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Greater Levels of Self-Reported Adherence to Pre-Exposure Prophylaxis (PrEP) are Associated with Increased Condomless Sex Among Men Who Have Sex with Men

AIDS and Behavior volume 24, pages 3192–3204 (2020)Cite this article

Abstract

The effectiveness of pre-exposure prophylaxis (PrEP) against HIV acquisition depends on treatment adherence; however, within-person associations between levels of PrEP adherence and engagement in condomless sex have not been well studied. In the context of a demonstration project, 372 men who have sex with men received once-daily PrEP and completed six study visits over 48 weeks. Two-part growth mixture modeling was used to examine the longitudinal trajectory of condomless anal intercourse (CAI) and self-reports of PrEP adherence, controlling for relevant covariates. Over time, greater PrEP adherence was contemporaneously associated with both a higher likelihood of engaging in any CAI and with a greater number of CAI acts. Substance use was also associated with a higher likelihood of engaging in CAI. Contemporaneous associations between self-reported PrEP adherence and CAI suggest that adherence behaviors may be motivated by the desire to mitigate risk of HIV infection; however, exact directionality is unknown.

Resumen

La eficacia de la profilaxis Pre-exposición (PrEP) contra la adquisición del VIH depende de la adherencia al tratamiento; sin embargo, las asociaciones dentro de la persona entre los niveles de adherencia a PrEP y la participación en el sexo sin condón no han sido bien estudiadas. En un proyecto de demostración, 372 hombres que tienen relaciones sexuales con hombres recibieron PrEP diariamente y completaron seis visitas de estudio durante 48 semanas. El modelado de mezclas de crecimiento en dos partes se utilizó para examinar la trayectoria longitudinal de las relaciones sexuales anales sin condonación (CAI) y los autoinformes de adherencia a PrEP, controlando las covariables pertinentes. Con el tiempo, una mayor adherencia a PrEP se asoció a la misma vez con una mayor probabilidad de participar en cualquier CAI y tambien con un mayor número de CAI. El consumo de sustancias también se asoció con una mayor probabilidad de participar en CAI. Las asociaciones contemporáneas entre la adherencia a PrEP autoinformada y CAI sugieren que los comportamientos de adherencia pueden estar motivados por el deseo de mitigar el riesgo de infección por el VIH; sin embargo, se desconoce la direccionalidad exacta.

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Fig. 1

Notes: Subs. Use Substance use; PrEP Adh Pre-exposure prophylaxis adherence; CAI Condomless anal intercourse; int. intercept. Small filled circles on arrows denote random slopes while small filled circles at the end of arrows denote random intercepts estimated in the model. Doubleheaded arrows denote correlations between growth factors

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Acknowledgements

This work was supported by the California HIV Research Program (CHRP: EI-11-SD-005). Study drug was provided by Gilead Sciences and DBS assays were paid for through a grant from Gilead Sciences. The authors would like to thank all the participants who volunteered for this study and all research coordinators and assistants who made data collection possible.

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Authors and Affiliations

  1. Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, 95128, USA

    Elizabeth C. Pasipanodya

  2. UCLA Center for HIV Identification, Prevention and Treatment Services (CHIPTS), Los Angeles, CA, 90024, USA

    Michael J. Li

  3. Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, 92093, USA

    Sonia Jain, Xiaoying Sun, Eric Ellorin, Jill Blumenthal & Sheldon H. Morris

  4. Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA

    Jessica Tobin, Michael Dube & Joel Milam

  5. Los Angeles Biomedical Research Institute At Harbor-UCLA Medical Center, Torrance, CA, 90502, USA

    Eric S. Daar

  6. The Lundquist Institute, Torrance, CA, 90502, USA

    Katya Corado

  7. Department of Psychiatry, HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, MC8231, San Diego, CA, 92103, USA

    David J. Moore

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Pasipanodya, E.C., Li, M.J., Jain, S. et al. Greater Levels of Self-Reported Adherence to Pre-Exposure Prophylaxis (PrEP) are Associated with Increased Condomless Sex Among Men Who Have Sex with Men. AIDS Behav 24, 3192–3204 (2020). https://doi.org/10.1007/s10461-020-02881-7

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Keywords

  • HIV
  • PrEP
  • Adherence
  • Risk compensation
  • Condomless sex