using the short version of the New Scale of Sexual Satisfaction (N-SSSS)\u003csup\u003e23\u003c/sup\u003e on a five-point Likert scale ranging from not at all satisfied (1) to extremely satisfied (5). The sum of the scores was computed for participants who had a sex partner in the past six months (scores ranged 12 \u0026ndash; 60)\u0026nbsp;\u003csup\u003e23\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eHIV-related stigma\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eHIV-related stigma, as perceived by people with HIV, encompasses negative attitudes, beliefs, and actions from others, as well as internalized feelings of shame and fear of disclosure. In this study, we focus on the public attitudes domain, which involves societal views and misconceptions about people living with HIV, significantly impacting their social interactions and quality of life\u0026nbsp;\u003csup\u003e24,39\u003c/sup\u003e. To assess HIV-related stigma for the current situation (section I), we used the concerns with public attitudes towards PHIV subscale of the short version of the Berger HIV Stigma Scale (HSS)\u0026nbsp;\u003csup\u003e24\u003c/sup\u003e. Scores ranged from strongly disagree (1) to strongly agree (4). The subscale was used in sections I, II and III (scores ranged from 4 \u0026ndash; 16).\u003c/p\u003e\n\u003ch2\u003eData analyses\u003c/h2\u003e\n\u003cp\u003eQoL, sexual satisfaction, and stigma scales were transformed to Z-scores. Descriptive statistics were used to describe demographic characteristics, current QoL, sexual satisfaction, and stigma in our study population. Analyses were performed separately for PHIV and key populations. Missing values were not imputed. We examined whether gender, age, time since HIV diagnosis, relationship status, and migration background were associated with QoL, sexual satisfaction, and stigma, using univariable linear regression analyses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo examine the expected impact of each cure scenario we used several methods. First, we examined the percentage of participants who expected their QoL to improve, remain the same, or worsen after each cure scenario on the internalized stigma, mental health, social activities, physical health, and overall QoL-items. Second, the expected change in QoL, sexual satisfaction, and stigma after PTC and elimination were examined\u0026nbsp;separately for each outcome by comparing scores for the current situation and after each cure scenario using linear mixed models for both PHIV and key populations (i.e., twelve in total). In both groups, we examined whether expected changes were influenced by age (young vs middle and young vs old), education, relationship status, migration background and among PHIV also by gender (male versus female), time since HIV diagnosis and sexual orientation. Therefore, we added each characteristic and their interaction with the cure scenario in separate models (i.e., 78 in total). Finally, we explored HIV cure preferences by examining percentages of participants who preferred PTC and elimination. Statistical analyses were performed with SPSS, version 27\u0026nbsp;\u003csup\u003e40\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eParticipant characteristics\u003c/h2\u003e\n\u003cp\u003eA total of 892 participants started the survey. Of these, 717 participants \u0026ndash; including 222 PHIV and 495 participants from key populations \u0026ndash; completed at least section I (i.e., current situation) and section II (PTC) of the questionnaire and were included in the analyses (\u003cstrong\u003eTable 1\u003c/strong\u003e). A total of 648 participants completed all three sections. Among PHIV, 91% identified as male, 60% were highly educated, and the mean time since HIV diagnosis was 13.6 years. Among participants from key populations, 97% identified as male and 78% were highly educated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style=\"font-family:Arial;\"\u003eTable 1. Participant characteristics.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse: collapse;border: none;width: 100%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 27.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:23.42%;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:27.9pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003ePHIV (n = 222)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:26.64%;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:27.9pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eKey populations (n = 495)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;border: none;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eGender (n (%))\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;border: none;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;border: none;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eMale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e201 (91%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e480 (97%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eFemale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e18 (8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e3 (1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eNon-binary\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e3 (1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e12 (2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eAge in years (n (%))\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e18 \u0026ndash; 34 years\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;color:black;\"\u003e30 (14%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;color:black;\"\u003e158 (32%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e35 \u0026ndash; 54 years\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;color:black;\"\u003e111 (50%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;color:black;\"\u003e250 (51%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026gt;= 55 years\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;color:black;\"\u003e81 (36%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;color:black;\"\u003e87 (18%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eEducation \u003csup\u003eA\u0026nbsp;\u003c/sup\u003e(n (%))\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eLow-middle\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e89 (40%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e108 (22%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eHigh\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e133 (60%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e385 (78%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eSexual orientation (n (%))\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eLGBTQIA+\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e197 (89%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e489 (99%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eStraight\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e25 (11%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e6 (1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eRelationship status \u003csup\u003eB\u003c/sup\u003e (n (%))\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eSingle\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e126 (58%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e344 (70%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eRelationship\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e91 (42%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e124 (25%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eMigration background \u003csup\u003eC\u0026nbsp;\u003c/sup\u003e(n (%))\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eDutch\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e190 (86%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e410 (83%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eNon-Dutch\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eTime since diagnosis in years (m (SD))\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e31 (14%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;color:black;\"\u003e13.6 (9.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e82 (17%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eCurrent PrEP use among key populations (n (%))\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:35.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eNo\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e345 (71.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:35.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e150 (30.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eKey population (n (%)) \u003csup\u003eD\u003c/sup\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:35.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eMan who has sex with men\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e286 (91.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:35.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003ePartner has HIV\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e25 (7.8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:35.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eCommunity (family member, or friend has HIV)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e5 (1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:35.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eSex worker\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e6 (2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:35.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003ePaid for sex\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e8 2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:35.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eInjected drugs\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e8 (2.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003eCurrently experienced (section I) (m (SD))\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:35.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eQoL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e73.9 (18.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e78.9 (14.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:35.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eSexual satisfaction\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e43.1 (10.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e43.5 (9.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.94%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:35.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eStigma\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.42%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e7.4 (2.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.64%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e7.5 (1.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003eA\u0026nbsp;\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-size:11px;font-family:Calibri;\"\u003eThe International Standard Classification of Education was used to categorize education.\u003c/span\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003e\u003csup\u003e37\u003c/sup\u003e\u003c/span\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003e\u0026nbsp;Among key populations two missings were observed.\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003eB\u0026nbsp;\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-size:11px;font-family:Calibri;\"\u003eFive and 27 missings were observed among PHIV and key populations, respectively.\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003eC\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-size:11px;font-family:Calibri;\"\u003e\u0026nbsp;Among PHIV one participant and among key populations four participants did not indicate their country of birth.\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003eD\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-size:11px;font-family:Calibri;\"\u003e\u0026nbsp;Multiple answers were provided, percentages do not add up to 100%.\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003ePHIV = people with HIV; LGBTQIA+ = Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and \u0026ldquo;+\u0026rdquo;all of the other identities not included in the short acronym; QoL = quality of life.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch2\u003eCurrent QoL, sexual satisfaction, and stigma \u0026nbsp;\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e reports the associations between participant characteristics and current QoL, sexual satisfaction, and stigma. PHIV older than 55 years experienced higher QoL than PHIV between 18 and 34 years old. PHIV between 35 and 54 years old and older than 55 years experienced less stigma than PHIV aged 18 \u0026ndash; 34 years. Among key populations, participants between 35 and 54 years old experienced higher QoL than key populations between 18 and 34 years. In addition, key populations between 35 and 54 years old and older than 55 years perceived less stigma towards PHIV than participants aged 18 \u0026ndash; 34 years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-family:Calibri;\"\u003eTable 2. Differences in current QoL, sexual satisfaction, and stigma by participant characteristics.\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width:100.0%;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 2.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:21.88%;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:2.85pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eQoL\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eB (95% CI)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:25.0%;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:2.85pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eSexual satisfaction\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eB (95% CI)\u003csup\u003eA\u003c/sup\u003e\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:20.3%;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:2.85pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eStigma\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eB (95% CI)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width:100.0%;border:none;border-bottom: solid windowtext 1.0pt;padding: 0in 5.4pt 0in 5.4pt;height:16.6pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003ePHIV (n = 222)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eGender (male vs. female (ref))\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e0.40 (-0.08; 0.89)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Arial;color:black;\"\u003e-0.66 (-1.24; -0.08)\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e-0.26 (-0.74; 0.22)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eAge (35 \u0026ndash; 54 years vs. 18 \u0026ndash; 34 years (ref))\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e0.37 (-0.06; 0.80)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;color:black;\"\u003e0.21 (-0.28; 0.70)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;font-family:Arial;\"\u003e-0.53 (-0.92; -0.13)\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eAge (\u0026gt;=55 years vs. 18 \u0026ndash; 34 years (ref))\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e0.22 (0.004; 0.43)*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;color:black;\"\u003e0.17 (-0.04; 0.38)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;font-family:Arial;\"\u003e-0.37 (-0.57; -0.16)\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eEducation (high vs. low-middle (ref))\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e0.20 (-0.08; 0.47)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;color:black;\"\u003e0.02 (-0.29; 0.33)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e0.05 (-0.22; 0.32)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eSexual orientation (LGBTQIA+ vs. straight (ref))\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e0.39 (-0.03; 0.81)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;color:black;\"\u003e-0.45 (-0.94; 0.03)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e-0.17 (-0.59; 0.25)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eRelationship status (single vs. relationship (ref))\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Arial;\"\u003e-0.28 (-0.55; -0.01)\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;color:black;\"\u003e-0.05 (-0.36; 0.27)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e-0.15 (-0.42; 0.12)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eMigration background (Dutch vs. non-Dutch (ref))\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e-0.16 (-0.55; 0.23)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;color:black;\"\u003e0.14 (-0.31; 0.59)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e-0.60 (-0.97; -0.23)*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eTime since diagnosis (per year increase)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e0.003 (-0.01; 0.02)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Arial;color:black;\"\u003e-0.02 (-0.04; -0.002)\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Arial;\"\u003e-0.03 (-0.04; -0.01)\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width:100.0%;border:none;border-bottom: solid windowtext 1.0pt;padding: 0in 5.4pt 0in 5.4pt;height:17.9pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;color:black;\"\u003eKey populations (n = 495)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eAge (35 \u0026ndash; 54 years vs. 18 \u0026ndash; 34 years (ref))\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Arial;\"\u003e0.25 (0.05; 0.45)\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;color:black;\"\u003e-0.01 (-0.25; 0.24)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Arial;color:black;\"\u003e-0.62 (-0.80; -0.43)\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eAge (\u0026gt;=55 years vs. 18 \u0026ndash; 34 years (ref))\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e0.11 (-0.03; 0.24)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;color:black;\"\u003e-0.11 (-0.26; 0.04)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Arial;color:black;\"\u003e-0.41 (-0.54; -0.29)\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e*\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family: Arial;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eEducation (high vs. low-middle (ref))\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e0.15 (-0.06; 0.37)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;color:black;\"\u003e0.07 (-0.19; 0.32)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e-0.11 (-0.32; 0.10)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eRelationship status (single vs. relationship (ref))\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e-0.04 (-0.25; 0.16)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Arial;color:black;\"\u003e-0.27 (-0.50; -0.04)\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Calibri;\"\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family:Arial;\"\u003e0.23 (0.03; 0.44)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.82%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003eMigration background (Dutch vs. non-Dutch (ref))\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.88%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e0.14 (-0.10; 0.37)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;color:black;\"\u003e0.17 (-0.11; 0.44)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;font-family: Calibri;\"\u003e-0.04 (-0.27; 0.20)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width:100.0%;border:none;border-bottom: solid windowtext 1.0pt;padding: 0in 5.4pt 0in 5.4pt;height:76.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003eScores for QoL, sexual satisfaction, and stigma were transformed to Z-scores. The results were obtained using a univariate linear regression analysis. * Indicates a significant result. QoL = Scores for QoL measured with the VAS.\u003c/span\u003e\u003cspan style=\"font-size:14px;font-family: Arial;\"\u003e\u003csup\u003e22\u003c/sup\u003e\u003c/span\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003e\u0026nbsp;Sexual satisfaction was measured using the N-SSSS.\u003c/span\u003e\u003cspan style=\"font-size:14px;font-family: Arial;\"\u003e\u003csup\u003e23\u003c/sup\u003e\u003c/span\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003e\u0026nbsp;Stigma was measured using the Berger stigma scale.\u003c/span\u003e\u003cspan style=\"font-size:14px;font-family: Arial;\"\u003e\u003csup\u003e24\u003c/sup\u003e\u003c/span\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003eA\u0026nbsp;\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-size:11px;font-family:Calibri;\"\u003eSexual satisfaction was only computed for participants with a sex partner in the past six months: PHIV n = 159, key populations n = 361.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003eQoL = quality of life; CI = confidence interval; PHIV = people with HIV; LGBTQIA+ = Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and \u0026ldquo;+\u0026rdquo;all of the other identities not included in the short acronym; e.\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;\"\u003eNote: Differences in the current QoL, sexual satisfaction and stigma for gender and sexual orientation for key populations are not shown due to the low number of female and straight participants in the sample.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch2\u003eExpected change in life after hypothetical HIV cure: internalized stigma, mental health, social activities, physical health, and overall QoL\u003c/h2\u003e\n\u003cp\u003eWe measured whether PTC or elimination would worsen, not affect, or improve participants\u0026rsquo; internalized stigma, mental health, social activities, physical health, and overall QoL using the\u0026nbsp;expected change for QoL\u0026nbsp;items (\u003cstrong\u003eFigure 1 a\u0026ndash;d\u003c/strong\u003e). Across domains, improvements were expected by 52% to 70% of PHIV for both cure scenarios. For both cure scenarios, the most improvement was expected for the overall QoL (range 63 - 70% of PHIV), while the least improvement was expected for social activities (range 37 - 42% of PHIV). For key populations, improvements across domains were expected by 31% to 69% of participants. For both cure scenarios, the most improvement was expected for internalized stigma (range 61 - 69 % of key populations), while the least improvement was expected for physical health (range 31 - 36% of key populations).\u003c/p\u003e\n\u003ch2\u003eExpected change after cure: QoL, sexual satisfaction, and stigma scales\u003c/h2\u003e\n\u003cp\u003eThe expected changes in QoL, sexual satisfaction, and stigma between the current situation and after PTC and elimination are shown in z-scores in \u003cstrong\u003eFigure 2 a\u0026ndash;c\u003c/strong\u003e.\u0026nbsp;PHIV expected significantly improved QoL (PTC: 0.37, 95% CI: 0.27 to 0.47; elimination: 0.57, 95% CI: 0.46 to 0.68) and sexual satisfaction (PTC: 0.32, 95% CI: 0.22 to 0.42; elimination: 0.54, 95% CI: 0.40 to 0.68), and reduced stigma (PTC: -0.11, 95% CI: -0.20 to -0.02; elimination: -0.19, 95% CI: -0.30 to -0.08) after PTC and elimination compared to the current situation.\u0026nbsp;Key populations also expected improvements for both HIV cure scenarios on sexual satisfaction (PTC: 0.34, 95% CI: 0.25 to 0.43; elimination: 0.46, 95% CI: 0.36 to 0.56) and stigma (PTC -0.28, 95% CI: -0.36 to -0.20; elimination -0.61, 95% CI: -0.69 to -0.53). For QoL, expected improvement was found after elimination (0.17, 95% CI: 0.12 to 0.22) but not after PTC (0.02, 95% CI: -0.03 to 0.07)\u0026nbsp;(\u003cstrong\u003eFigure 2 d\u0026ndash;f\u003c/strong\u003e).\u003c/p\u003e\n\u003ch2\u003eRole of participant characteristics on expected change after cure\u003c/h2\u003e\n\u003cp\u003eWe investigated the effect of participant characteristics on the expected change in QoL, sexual satisfaction, and stigma after PTC and elimination compared to the current situation in both groups. Of these 78 linear mixed models, five models showed a significant effect of age (\u003cstrong\u003eSupplementary file A, Figures 3\u0026ndash;6, 11\u003c/strong\u003e). For the other characteristics, few models showed a significant effect: one model showed an effect of gender, two models showed an effect of migration background, and one model showed an effect of relationship status on expected change (\u003cstrong\u003eSupplementary file A\u003c/strong\u003e,\u003cstrong\u003e\u0026nbsp;figures 7\u0026ndash;10).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eModels with an age effect showed that PHIV between 18 and 34 years expected more improvement in QoL and sexual satisfaction than PHIV aged 55 years and older after elimination. This group also expected a larger reduction in HIV-related stigma after both PTC and elimination (\u003cstrong\u003eSupplementary file A\u003c/strong\u003e, \u003cstrong\u003eFigures 3 \u0026ndash; 6\u003c/strong\u003e). For QoL and stigma, current differences between young and older PHIV were expected to become smaller, but for sexual satisfaction the current difference between young and older PHIV was expected to become larger. Participants between 18 \u0026ndash; 34 years from key populations expected a larger reduction in HIV-related stigma after elimination than older people, resulting in a smaller difference between age groups after cure (\u003cstrong\u003eSupplementary file A\u003c/strong\u003e, \u003cstrong\u003eFigure 11\u003c/strong\u003e).\u003c/p\u003e\n\u003ch2\u003ePreference of PTC versus elimination\u003c/h2\u003e\n\u003cp\u003eFinally, we assessed the preference of participants regarding PTC or elimination. Seventy-one percent of participants from PHIV and 88% of participants from key populations preferred elimination over PTC.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this is the first study to quantitatively explore the expected impact of HIV cure scenarios on QoL, sexual satisfaction, and stigma, separately among PHIV and key populations. PHIV expected that both PTC and elimination would positively affect their QoL and sexual satisfaction, and would also reduce stigma. Similarly, key populations expected a positive impact following both scenarios, with the exception of no improvement in QoL following PTC. Similarly, many participants, both PHIV and key populations, expected positive changes in internalized stigma, mental health, social activities, physical health, and overall QoL. Additionally, the expected change in QoL, sexual satisfaction, and stigma resulting from an HIV cure varied by age.\u003c/p\u003e \u003cp\u003eIn general, participants expected improvement following a hypothetical cure for HIV on many domains, including internalized stigma, mental health, social activities, physical health, QoL, and sexual satisfaction. This expected positive impact on important domains aligns with findings regarding HIV elimination from qualitative research conducted among both PHIV and key populations \u003csup\u003e2,8,11,12,16,41\u0026ndash;45\u003c/sup\u003e. However, regarding PTC, previous qualitative work from the Netherlands and Australia showed that PHIV and key populations did not consider PTC a cure for HIV as it would not alleviate burdens associated with HIV, such as worries about transmission and stigma \u003csup\u003e2,16\u003c/sup\u003e. Current state-of-the-art research indicates that long-term control of the viral reservoir, akin to PTC, is more likely than complete HIV elimination to become widely available \u003csup\u003e8,11,13,30\u0026ndash;36\u003c/sup\u003e. Remarkably, our findings suggested a significant improvement not only for HIV elimination but also for the more achievable PTC curative strategy. We hypothesize that the expected impact of a cure for HIV may vary based on the characteristics of a cure, such as, viral rebound. In our PTC vignette, post-cure monitoring was added, and it was not possible to transfer HIV and monitoring was added. Potential cures for HIV may have characteristics that require more vigilance for PHIV, their partners, and communities which may influence QoL, sexual satisfaction, and stigma.\u003c/p\u003e \u003cp\u003eWe detected several age-related effects in this study. Firstly, among both PHIV and key populations, we found that older participants reported currently experiencing less stigma and higher QoL compared to their younger counterparts. The positive current outlook on QoL and stigma among older participants may be attributed to their general optimism and hope regarding a potential cure for HIV in the future \u003csup\u003e2,46\u003c/sup\u003e. While optimism is considered a personality trait, it can also be cultivated over time \u003csup\u003e46\u003c/sup\u003e. Additionally, the accumulated experience of life with HIV over the years may contribute to the more positive outlook among older PHIV regarding their current experiences related to QoL, sexual satisfaction, and stigma \u003csup\u003e47\u003c/sup\u003e. Older PHIV and key populations in our study may have experienced the burden of HIV before ART, which includes fear of HIV acquisition or transmission, the necessity of extensive medication, and associated side effects. Comparing their current situation with the past may have led to a more favorable perception of their present circumstances \u003csup\u003e6,12,48\u003c/sup\u003e. Furthermore, older PHIV and key populations may be more accustomed to life with HIV compared to younger participants, who have not experienced the HIV epidemic of the \u0026lsquo;80s and \u0026lsquo;90s firsthand \u003csup\u003e6,12,49\u003c/sup\u003e. Secondly, among both PHIV and key populations we identified several indications suggesting that participants between the ages of 18 and 34 expected greater improvements in QoL, sexual satisfaction, and more reduction in stigma following either PTC or HIV elimination compared to older participants. Smaller differences were ascertained in expected QoL, sexual satisfaction, and stigma between age groups after cure. These indications of greater expected improvement among participants aged 18 to 34 years may stem from an overestimation of the current influence of HIV on QoL, sexual satisfaction, and stigma. This hypothesis is supported by studies \u003csup\u003e49\u0026ndash;55\u003c/sup\u003e that have demonstrated an overestimation of the consequences of HIV on QoL and stigma, as well as the perceived severity of living with HIV compared to the actual experiences of PHIV.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThis study is one of the first to quantitatively evaluate the potential impact of two hypothetical HIV cure scenarios in both PHIV and key populations. However, there are several limitations to consider. Firstly, the results are based on a context where biomedical interventions for HIV, such as ART and pre-exposure prophylaxis, are widely accessible. PHIV and key populations in our study reported high QoL scores and low levels of public stigma. Contextual differences may influence the perceived impact observed in our study. We recommend exploring the impact of an HIV cure in different geographical and cultural settings and on marginalized populations \u003csup\u003e2,16\u0026ndash;19,21\u003c/sup\u003e. Secondly, our samples of PHIV and key populations, which were recruited through convenience sampling, may not be fully representative for all affected populations in the Netherlands. Our sample of PHIV was compared to the Dutch HIV Monitoring Report data \u003csup\u003e1,56\u003c/sup\u003e, showing similar age and time since diagnosis distributions: 50% aged 35\u0026ndash;54 years and 36% over 55, with 60% diagnosed over 10 years ago in the Dutch population of PHIV. However, our sample had a higher proportion of individuals with a migration background (14% vs. 10%) and a lower proportion of women (8% vs. 19%) compared to the general PHIV population in the Netherlands \u003csup\u003e1\u003c/sup\u003e. In addition, our samples of PHIV and key populations, included mainly highly educated MSM. \u003csup\u003e1,53,57\u0026ndash;59\u003c/sup\u003e. More research is needed to explore the impact of HIV cure strategies across diverse populations, such as women and straight PHIV, both with and without a migration background, as well as populations with low socioeconomic positions. Thirdly, our study may have attracted participants who are more hopeful about an HIV cure, potentially biasing the expected positive changes reported. However, existing research suggests that individuals with other chronic conditions often experience feelings of hopelessness, stress, fatigue, and despair \u003csup\u003e60\u0026ndash;63\u003c/sup\u003e. Finally, due to numerous statistical tests, we focused on overall patterns rather than individual significant findings. We advise caution when interpreting single significant findings related to gender, migration background, and relationship status.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, both PHIV and key populations generally expected a positive impact on QoL, sexual satisfaction, and stigma following either HIV PTC or elimination. Considering our current knowledge of HIV cure research, the development of an effective PTC scenario on a global scale appears much more feasible than achieving true elimination. Our data provide reassurance that people with and without HIV would nonetheless expect significant benefits from PTC, including a reduction in experienced stigma. Nevertheless, we believe further research is needed to explore the perceived impact of the characteristics of a PTC, such as viral rebound or continued monitoring, among PHIV, their sexual partners and other key populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor declaration statement\u003c/h2\u003e\n\u003cp\u003eThe institution of M. F. Schim van der Loeff received study funding from GSK; he served on advisory boards of GSK and Merck. P.Reiss through his institution has received grant support from Gilead Sciences, ViiV Healthcare and Merck \u0026amp; Co. Ganna Rozhnova is an editorial board member of \u003cem\u003eCommunications Medicine\u003c/em\u003e. The other authors have no competing interests to disclose.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthor contributions\u003c/h2\u003e\n\u003cp\u003eK.A.G.J.R: Conceptualization; Data collection; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Supervision; Validation; Writing - original draft; Writing - review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eF.R.G.: Data collection; Data curation; Writing - review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eA.M.: Data collection; Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eM.L.V.: Resources; Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eM.D.: Resources; Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eP.R.: Investigation; Resources; Writing - review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eM.E.K.: Data curation, Writing - review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eP.N.: Formal analysis; Methodology; Writing - review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eM.S.v.d.L.: Methodology; Writing - review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eM.B.: Conceptualization; Funding acquisition; Formal analysis; Methodology; Supervision; Writing - review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eG.R.: Conceptualization; Funding acquisition; Supervision; Investigation; Project administration; Resources; Writing - review \u0026amp; editing.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eWe gratefully acknowledge the participants who were willing to share their experiences with us. In addition, we are thankful for their valuable contribution to our recruitment to all staff of the Amsterdam Cohort Studies, the AGEhIV Cohort Study, the infectious diseases outpatient clinic of the University Medical Center Utrecht, Bertus Tempert and Renee Finkelflügel from the Dutch HIV Association. We gratefully acknowledge Gail Henderson, Holly Peay, Stuart Rennie, and Fred Verdult for their involvement during the initial stages of this study. The authors gratefully thank Peter Zuithoff for his expert statistical consultations on linear mixed models. Finally, we thank our collaborators on the Aidsfonds project P-52901 (Daniela Bezemer, Godelieve de Bree, Janneke Heijne, Sebastiaan Verboeket, Udi Davidovich, Sigrid Vervoort, Berend van Welzen, and Ard van Sighem) for helpful discussions. The authors gratefully acknowledge funding by the Aidsfonds Netherlands, grant number P-52901.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe authors gratefully acknowledge funding by the Aidsfonds Netherlands, grant number P-52901.\u003c/p\u003e\n\u003ch2\u003eEthical approval\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the ethics committee of the University Medical Center Utrecht (UMCU): 20-546/C.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData availability statement\u003c/h2\u003e\n\u003cp\u003eOnly the authors have access to the raw data quoted in this study due to confidentiality. Any reasonable request for access to material relating to the study can be made directly to the corresponding author, who will decide on information sharing on a case-by-case basis.\u003c/p\u003e\n\u003ch2\u003eCode availability\u003c/h2\u003e\n\u003cp\u003eAny reasonable request for access to SPSS syntaxes relating to the study can be made directly to the corresponding author, who will decide on information sharing on a case-by-case basis.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;van Sighem A.I.\u003cem\u003e\u0026nbsp;et al.\u003c/em\u003e HIV Monitoring Report 2022. 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Hope, despair and hopelessness in living with HIV/AIDS: a grounded theory study. \u003cem\u003eJ Adv Nurs\u003c/em\u003e \u003cstrong\u003e33\u003c/strong\u003e, 764-775 (2001).\u0026nbsp;\u003ca href=\"https://doi.org/10.1046/j.1365-2648.2001.01712.x\"\u003ehttps://doi.org/10.1046/j.1365-2648.2001.01712.x\u003c/a\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"nature-portfolio","isNatureJournal":true,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"","title":"Nature Portfolio","twitterHandle":"","acdcEnabled":false,"dfaEnabled":false,"editorialSystem":"ejp","reportingPortfolio":"","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"HIV cure, survey, quality of life, key populations","lastPublishedDoi":"10.21203/rs.3.rs-4311908/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4311908/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective This study explored the expected impact of two hypothetical HIV cure scenarios on quality of life (QoL), sexual satisfaction, and stigma among people with HIV (PHIV) and key populations (i.e., partners of PHIV, family members, friends and other contacts, and MSM without HIV) in the Netherlands.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDesign A cross-sectional survey was conducted among PHIV and key populations in the Netherlands from October 2021 until June 2022. Methods QoL, sexual satisfaction, and stigma were assessed with an online survey to compare participants’ current situation and for two hypothetical HIV cure scenarios: HIV post-treatment control (PTC), where HIV is suppressed without the need for ongoing antiretroviral treatment (ART), but the viral reservoir is expected to persist, and HIV elimination, where HIV is completely removed from the body.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults PHIV (n=222) expected improved QoL and sexual satisfaction, as well as reduced stigma compared to their current situation following both PTC and elimination. Key populations (n=495) similarly expected improvements for both HIV cure scenarios, except no expected improvement was found for QoL following PTC. The expected impact of a cure on QoL, sexual satisfaction, and stigma varied by age. Participants aged between 18 and 34 years expected greater improvement following both cure scenarios compared to older participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion Both PHIV and key populations without HIV expect an HIV cure to have a positive impact on QoL, sexual satisfaction, and stigma. This impact is expected not only for HIV elimination but also for HIV PTC, the development of which appears more feasible.\u003c/p\u003e","manuscriptTitle":"The Expected Impact of HIV Post-Treatment Control and HIV Elimination on Quality of Life, Sexual Satisfaction, and Stigma Among People With HIV and Key Populations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-25 21:21:56","doi":"10.21203/rs.3.rs-4311908/v1","editorialEvents":[],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"communications-medicine","isNatureJournal":true,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"commsmed","sideBox":"Learn more about [Communications Medicine](http://www.nature.com/commsmed)","snPcode":"43856","submissionUrl":"https://mts-commsmed.nature.com/cgi-bin/main.plex","title":"Communications Medicine","twitterHandle":"@commsmedicine","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Communications Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"70a3dd7f-583c-438a-aea3-0c7b9dea63c0","owner":[],"postedDate":"November 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":40743085,"name":"Health sciences/Diseases/Infectious diseases/HIV infections"},{"id":40743086,"name":"Health sciences/Diseases/Infectious diseases/Viral infection"}],"tags":[],"updatedAt":"2025-05-04T07:06:04+00:00","versionOfRecord":{"articleIdentity":"rs-4311908","link":"https://doi.org/10.1038/s43856-025-00853-3","journal":{"identity":"communications-medicine","isVorOnly":false,"title":"Communications Medicine"},"publishedOn":"2025-05-03 04:00:00","publishedOnDateReadable":"May 3rd, 2025"},"versionCreatedAt":"2024-11-25 21:21:56","video":"","vorDoi":"10.1038/s43856-025-00853-3","vorDoiUrl":"https://doi.org/10.1038/s43856-025-00853-3","workflowStages":[]},"version":"v1","identity":"rs-4311908","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4311908","identity":"rs-4311908","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}