PrEP use may inform sexual decision-making among MSM

Issue: January 2016

ATLANTA — Use of HIV pre-exposure prophylaxis may drive decisions about sex and condom use among serodiscordant couples, according to findings presented here at the CDC’s National HIV Prevention Conference.

“In Seattle, we found that men are asking their sex partners about being on PrEP, and that it does appear to somewhat influence sexual decision-making,” Christine M. Khosropour, MPH, from the department of epidemiology at the University of Washington School of Public Health, told Infectious Disease News.

Christine M. Khosropour

PrEP use is increasing among men who have sex with men, according to researchers. Whether MSM incorporate PrEP use into their decisions about having sex and using condoms with a partner, however, has not been well studied, they said.

Khosropour and colleagues enrolled 913 MSM attending an STD clinic in Seattle from January to March. Respondents were part of an ongoing study of seroadaptive behaviors and HIV risk. They completed a computer-based survey on sexual behaviors in the past year, and those with an HIV-negative partner were asked whether they chose to have sex or used condoms based on whether their partner was taking PrEP. In addition, those taking PrEP were asked if they had condomless anal intercourse with an HIV-positive partner as a result of the respondent being on PrEP. Khosropour and colleagues examined the associations between sexual decision-making and the respondents’ HIV status, condomless sexual intercourse and HIV treatment status.

The study included 911 HIV-negative respondent visits and 98 HIV-positive respondent visits.

The researchers said the discussion of PrEP with HIV-negative partners before sex was common but differed for HIV-positive and HIV-negative men (68% vs. 49%; P = .004).

More HIV-positive MSM than HIV-negative MSM decided to have sex based on their partners’ PrEP use (29% vs. 16%; P = .01).

Results of the survey also indicated that HIV-positive MSM were more likely than HIV-negative MSM to not use a condom with an HIV-negative partner based on the partner’s PrEP use (40% vs. 22%; P = .001).

HIV-negative MSM who incorporated their partner’s PrEP use into their sexual decision-making were more likely to report condomless anal intercourse with an HIV-negative partner compared with those who did not base their decisions on partner PrEP use (81% vs. 68%; P = .003).

Additionally, MSM with HIV who reported taking ART were more likely to incorporate their partner’s PrEP use into their sexual decision-making than MSM who were not taking ART (44% vs. 0%), as were MSM with an undetectable viral load compared with those with a detectable viral load (44% vs. 25%). However, neither of these findings was statistically significant.

“What we found was that for HIV-positive men, it seems that if their HIV-negative partner is on PrEP … their decision about not using condoms is influenced by the partner being on PrEP,” Khosropour said.

The researchers acknowledged that they did not have HIV testing data, and therefore could not determine if newly HIV-positive tests affect these behaviors. Another potential limitation to the study was that Khosropour and colleagues could not ascertain behaviors with specific partners.

The researchers added that ongoing surveillance of these behaviors is critical to understanding the potential individual and population-level effects on HIV risk.

“Rolling out PrEP is one step, but also from a behavioral perspective in clinical settings, [clinicians need] to make sure to counsel men about talking to their partners about PrEP,” Khosropour said. – by John Schoen

Reference:

Khosropour C, et al. Abstract 1897. Presented at: National HIV Prevention Conference; Dec. 6-9, 2015; Atlanta.

Disclosure: Infectious Disease News was unable to confirm relevant financial disclosures at the time of publication.