PrEP in MSM linked to uptick in community-level risk compensation, decline in condom use

  • Lancet HIV
  • 7 Jun 2018

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • A rapid uptake of preexposure prophylaxis (PrEP) by gay, bisexual men is associated with community-level, risk compensative behaviors, namely rapid decline in condom use.

Why this matters

  • Clinicians should continue to encourage PrEP uptake by men who have sex with men (MSM) but anticipate potential risk compensation.
  • Education, consistent follow-up in male users/nonusers of PrEP are essential to encourage preventive sexual behavior, prevent sexually transmitted disease, HIV rebound.

Key results

  • 16,827 participants reported casual sex in prior 6 months.
  • Recent PrEP use by HIV-negative men increased from 2% in 2013 (44/2962) to 24% in 2017 (783/4018) (P<.0001>
  • Proportion of all men reporting consistent condom use decreased from 46% (1360/2962) to 31% (1229/4018) (P<.0001 most of this change occurred during>
  • Proportion of condomless anal intercourse with casual partners (CAIC) increased significantly among HIV-negative men receiving PrEP, from 1% (26/2962) to 16% (652/4018; P<.0001>
  • CAIC increased from 30% (800/2646) to 39% (1166/2986) in HIV-negative, non-PrEP users.

Study design

  • An observational study evaluating the effect of PrEP on condom use by gay, bisexual Australian men from January 2013 to March 2017.
  • Funding: Australian Government Department of Health, and others.

Limitations

  • Findings based on cumulative behavior, potential risk overestimation.
  • Limited demographics (age).

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