title: Implementation challenges and opportunities for HIV Treatment as Prevention (TasP) among young men in Vancouver, Canada: a qualitative study.
abstract: BACKGROUND
  Despite evidence supporting the preventative potential of HIV Treatment as Prevention (TasP), scientific experts and community stakeholders have suggested that the success of TasP at the population level will require overcoming a set of complex and population-specific implementation challenges. For example, the factors that might influence decisions to initiate 'early' treatment have yet to be thoroughly understood; neither have questions about the factors that enhance or impede their ability to achieve long-term adherence to ARVs or the social norms regarding various treatment regimens been examined in detail. This knowledge gap may hamper opportunities to effectively develop public health practices that are informed by the various challenges and opportunities related to TasP implementation and scale up.
  
  
  METHODS
  Drawing on 50 in-depth, individual interviews with young men ages 18-24 in Vancouver, Canada, this study examines young men's perspectives regarding factors that might affect their engagement with TasP.
  
  
  RESULTS
  While findings from the current study indicate young men generally have a high receptiveness to TasP, our findings also identify key social and structural forces that will warrant ongoing consideration for TasP implementation. For example, participants described how an enhanced awareness regarding treatment (including awareness of the universal availability of treatment in Vancouver) would be a necessary, but not sufficient, condition to decide to endorse TasP. Their decisions about engaging in HIV care in the context of TasP (e.g., HIV testing, treatment initiation, long-term adherence) also appear to be contingent on their ability to negotiate or 'balance' the risks and benefits to themselves and others. The findings also offer insight into the complex and sometimes controversial narratives that continue to emerge regarding risk compensation practices in the context of TasP.
  
  
  CONCLUSIONS
  Based on the results of this study, we identify several areas that hold promise for informing the effective scale up of TasP, including new information regarding implementation adaptation strategies.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.|School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
authors.forename: Rod
authors.identifier: http://orcid.org/0000-0002-1464-1584
authors.initials: R
authors.lastname: Knight
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
authors.forename: Will
authors.initials: W
authors.lastname: Small
authors.affiliation: School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Thomson
authors.affiliation: School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada.|Ontario HIV Treatment Network, Toronto, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Gilbert
authors.affiliation: School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada. jean.shoveller@ubc.ca.
authors.forename: Jean
authors.initials: J
authors.lastname: Shoveller
mesh_terms: D000293:Adolescent; D001364:Awareness; D002170:Canada; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D065129:Pre-Exposure Prophylaxis / Q000458:organization & administration*; D011634:Public Health; D036301:Qualitative Research; D055815:Young Adult
keywords: Canada; HIV/AIDS; Treatment as prevention; Young men