Psychosocial Predictors of Trust In U=U HIV Prevention Messaging Among Adolescents Living with HIV In Uganda

Background

The Undetectable = Untransmittable (U=U) campaign affirms that people living with HIV who maintain an undetectable viral load cannot sexually transmit the virus. Among adolescents living with HIV (ALHIV) in sub-Saharan Africa, where the epidemic burden is disproportionate trust in U=U messaging remains poorly understood. This study assessed the psychosocial factors associated with trust in U=U HIV prevention messaging among adolescents living with HIV in Uganda.

Methods

This study uses Wave 3 (24-month follow-up) data from the M-Suubi cluster randomized controlled trial, a three-arm multilevel intervention designed to reduce HIV stigma and improve HIV treatment adherence among ALHIV attending boarding schools in southwestern Uganda. The convenient sample comprised 620 adolescents aged 10–17 years. The primary outcome was self-reported trust in U=U messaging, operationalized as a four-category ordinal variable (no trust to complete trust). Independent variables included HIV-related shame, HIV-associated stigma, self-concept, hopelessness, age, gender, prior U=U awareness, and study arm. Ordinal logistic regression served as the primary analytic model; multinomial logistic regression was conducted as a robustness check.

Results

Participants had a mean age of 15.4 years; 53.5% were female. Prior U=U awareness was low (31.8%). Trust was heterogeneous: 37.5% reported complete trust while 17.7% reported no trust. In adjusted ordinal logistic regression models, higher self-concept was significantly associated with greater trust in U=U (OR = 1.027, p < 0.05). HIV-associated stigma was also positively associated with higher trust (OR = 1.126, p < 0.01), shifting adolescents away from lower trust categories. HIV-related shame showed a negative but non-significant association with trust (OR = 0.934, p > 0.05). Age, gender, hopelessness, prior U=U awareness, and study arm were not significantly associated with trust (p > 0.05). Multinomial regression findings were consistent with the primary model.

Conclusions and Implications

Trust in U=U messaging among ALHIV in Uganda is fundamentally shaped by psychosocial context rather than information exposure alone, highlighted by the non-significant role of prior awareness in predicting trust. These findings challenge purely informational HIV prevention approaches and carry critical implications for social work practice. First, interventions must prioritize self-concept strengthening through evidence-based interventions including cognitive-behavioral therapy, mentorship, and asset-building programs to improve receptivity to U=U messaging. Second, the positive association between stigma and trust calls for nuanced, context-sensitive programming: while stigma-exposed adolescents may engage more deeply with affirming messages, sustained anti-stigma efforts remain essential. Lastly, the low rate of prior U=U awareness demands youth-tailored communication strategies integrated within existing adolescent HIV care services. Social workers are uniquely positioned to bridge psychosocial support and health communication, advancing U=U uptake among ALHIV across sub-Saharan Africa.