Sexual Behaviour Of Heterosexual Men And Women Receiving Antiretroviral Pre-exposure Prophylaxis For HIV Prevention: A Longitudinal Analysis
Date
2013-12Author
Mugwanya, Kenneth K
Donnell, Deborah
Celum, Connie
Thomas, Katherine K
Ndase, Patrick
Mugo, Nelly
Katabira, Elly
Ngure, Kenneth
Baeten, Jared M
Type
ArticleLanguage
enMetadata
Show full item recordAbstract
Background
Scarce data are available to assess sexual behaviour of individuals using antiretroviral pre-exposure prophylaxis for HIV prevention. Increased sexual risk taking by individuals using effective HIV prevention strategies, like pre-exposure prophylaxis, could offset the benefits of HIV prevention. We studied whether the use of pre-exposure prophylaxis in HIV-uninfected men and women in HIV-serodiscordant couples was associated with increased sexual risk behaviour.
Methods
We undertook a longitudinal analysis of data from the Partners PrEP Study, a double-blind, randomised, placebo-controlled trial of daily oral pre-exposure prophylaxis among HIV-uninfected partners of heterosexual HIV-serodiscordant couples (n=3163, ≥18 years of age). Efficacy for HIV prevention was publicly reported in July 2011, and participants continued monthly follow-up thereafter. We used regression analyses to compare the frequency of sex—unprotected by a condom—during the 12 months after compared with the 12 months before July 2011, to assess whether knowledge of pre-exposure prophylaxis efficacy for HIV prevention caused increased sexual risk behaviour.
Results
We analysed 56 132 person-months from 3024 HIV-uninfected individuals (64% male). The average frequency of unprotected sex with the HIV-infected study partner was 59 per 100 person-months before unmasking versus 53 after unmasking; we recorded no immediate change (p=0·66) or change over time (p=0·25) after July, 2011. We identified a significant increase in unprotected sex with outside partners after July, 2011, but the effect was small (average of 6·8 unprotected sex acts per year vs 6·2 acts in a predicted counterfactual scenario had patients remained masked, p=0·04). Compared with before July, 2011, we noted no significant increase in incident sexually transmitted infections or pregnancy after July, 2011.
Interpretation
Pre-exposure prophylaxis, provided as part of a comprehensive prevention package, might not result in substantial changes in risk-taking sexual behaviour by heterosexual couples.
URI
http://www.sciencedirect.com/science/article/pii/S1473309913702263http://hdl.handle.net/11295/65422
Citation
The Lancet Infectious Diseases Volume 13, Issue 12, December 2013, Pages 1021–1028Publisher
Universty of Nairobi
Collections
- Faculty of Health Sciences (FHS) [10377]