Sexual behavior risk compensation associated with HIV pre-exposure prophylaxis (PrEP) among men who have sex with men, The American Men’s Internet Survey, 2019 Público

Abstract

Objective: Assess the impact of pre-exposure prophylaxis (PrEP) use on reported condomless anal intercourse (CAI).

 

Introduction: Pre-exposure prophylaxis (PrEP) is an effective, once daily oral pill indicated for populations at high risk of HIV transmission, including men who have sex with men (MSM). PrEP, when taken regularly, effectively prevents HIV transmission but does not protect against other non-HIV-STDs. PrEP users are still encouraged to practice safe sexual behaviors including wearing a condom during sex. It is possible that use of PrEP will result in risk compensation behavior in which PrEP users engage in riskier sexual behaviors, like CAI, because they feel protected by PrEP. 

 

Methods: We analyzed data from the 2019 American Men’s Internet Survey (AMIS), an annual online survey of HIV risk behaviors among MSM in the United States. The primary exposure of interest was PrEP use within the last 12 months and its association with CAI reported in the last 12 months. Univariate logistical regression models were developed to evaluate crude associations of CAI and PrEP use with education, age, insurance status, experienced stigma, income, and healthcare provider (HCP) use. Unadjusted and adjusted prevalence ratios comparing the prevalence of CAI among PrEP users and non-users were estimated using predicted margins logistic regression.

 

Results: Among 9,226 HIV-negative AMIS participants, 6,356 (69%) reported CAI in the last 12 months. In unadjusted models, education, age, insurance status, and experienced stigma were associated with reporting CAI. In the adjusted model, the prevalence of CAI was higher among PrEP-using MSM compared to non-users (PR: 1.31, 95% CI: 1.28-1.35).

 

Discussion: In this analysis, MSM who used PrEP in the past 12 months were more likely to report CAI after controlling for education, age, insurance status, experienced stigma, income, and HCP use. While these results suggest PrEP use may result in risk compensation behaviors, additional longitudinal studies are needed to assess the temporality of these associations, and external factors associated with PrEP use and CAI.

Table of Contents

Introduction…………………..……………………………………………………...……………1

Methods…………………………………………………………………………………...………5

Results…………………………………………………………………………….………………8

Discussion……………………………………………………………...………………………...10

References………………………………………………………...…………………………...…14

Tables……………………………………………………………..……………………………...17

Figures………………………………………………………………….……………………...…20

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Palavra-chave	PrEP MSM Risk Compensation HIV
Committee Chair / Thesis Advisor	Jeb Jones, Emory University

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