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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Sexual behaviour of heterosexual men and women receiving antiretroviral pre-exposure prophylaxis for HIV prevention: A longitudinal analysis
The Lancet Infectious Diseases, Volume 13, No. 12, Year 2013
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Description
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 56132 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. Funding: The Bill & Melinda Gates Foundation and the US National Institute of Mental Health. © 2013 Elsevier Ltd.
Authors & Co-Authors
Mugwanya, Kenneth K.
United States, Seattle
University of Washington
Uganda, Kampala
Makerere University
Donnell, Deborah J.
United States, Seattle
Fred Hutchinson Cancer Research Center
United States, Seattle
University of Washington
Celum, Connie L.
United States, Seattle
University of Washington
Thomas, Katherine K.
United States, Seattle
University of Washington
Ndase, Patrick
United States, Seattle
University of Washington
Mugo, Nelly Rwamba
United States, Seattle
University of Washington
Kenya, Nairobi
University of Nairobi
Kenya, Nairobi
Kenyatta National Hospital
Katabira, Elly Tebasoboke
Uganda, Kampala
Makerere University
Ngure, Kenneth K.
United States, Seattle
University of Washington
Kenya, Nairobi
Kenyatta National Hospital
Kenya, Nairobi
Jomo Kenyatta University of Agriculture and Technology
Baeten, Jared M.
United States, Seattle
University of Washington
Statistics
Citations: 109
Authors: 9
Affiliations: 6
Identifiers
Doi:
10.1016/S1473-3099(13)70226-3
ISSN:
14733099
e-ISSN:
14744457
Research Areas
Disability
Health System And Policy
Infectious Diseases
Maternal And Child Health
Mental Health
Sexual And Reproductive Health
Study Design
Cohort Study
Participants Gender
Male
Female