Changes in Sexual Behaviour Following PrEP Initiation Among Australian Gay and Bisexual Men in Relationships: Results from a Prospective Observational Study

Bavinton, Benjamin R.; Hammoud, Mohamed; Holt, Martin; Saxton, Peter; Bourne, Adam; MacGibbon, James; Jin, Fengyi; Maher, Lisa; Prestage, Garrett

doi:10.1007/s10461-021-03232-w

Cited by 7 publications

(10 citation statements)

References 27 publications

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“…For example, PrEP users in relationships were much more likely to have a partner who also used PrEP (59% of PrEP users vs. 9% of non-users). This is consistent with previous research that found GBM in relationships who initiate PrEP are more likely to also have a partner who uses PrEP (Bavinton et al, 2021 ). Relatedly, most PrEP users (89%) in our sample reported that their partner knew they were taking PrEP.…”

Section: Discussionsupporting

confidence: 92%

“…Some research has reported changes to sexual practices among men in relationships after commencing PrEP. For example, an Australian cohort study of GBM found that men in relationships who initiated PrEP were much more likely to have a partner who also used PrEP, to have casual sex, and to report receptive condomless sex compared with non-PrEP-users (Bavinton et al, 2021 ). Other research has found that PrEP users tend to report more sexual partners and more condomless sex than GBM who do not use PrEP (e.g., MacGibbon et al, 2021 ; Traeger et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

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Explicit Relationship Agreements and HIV Pre-exposure Prophylaxis Use by Gay and Bisexual Men in Relationships

et al. 2022

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Relationship agreements are important for HIV prevention among gay and bisexual men (GBM) in relationships, with research earlier in the HIV epidemic often finding that agreements specified monogamy or condom use with casual partners. There is evidence that HIV pre-exposure prophylaxis (PrEP) has shifted sexual practices among some men in relationships, such as allowing condomless sex with casual partners, but there has been little attention paid to relationship agreements among GBM who use PrEP. In this paper, we analyzed national, Australian, cross-sectional data from an online survey completed by non-HIV-positive GBM in 2021 (N = 1,185). Using logistic regression, we identified demographic characteristics, sexual practices and the types of relationship agreement that were associated with PrEP use among GBM in relationships. Using Pearson’s chi-squared tests, we explored whether PrEP users in relationships reported similar sexual practices to PrEP users not in relationships. PrEP use among GBM in relationships was independently associated with older age, identifying as gay, being in a non-monogamous relationship, having a spoken (explicit) relationship agreement, having a primary HIV-negative partner taking PrEP or a primary partner living with HIV, reporting recent condomless casual sex, reporting an STI diagnosis in the past year, and knowing at least one other PrEP user. We found that PrEP users in relationships had similar sexual practices to PrEP users not in relationships. GBM in relationships who have casual sex and who meet PrEP suitability criteria may be good candidates for PrEP. Our findings suggest that explicit relationship agreements remain important for HIV prevention, and they support PrEP use among GBM in relationships.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Explicit Relationship Agreements and HIV Pre-exposure Prophylaxis Use by Gay and Bisexual Men in Relationships

et al. 2022

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“…Although PrEP was associated with STI diagnosis in the simple, non-mediated model, in the mediated model, the direct path was not statistically significant. Our findings extend recent work showing that GBM who initiate PrEP use were significantly more likely to engage in CAS in the subsequent 6 months 11. Our study also extends previous literature focused on clinical cohorts of PrEP users or GBM presenting to STI clinics 7 8…”

Section: Discussionsupporting

confidence: 88%

“…However, in more recent research, PrEP initiation was associated with an increase in the proportion of GBM reporting never using condoms during anal sex as well as increases in the number of CAS partners 9 10. Other studies indicate that, as PrEP use increases, condom use simultaneously decreases 11. Although evidence has not been consistent on associations between PrEP and number of male sex partners,7 11 if PrEP is associated with an increased number of male sex partners, PrEP would also indirectly increase the likelihood of engaging in any sexual behaviour, including CAS and oral sex.…”

Section: Introductionmentioning

confidence: 93%

“…Other studies indicate that, as PrEP use increases, condom use simultaneously decreases 11. Although evidence has not been consistent on associations between PrEP and number of male sex partners,7 11 if PrEP is associated with an increased number of male sex partners, PrEP would also indirectly increase the likelihood of engaging in any sexual behaviour, including CAS and oral sex.…”

Section: Introductionmentioning

confidence: 99%

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Pre-exposure prophylaxis and bacterial sexually transmitted infections (STIs) among gay and bisexual men

et al. 2022

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ObjectivesWhile pre-exposure prophylaxis (PrEP) prevents HIV acquisition among gay, bisexual and other men who have sex with men (GBM), PrEP-using GBM may be more likely to engage in sexual behaviours associated with bacterial STIs. We examined associations between PrEP use, condomless anal sex (CAS), number of anal sex partners, oral sex and bacterial STI diagnoses among GBM living in Canada’s three largest cities.MethodsAmong HIV-negative/unknown-status GBM in the baseline of the Engage cohort study, we fit a structural equation model of the associations between any PrEP use, sexual behaviours and bacterial STI diagnosis. We estimated direct and indirect paths between PrEP use and STI via CAS, number of anal sex partners and oral sex.ResultsThe sample included 2007 HIV-negative/unknown status GBM in Montreal, Toronto and Vancouver. There was a significant direct association between PrEP use and current STI diagnosis (β=0.181; 95% CI: 0.112 to 0.247; p<0.001), CAS (β=0.275; 95% CI: 0.189 to 0.361; p<0.001) and number of anal sex partners (β=0.193; 95% CI: 0.161 to 0.225; p<0.001). In the mediated model, the direct association between PrEP use and STIs was non-significant. However, the indirect paths from PrEP to CAS to STIs (β=0.064; 95% CI: 0.025 to 0.120; p=0.008), and from PrEP to greater number of anal sex partners to CAS to STIs were significant (β=0.059; 95% CI: 0.024 to 0.108; p=0.007).ConclusionsOur study adds to the growing awareness that PrEP use among GBM may be associated with bacterial STIs because PrEP users have more anal sex partners and are more likely to engage in CAS. The results underscore the importance of providing effective STI counselling and regular testing to PrEP users, adapting PrEP care and related STI testing to individual needs, and the need for effective prevention strategies for bacterial STIs.

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Sexual behaviour and STIs among MSM living with HIV in the PrEP era: the French ANRS PRIMO cohort study

Baltes,

de Boissieu,

Champenois

et al. 2024

J Int AIDS Soc.

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IntroductionIn a context of declining condom use and high sexually transmitted infection (STI) incidence, the diffusion of “treatment as prevention” (Tasp) and more recently pre‐exposure prophylaxis (PrEP) may have changed the sexual behaviour of newly diagnosed men who have sex with men (MSM) with HIV.MethodsSix hundred and nine MSM were enrolled and followed annually between 2014 and 2021 in the ANRS PRIMO Cohort (ClinicalTrials.gov:NCT03148964) from the time of HIV seroconversion. We studied changes over calendar time in sexual behaviour before and after HIV diagnosis. Factors associated with inconsistent condom use (ICU) after HIV diagnosis, PrEP use by partner(s) and bacterial STI acquisition were studied in random‐effects models.ResultsIn the 6 months preceding HIV diagnosis, the number of sexual partners decreased from a median of 10 (IQR: 4−19) in 2014 to 6 (3−11) in 2021. After HIV diagnosis, ICU increased from 57.1% (16/28) of visits in 2014 up to 84.2% (229/272) in 2020−2021. Up to 25% (63/229) of MSM with HIV in recent years reported the use of PrEP by their partner(s) as the reason for ICU; these MSM were less frequently in a stable relationship, had a higher number of sexual partners and higher education level than those who did not report the use of PrEP by their partner(s). STI incidence after HIV diagnosis increased between 2014 and 2016 and remained high afterwards. STI risk was no longer associated with PrEP use by partners after adjustment for the number of partners and calendar period. ICU, age below 35 years, not being in a stable relationship, higher number of sexual partners were independently associated with an increased risk of STI.ConclusionsImplementation of TasP and more recently PrEP has led to major changes in the sexual behaviour of MSM with HIV. ICU has become overwhelmingly prevalent, PrEP use by the partner increasingly being the reported reason for ICU, behind TasP, which remains the main reason. Characteristics of MSM at the time of diagnosis of HIV have changed, with fewer number of sexual partners today than in 2014, which must lead to broaden the indications for PrEP prescription. STIs incidence remains high in MSM with HIV and requires improvements in screening and prevention methods such as pre‐ or post‐exposition antibiotics or vaccines.

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Changes in Sexual Behaviour Following PrEP Initiation Among Australian Gay and Bisexual Men in Relationships: Results from a Prospective Observational Study

Cited by 7 publications

References 27 publications

Explicit Relationship Agreements and HIV Pre-exposure Prophylaxis Use by Gay and Bisexual Men in Relationships

Explicit Relationship Agreements and HIV Pre-exposure Prophylaxis Use by Gay and Bisexual Men in Relationships

Pre-exposure prophylaxis and bacterial sexually transmitted infections (STIs) among gay and bisexual men

Sexual behaviour and STIs among MSM living with HIV in the PrEP era: the French ANRS PRIMO cohort study

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