Abstract
Background: Young men who have sex with men (YMSM) are disproportionately impacted by HIV. Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition. It remains unclear if PrEP use increases rates of condomless sex (ie, risk compensation), which may increase risk of infection if PrEP adherence is not optimal. This study aimed to examine whether PrEP use and PrEP adherence were associated with change in sexual risk behaviors in a large longitudinal cohort of YMSM reporting on multiple sexual partnerships over time. Method: Data were obtained from the first 3 visits of an ongoing cohort study of YMSM in Chicago (analytic N = 953; 14.1% HIV-positive at baseline). Participants reported up to 4 sexual partnerships at each visit, including sexual behavior, PrEP use, and PrEP adherence within partnerships. Results: YMSM reported higher rates of receptive condomless anal sex (CAS) in partnerships during which they were on PrEP compared with those when they were not on PrEP. This association was consistent across both HIV-negative and HIV-positive participants reporting on partnerships with both perceived HIV-negative/unknown and HIV-positive partners. The rate of receptive CAS was higher in PrEP nonadherent partnerships compared with non-PrEP partnerships. The rate of receptive CAS was also higher in PrEP nonadherent than adherent partnerships, but this was not statistically significant. Conclusions: These analyses provide compelling data suggesting that YMSM are engaging in risk compensation when on PrEP. If rates of receptive CAS are highest among YMSM who are PrEP nonadherent, PrEP as a prevention strategy could fail to curb HIV incidence among YMSM.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 358-364 |
| Number of pages | 7 |
| Journal | Journal of Acquired Immune Deficiency Syndromes |
| Volume | 77 |
| Issue number | 4 |
| DOIs | |
| State | Published - 2018 |
Funding
Received for publication August 31, 2017; accepted November 13, 2017. From the *Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; and †Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL. Supported by a grant from the National Institute on Drug Abuse (U01DA036939; PI: B.M.). The authors have no conflicts of interest to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Correspondence to: Michael E. Newcomb, PhD, Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Avenue, #14-059, Chicago, IL 60611 (e-mail: [email protected]). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Keywords
- Adherence
- HIV/AIDS
- Preexposure prophylaxis
- Risk compensation
- Young men who have sex with men
- condom use
ASJC Scopus subject areas
- Infectious Diseases
- Pharmacology (medical)
