Middlesex University

‘Is the risk really zero?’ Awareness and attitudes about HIV
and biomedical prevention methods [TasP, U=U and PrEP]
among men who have sex with men in England
Proposal
1. Introduction
HIV [Human Immunodeficiency Virus] remains a key public health concern in England, across Europe and around
the world (Baylis et al., 2017; EMIS Network, 2013; IAPAC, 2018). To date, more than 39 million people have
died from AIDS-related illnesses worldwide (UNAIDS, 2014). In spite of the availability of effective antiretroviral
therapy [ART] since the advent of protease inhibitors in the mid-1990s, HIV remains highly stigmatised with
much ignorance and hysteria generated, even among LGBT [lesbian, gay, bisexual and transgender] communities,
which are often the target of health promotion campaigns (Hibbert et al., 2018; Auzenbergs et al., 2018).

It is regrettable that gay, bisexual and other men who have sex with men [MSM], who were the loudest and
most effective AIDS [Acquired Immunodeficiency Syndrome] activists and advocates in the pre-treatment era,
continue to see the highest incidence and prevalence HIV rates in their communities in England. More than half
of all people with diagnosed HIV in England are MSM, and roughly 77 per 1,000 MSM (aged 15 to 59) have HIV,
which rises to 128 per 1,000 in London (Nash et al., 2018; Brown et al., 2017a, 2017b; Public Health England,
2018; Forde et al., 2018).

However, there is cause for hope: the efficacy of a combination prevention for HIV – that is pre-exposure
prophylaxis [PrEP] for the most at-risk populations combined with treatment as prevention [TasP] along with
an encouragement to test regularly as well as consistent condom use by those not using PrEP or TasP – is
thought to have led to a dramatic and unprecedented reduction in the numbers of new HIV diagnoses among
MSM between 2015 and 2017 of 44% in London (2015: n=1,415; 2017: n=798) and 28% in England outside of
London (2015: n=1,618; 2017: n=1,167) (McCormack, 2016; Brown et al., 2017a, 2017b; Public Health England,
2018; Nash et al., 2018; Forde et al., 2018).

The evidence base around the effectiveness of TasP has been growing since the introduction of ART. In 1998,
doctors treating the first HIV-positive patients with ART reported that their HIV-negative partners did not
acquire HIV (Collins, 2017). Ten years later, in response to laws criminalising people with HIV [PLWHIV] in
Switzerland, Vernazzaa et al. (2008) published the Swiss Statement, which stated, with caveats about the absence
of sexually transmitted infections [STIs] and adherence to daily ART, that an HIV-positive person with an
undetectable viral load was not infectious to their sexual partners. That the Swiss Statement proved so
controversial at the time highlights the pervasive nature of HIV stigma and the reluctance of many health
promoters, even today, to move on from a safer sex orthodoxy based solely on condoms and to consider adding
biomedical methods to the HIV prevention toolkit.

It is notable that in the decade since the Swiss Statement no cases of transmission from an HIV-undetectable
person have been reported in the literature (Collins, 2017). The multinational PARTNER and PARTNER 2
cohort studies as well as the Opposites Attract cohort study in Australia recruited serodifferent couples, where
one partner was HIV positive and the other was HIV negative, who were not always using condoms to assess
the effectiveness of TasP. Zero linked transmissions were found in the three studies (Rodger et al., 2016; Collins,
2017; Philpot et al., 2018).

Out of these studies’ findings grew the Undetectable = Untransmittable slogan [U=U] – widely known as
#UequalsU on social media – that has spawned a worldwide activism and empowerment movement for people
living with HIV [PLWHIV], spearheaded by the US-based Prevention Access Campaign [PAC]. At the time of
writing, more than 800 community organisations from almost 100 countries have signed PAC’s consensus

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statement (2016), which states unequivocally that “people living with HIV on ART with an undetectable viral load in
their blood have a negligible risk of sexual transmission of HIV”. 1 In its latest Standards of Care for People Living with
HIV, the British HIV Association [BHIVA] emphasises that “awareness of the effectiveness of treatment is a powerful
tool to support people living with HIV and a challenge to the stigma that they often face; all people living with HIV should
be provided with this information and its implications” (BHIVA, 2018, p.12).

This study aims to assess levels of HIV awareness among MSM in England, in particular their knowledge,
understanding and perceptions of TasP and PrEP; their determinants and recent trends.

2. Methods
2a. Research objectives and questions

Rendina and Parsons (2018) found in their nationwide survey of MSM in the United States that the U=U message
was thought to be inaccurate by a majority of participants who were HIV-negative or did not know their status.
Nearly one-third of the HIV-positive participants were similarly sceptical. Card et al. (2017) found that, while
there had been increasing levels of awareness of TasP over time among MSM in Vancouver, Canada, levels of
awareness across sociodemographic groups were uneven, e.g. those with low socioeconomic status were more
frequently unaware of TasP.

In light of this, the objectives of this study are to determine whether, among MSM in England, levels of knowledge
and understanding around HIV have increased between 2010 and 2017; and to identify the determinants of
greater levels of knowledge and understanding of and belief in the U=U message and the effectiveness of PrEP
in 2017.

This study will seek to answer the following questions:

1. Have levels of HIV awareness and knowledge among MSM in England increased between 2010 and 2017,
and have they increased uniformly across sociodemographic groups over time?
2. What are the predictors of greater levels of HIV awareness and knowledge among MSM in England in
2017?
3. Among HIV-negative MSM in England, does taking PrEP predict acceptance of the U=U message?
4. Among HIV-positive MSM in England, does recency of diagnosis predict acceptance of PrEP and U=U?
Are HIV-positive MSM in England who were diagnosed in the pre-treatment era (before 1996) more
sceptical of PrEP and U=U than those subsequently diagnosed?

Access has been sought to the England datasets for EMIS [European Men-who-have-sex-with-men Internet
Survey] 2017 and 2010, as well as the comparable GMSS [Gay Men’s Sex Survey] conducted online solely in
England in 2014.

2b. Design

EMIS 2010 aimed to develop a pan-European internet survey to provide comparable data on a country-by-
country basis. It worked with 77 collaborating partners across Europe with the shared aim among the partners
to empower participants to have “the best sex with the least harm”. As well as collecting valuable data about
MSM across Europe, the survey was to have an educative role as a public health intervention: survey items
provided accurate information about HIV and safer sex to MSM in settings where access to such information
would be socially stigmatised (Weatherburn et al., 2013; Sigma Research on behalf of the EMIS Collaboration,
2010).

1
PAC cautions against the use of the word ‘negligible’ in public health messaging, as it is often misconstrued as
meaning there is still a risk of transmission. It is recommended the words ‘effectively no risk’, ‘cannot transmit’
or ‘do not transmit’ are used instead.

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Survey questions were designed to enable the greatest comparisons with previous and future national as well as
regional surveys. Survey length was somewhat contentious among the partners, but consensus was found around
a longer survey that gathered more data with the potential for greater rates of attrition (Weatherburn et al.,
2013).

In each survey, respondents were told that the following statements were true and then asked to rate their
knowledge, understanding and perceptions about each item using a five-point scale: 1 = I already knew this; 2 =
I wasn’t sure about this; 3 = I didn’t know this already; 4 = I don’t understand this; 5 = I do not believe this.

Knowledge of HIV and HIV testing

• AIDS is caused by a virus called HIV (Q61, EMIS 2010; GMSS 2014; Q049, EMIS 2017)
• You cannot be confident about whether someone has HIV or not from their appearance (Q62, EMIS
2010; GMSS 2014; Q050, EMIS 2017)
• There is a medical test that can show whether or not you have HIV (Q63, EMIS 2010; GMSS 2014;
Q051, EMIS 2017)
• If someone becomes infected with HIV it may take several weeks before it can be detected in a test
(Q65, EMIS 2010; GMSS 2014; Q052, EMIS 2017)

Knowledge of HIV treatment and TasP

• There is currently no cure for HIV infection (Q66, EMIS 2010; GMSS 2014; Q053, EMIS 2017)
• HIV infection can be controlled with medicines so that its impact on health is much less (Q67, EMIS
2010; GMSS 2014; Q054, EMIS 2017)
• Effective treatment of HIV infection reduces the risk of HIV being transmitted (Q68, EMIS 2010; GMSS
2014; item removed, EMIS 2017)

Knowledge of U=U

• A person with HIV who is on effective treatment (called ‘undetectable viral load’) cannot pass their
virus to someone else during sex (Q055, EMIS 2017 only; replaces Q68 above in EMIS 2010)

Knowledge of PrEP

• Have you heard of PrEP? Yes/No (Q102, EMIS 2017 only)

• Pre-Exposure Prophylaxis (PrEP) involves someone who does not have HIV taking pills before as well
as after sex to prevent them getting HIV (Q103, EMIS 2017 only)
• PrEP can be taken as a single daily pill if someone does not know in advance when they will have sex
(Q104, EMIS 2017 only)
• If someone knows in advance when they will have sex, PrEP needs to be taken as a double dose
approximately 24 hours before sex and then at both 24 and 48 hours after the double dose (Q105,
EMIS 2017 only)

This study will analyse the England datasets of EMIS 2010, GMSS 2014 and EMIS 2017.

2c. Settings and temporal points

Data were collected via online self-completion surveys implemented in countries across Europe. Surveys were
launched between June and September 2010 (EMIS 2010), July and October 2014 (GMSS 2014), and October
2017 and January 2018 (EMIS 2017) (Sigma Research, 2010, 2019; Hickson et al., 2016).

Access has been sought to the England data of EMIS 2010, GMSS 2014 and EMIS 2017.

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2d. Participants, sampling strategy and sample size

Prior to EMIS 2010, most studies of MSM had relied on convenience sampling and recruited in community
settings or in clinical services attrition (Weatherburn et al., 2013). Weatherburn et al. (2013) argue that a lack
of sampling frames for online surveys mean that random sampling is challenging and may be impossible. De Vaus
(pp.66–92, 2014) and Sedgwick (2015) discuss biases in cross-sectional internet and phone surveys, in particular
self-selection bias and the issues of generalisability. As the participants in the 2010, 2014 and 2017 surveys are
different, caution will be needed when interpreting the results: do the changes in awareness and attitudes reflect
a trend or are they simply differences between the groups Marcus et al. (2012) compared self-reported
prevalence of HIV in EMIS 2010 with existing national estimates. They found that for comparison with the
modelled estimate the self-selection bias of the internet survey with its increased participation of MSM with
diagnosed HIV needed to to be taken into account.

Participants of the EMIS 2010 and 2017 surveys were MSM and/or felt attracted to men, living in any of the
European countries where the survey was launched, and were at or over the age of homosexual consent of the
country lived in (Weatherburn et al., 2013). GMSS 2014 was conducted solely in England.

Table 1: Cases submitted and non-qualifiers in EMIS 2010, GMSS 2014 and EMIS 2017

Submitted Non-qualifiers Qualifiers

EMIS 2010 16101 24 16077
GMSS 2014 15360 - -
EMIS 2017 10159 31 10128
Sources: Sigma Research, 2010, 2019; Hickson et al., 2016

Table 1 shows the number of cases submitted and non-qualifiers for EMIS 2010, GMSS 2014 and EMIS 2017. For
the 2010 survey, 27 national websites in the UK carried banner adverts – with 46.6% of participants (n>16,000)
coming from the Gaydar site, 16.2% from Manhunt and 14.8% from PlanetRomeo. Cards (n=20,000) and posters
(n=500) were distributed to gay community venues to aid recruitment to the online survey (Weatherburn et al.,
2013).

Recruitment to the 2014 and 2017 surveys took advantage of the advent of social media and geospatial apps,
such as Grindr. The final sample of the 2014 survey consisted of 15,360 men, 43.9% of whom were recruited
through gay dating apps and websites and 31.7% through Terrence Higgins Trust’s It Starts with Me (THT ISWM)
Facebook page (Hickson, 2016). The 2017 survey followed a similar pattern of recruitment to the 2014 survey
(Sigma Research, 2019).

2e. Plan of data analysis

Univariate and multivariate analysis of the data will be undertaken. The participants’ sociodemographic and health
profile will be analysed with univariate analysis. Descriptive analysis will also be used to assess their levels of
knowledge of HIV and HIV testing, HIV treatment and TasP, U=U and PrEP. A scoring system will be devised to
categorise the levels of knowledge, understanding and belief each item listed above represents.

Bivariate analysis will be used to identify possible determinants of awareness and knowledge. For this purpose,
it is proposed that the chi-squared and Cramer’s V tests will be used.

Analysis will be run with SPSS v 25 at a 95% confidence interval [CI].

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3. Ethics analytical reflection

The surveys were carried out online and no identifiable data were collected or will be retrieved. On completion
of each survey, the participant was forwarded to a local HIV information site, e.g. the THT ISWM site
(Weatherburn et al., 2013).

4. Logistics
4a. Activities and milestones timeline

By 1 April, data will have been retrieved and checked. By 15 April, the ethics application will have been submitted.
By 1 May, coding will have been completed. By 1 June, univariate analysis will have been undertaken. By 15 July,
multivariate analysis will have been undertaken. By 1 September, the first draft of the dissertation will have been
written. The final dissertation will be submitted on 30 September.

4b. Budget and other expenses

Accessing journal articles and interlibrary loans for books not available at Middlesex University is budgeted at
around £50. There is no cost to accessing or retrieving the data for analysis, for software or secure data storage.

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References
Auzenbergs, M., Delpech, V., Gold, D., Kall, M., Petretti, S., Smithson, K. and Summersbey, E. (2018). Changing
Perceptions – a community-led Positive Voices project. London: Public Health England / Positively UK / National
AIDS Trust / Watipa. Available at: https://changingperceptions.co.uk [Accessed 20 November 2018].

Baylis, A., Buck, D., Anderson, J., Jabbal, J. and Ross, S. (2017). The future of HIV services in England: shaping the
response to changing needs. London: The King’s Fund. Available at:
https://www.kingsfund.org.uk/publications/future-hiv-services-england [Accessed 20 November 2018].

British HIV Association [BHIVA]. (2018). Standards of Care for People Living with HIV 2018. [online] London:
Mediscript. Available at: https://www.bhiva.org/standards-of-care-2018 [Accessed 15 February 2019].

Brown, A., Kirwan, P., Chau, C., Khawam, J., Gill, O. and Delpech, V. (2017a). Towards elimination of HIV
transmission, AIDS and HIV-related deaths in the UK — 2017 report. London: Public Health England. Available at:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/662306/Towards_elimination_of
_HIV_transmission_AIDS_and_HIV_related_deaths_in_the_UK.pdf [Accessed 30 November 2018].

Brown, A., Mohammed, H., Ogaz, D., Kirwan, P., Yung, M., Nash, S., Furegato, M., Hughes, G., Connor, N.,
Delpech, V., Gill, O. (2017b). Fall in new HIV diagnoses among men who have sex with men (MSM) at selected
London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)?. Euro
Surveill. 2017;22(25):pii=30553.

Card, K., Armstrong, H., Lachowsky, N., Cui, Z., Sereda, P., Carter, M., Montaner, J., Hogg, R., Roth, E. and
Moore, D. (2017). Belief in Treatment As Prevention and Its Relationship to HIV Status and Behavioral
Risk. JAIDS Journal of Acquired Immune Deficiency Syndromes, p.1.

Collins, S. (2017). The evidence for U=U (Undetectable = Untransmittable): why negligible risk is zero risk.
HTB. London: HIV i-Base. [online] Available at: http://i-base.info/htb/32308 [Accessed 16 February 2019].

De Vaus, D. (2014). Surveys in social research. London: Routledge.

EMIS Network. (2013). EMIS 2010: The European Men-Who-Have-Sex-With-Men Internet Survey. Findings from 38
countries. Stockholm: European Centre for Disease Prevention and Control. Available at: http://www.emis-
project.eu/sites/default/files/public/publications/emis-
v2010_european_msm_internet_survey_38_countries_v5.pdf [Accessed 16 January 2019].

Forde, J., Kirwan, P., Louth, R., Corkin, H. and Crook, P. (2018). Annual epidemiological spotlight on HIV in
London: 2017 data. London: Public Health England. Available at:
https://www.gov.uk/government/publications/hiv-london-annual-data-spotlight [Accessed 16 January 2019].

Hibbert, M., Crenna-Jennings, W., Kirwan, P., Benton, L., Lut, I., Okala, S., Asboe, D., Jeffries, J., Kunda, C.,
Mbewe, R., Morris, S., Morton, J., Nelson, M., Thorley, L., Paterson, H., Ross, M., Reeves, I., Sharp, L., Sseruma,
W., Valiotis, G., Wolton, A., Jamal, Z., Hudson. A. and Delpech, V. (2018). The people living with HIV stigma
survey UK 2015: HIV-related sexual rejection and other experiences of stigma and discrimination among gay
and heterosexual men. AIDS Care. 30 (9), pp.1189–1196.

Hickson, F., Reid, D., Hammond, G. and Weatherburn, P. (2016). State of Play: findings from the England Gay
Men’s Sex Survey 2014. London: Sigma Research.

International Association of Providers of AIDS Care [IAPAC]. (2018). Fast-Track Cities: London. Washington,
DC: IAPAC. [online] Available at: http://www.fast-trackcities.org/cities/london [Accessed 20 November 2018].

16 April 2019 PRS4799: Research Methodology and Dissertation | 6

 Middlesex University

Marcus, U., Hickson, F., Weatherburn, P. and Schmidt, A. (2012). Prevalence of HIV among MSM in Europe:
comparison of self-reported diagnoses from a large scale internet survey and existing national estimates. BMC
Public Health, 12(1).

McCormack, S. (2016). Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD):
effectiveness results from the pilot phase of a pragmatic open-label randomised trial. The Lancet, 387(10013),
pp.53–60.

Nash, S., Desai, S., Croxford, S., Guerra, L., Lowndes, C., Connor, N. and Gill, O. (2018). Progress towards
ending the HIV epidemic in the United Kingdom: 2018 report. London: Public Health England. Available at:
https://www.gov.uk/government/publications/hiv-in-the-united-kingdom [Accessed: 16 January 2019].

Philpot, S., Prestage, G., Ellard, J., Grulich, A. and Bavinton, B. for the Opposites Attract study group. (2018).
How Do Gay Serodiscordant Couples in Sydney, Australia Negotiate Undetectable Viral Load for HIV
Prevention?. AIDS and Behavior, 22(12), pp.3981-3990.

Prevention Access Campaign. (2016). Risk of sexual transmission of HIV from a person living with HIV who has an
undetectable viral load: messaging primer & consensus statement. [online] Available at:
https://www.preventionaccess.org/consensus [Accessed 16 January 2019].

Public Health England. (2018). Trends in new HIV diagnoses and people receiving HIV-related care in the UK: data to
end of December 2017, Health Protection Report Volume 12 Number 32. London: Public Health England. Available
at:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/738222/hpr32
18_hiv17_v2.pdf [Accessed 20 November 2018].

Rendina, H. and Parsons, J. (2018). Factors associated with perceived accuracy of the Undetectable =
Untransmittable slogan among men who have sex with men: Implications for messaging scale-up and
implementation. Journal of the International AIDS Society, 21(1), p.e25055.

Rodger, A., Cambiano, V., Bruun, T., Vernazza, P., Collins, S., Van Lunzen, J., Corbelli, G., Estrada, V., Geretti,
A., Beloukas, A., Asboe, D., Viciana, P., Gutiérrez, F., Clotet, B., Pradier, C., Gerstoft, J., Weber, R., Westling,
K., Wandeler, G., Prins, J., Rieger, A., Stoeckle, M., Kümmerle, T., Bini, T., Ammassari, A., Gilson, R., Krznaric,
I., Ristola, M., Zangerle, R., Handberg, P., Antela, A., Allan, S., Phillips, A. and Lundgren, J. for the PARTNER
study group. (2016). Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples
When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA, 316(2), pp.171–81.

Sedgwick, P. (2015). Bias in observational study designs: cross sectional studies. BMJ, 350(mar06 3), pp.h1286-
h1286.

Sigma Research on behalf of the EMIS Collaboration. (2010). The European Men-who-have-sex-with-men Internet
Survey 2010: EMIS Variable Manual. [online] Available at:
https://webgate.ec.europa.eu/chafea_pdb/assets/files/pdb/20081214/20081214_d05-01_en_ps.pdf [Accessed 16
January 2019]

Sigma Research. (2019). The European Men-who-have-sex-with-men Internet Survey: EMIS 2017 Variable Manual.
London: Sigma Research, London School of Hygiene and Tropical Medicine. [online] Available at:
http://sigmaresearch.org.uk/files/EMIS-2017-Variable-Manual.pdf [Accessed 16 January 2019].

UNAIDS. (2014). 90–90–90 – An ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS.
Available at: http://www.unaids.org/en/resources/documents/2017/90-90-90 [Accessed 20 November 2018].

Vernazzaa, P., Hirschel, B., Bernasconi, E. and Flepp, M. (2008). HIV-infizierte Menschen ohne andere STD sind
unter wirksamer antiretroviraler Therapie sexuell nicht infektiös. Schweizerische Ärztezeitung, 89(05), pp.165-
169.

16 April 2019 PRS4799: Research Methodology and Dissertation | 7

 Middlesex University

Weatherburn, P., Schmidt, A., Hickson, F., Reid, D., Berg, R., Hospers, H. and Marcus, U. (2013). The
European Men-Who-Have-Sex-With-Men Internet Survey (EMIS): Design and Methods. Sexuality Research and
Social Policy, 10(4), pp.243–257.

Additional sources consulted

Ayala, G., Santos, G., Arreola, S., Garner, A., Makofane, K. and Howell, S. (2018). Blue-Ribbon Boys: factors
associated with PrEP use, ART use and undetectable viral load among gay app users across six regions of the
world. Journal of the International AIDS Society, 21, p.e25130.

Bell, J. and Waters, S. (2018). Doing your research project. London: McGraw-Hill Education.

Buckingham, A. and Saunders, P. (2009). The survey methods workbook. Oxford: Polity Press.

Crosby, R. and DiClemente, R. (2019). Structural interventions for HIV prevention. Oxford: Oxford University
Press.

Gafos, M., Brodnicki, E., Desai, M., McCormack, S., Nutland, W., Wayal, S., White, E., Wood, G., Barber, T.,
Bell, G., Clarke, A., Dolling, D., Dunn, D., Fox, J., Haddow, L., Lacey, C., Nardone, A., Quinn, K., Rae, C.,
Reeves, I., Rayment, M., White, D., Apea, V., Ayap, W., Dewsnap, C., Collaco-Moraes, Y., Schembri, G.,
Sowunmi, Y. and Horne, R. (2017). Acceptability of an open-label wait-listed trial design: Experiences from the
PROUD PrEP study. PLOS ONE, 12(4), p.e0175596.

Grulich, A., Guy, R., Amin, J., Jin, F., Selvey, C., Holden, J., Schmidt, H., Zablotska, I., Price, K., Whittaker, B.,
Chant, K., Cooper, C., McGill, S., Telfer, B., Yeung, B., Levitt, G., Ogilvie, E., Dharan, N., Hammoud, M.,
Vaccher, S., Watchirs-Smith, L., McNulty, A., Smith, D., Allen, D., Baker, D., Bloch, M., Bopage, R., Brown, K.,
Carr, A., Carmody, C., Collins, K., Finlayson, R., Foster, R., Jackson, E., Lewis, D., Lusk, J., O'Connor, C.,
Ryder, N., Vlahakis, E., Read, P., Cooper, D., Smith, D., Ooi, C., Martin, S., Soo, T., Templeton, D., Townson,
D., Forssman, B., Doong, N., Han Thai, G., Anderson, B., MacLeod, H. and Parkhill, N. (2018). Population-level
effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex
with men: the EPIC-NSW prospective cohort study. The Lancet HIV, 5(11), pp.e629-e637.

Hagger-Johnson, G. (2014). Introduction to Research Methods and Data Analysis in the Health Sciences. Abingdon:
Routledge.

Hickson, F., Melendez-Torres, G., Reid, D. and Weatherburn, P. (2017). HIV, sexual risk and ethnicity among
gay and bisexual men in England: survey evidence for persisting health inequalities. Sexually Transmitted
Infections, 93(7), pp.508-513.

Kaufman, M., Cornish, F., Zimmerman, R. and Johnson, B. (2014). Health Behavior Change Models for HIV
Prevention and AIDS Care. JAIDS Journal of Acquired Immune Deficiency Syndromes, 66, pp.S250-S258.

Lazarus, J., Safreed-Harmon, K., Barton, S., Costagliola, D., Dedes, N., del Amo Valero, J., Gatell, J., Baptista-
Leite, R., Mendão, L., Porter, K., Vella, S. and Rockstroh, J. (2016). Beyond viral suppression of HIV – the new
quality of life frontier. BMC Medicine, 14(1).

Nakagawa, F., Miners, A., Smith, C., Simmons, R., Lodwick, R., Cambiano, V., Lundgren, J., Delpech, V. and
Phillips, A. (2015). Projected Lifetime Healthcare Costs Associated with HIV Infection. PLOS ONE, 10(4),
p.e0125018.

Persson, A. (2012) Non/infectious corporealities: tensions in the biomedical era of ‘HIV normalisation’.
Sociology of Health & Illness. 35 (7), pp.1065–1079.

16 April 2019 PRS4799: Research Methodology and Dissertation | 8

 Middlesex University

Positively UK, British HIV Association (BHIVA), National HIV Nurses Association (NHIVNA) and Children’s
HIV Association (CHIVA). (2017). The National Standards of Peer Support in HIV. London: Positively UK.
Available at: http://hivpeersupport.com [Accessed 16 January 2019].

Punyacharoensin, N., Edmunds, W., De Angelis, D., Delpech, V., Hart, G., Elford, J., Brown, A., Gill, O. and
White, R. (2016). Effect of pre-exposure prophylaxis and combination HIV prevention for men who have sex
with men in the UK: a mathematical modelling study. The Lancet HIV, 3(2), pp.e94–e104.

Rai, T., Bruton, J., Day, S. and Ward, H. (2018). From activism to secrecy: Contemporary experiences of living
with HIV in London in people diagnosed from 1986 to 2014. Health Expectations. 21(6), p.1134–1141.

Sewell, J., Daskalopoulou, M., Nakagawa, F., Lampe, F., Edwards, S., Perry, N., Wilkins, E., O'Connell, R., Jones,
M., Collins, S., Speakman, A., Phillips, A. and Rodger, A. (2016). Accuracy of self-report of HIV viral load among
people with HIV on antiretroviral treatment. HIV Medicine, 18(7), pp.463-473.

Siegel, K. and Meunier, É. (2019). Awareness and Perceived Effectiveness of HIV Treatment as Prevention
Among Men Who Have Sex with Men in New York City. AIDS and Behavior. [online] Available at:
doi:10.1007/s10461-019-02405-y [Accessed 28 February 2019].

Storey, D., Seifert-Ahanda, K., Andaluz, A., Tsoi, B., Matsuki, J. and Cutler, B. (2014). What Is Health
Communication and How Does It Affect the HIV/AIDS Continuum of Care? A Brief Primer and Case Study
From New York City. JAIDS Journal of Acquired Immune Deficiency Syndromes, 66, pp.S241-S249.

Sullivan, P. and Siegler, A. (2018). Getting pre-exposure prophylaxis (PrEP) to the people: opportunities,
challenges and emerging models of PrEP implementation. Sexual Health, 15(6), p.522.

Walliman, N. (2016). Social research methods. London: SAGE.

White, P. (2017). Developing Research Questions. London: Palgrave.

Williams, M. (2003). Making sense of social research. London: Sage.

World Health Organization. (2001). Health Research Methodology. Geneva: World Health Organization.

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