Change in sexual risk behaviour after 6 months of pre-exposure prophylaxis use

Hoornenborg, Elske; Coyer, Liza; Laarhoven, Anna Van; Achterbergh, Roel C A; Vries, Henry De; Prins, Maria; Loeff, Maarten Schim van der

doi:10.1097/qad.0000000000001874

Cited by 71 publications

(42 citation statements)

References 14 publications

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“…However, PrEP use among MSM is expected to increase during the upcoming years [31]. A recent study in the Netherlands showed that over the first six months after initiation of PrEP, an increase in condomless anal sex with casual partners was observed [32]. Therefore, we recommend future studies to include PrEP use when assessing the relationship between chemsex and STI.…”

Section: Discussionmentioning

confidence: 99%

Chemsex among men who have sex with men living outside major cities and associations with sexually transmitted infections: A cross-sectional study in the Netherlands

et al. 2019

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Background The intentional use of drugs to have sex–chemsex–among men who have sex with men (MSM) might contribute to the high sexually transmitted infections (STI) prevalence in this group. Limited data is available on chemsex outside major cities. The current study investigated the use of a wide variety of drugs during sex among MSM living outside major cities in the Netherlands and their associations with STI. Methods In 2018, 350 MSM were recruited at STI clinics and 250 MSM completed an online questionnaire. Questionnaire data were linked to clients’ most recent STI laboratory test results. Chemsex was defined as using cocaine, crystal meth, designer drugs, GHB/GBL, ketamine, speed, or XTC/MDMA during sex in the preceding six months. The use of other drugs was also assessed. Determinants (chemsex, specific drugs, number of drugs, combining, and frequency) potentially associated with STI were assessed using multivariable logistic regression analyses adjusting for sociodemographic characteristics and sexual history. Results Chemsex was reported by 35% (95%CI: 29–41) of the 250 participants. XTC/MDMA (27%; 68/250) and GHB/GBL (26%; 64/250) were the most used drugs. STI positivity was 33% (29/87) in MSM engaging in chemsex and 12% (12/163) in MSM not engaging in chemsex (p<0.001). Half of MSM engaging in chemsex (45/87) used three of more different chemsex drugs; STI positivity in this group was 44% (20/45). The only factor independently associated with STI was the use of three or more chemsex drugs (aOR: 4.13, 95%CI: 1.77–9.62). Conclusion This study shows that chemsex is prevalent among MSM visiting the STI clinic outside major cities in the Netherlands, suggesting that health services in both urban and non-urban areas should be aware of and informed on chemsex. MSM who used multiple drugs are at particular risk for STI, indicating a special need for STI prevention and care in this group.

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Section: Discussionmentioning

confidence: 99%

Chemsex among men who have sex with men living outside major cities and associations with sexually transmitted infections: A cross-sectional study in the Netherlands

et al. 2019

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“…Nevertheless, our estimates of site-specific transmissibility could be biased as they are not adjusted for condom use. Moreover, our projections are sensitive to changes in sexual risk behavior, including the possibility of decreased condom use, e.g., in response to the introduction of HIV pre-exposure prophylaxis in the Netherlands [46]. Indirect effects on HPV transmission due to factors unrelated to HPV vaccination were beyond the scope of this study, but should be considered before planning selective vaccination of MSM.…”

Section: Discussionmentioning

confidence: 99%

Potential effectiveness of prophylactic HPV immunization for men who have sex with men in the Netherlands: A multi-model approach

et al. 2019

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Background Men who have sex with men (MSM) are at high risk for anal cancer, primarily related to human papillomavirus genotype 16 (HPV16) infections. At 8.5 per 100,000 per year, the incidence rate of anal cancer among MSM is similar to that of cervical cancer among adult women in the Netherlands. However, MSM are not included in most HPV vaccination programs. We explored the potential effectiveness of prophylactic immunization in reducing anogenital HPV16 transmission among MSM in the Netherlands. Methods and findings We developed a range of mathematical models for penile–anal HPV16 transmission, varying in sexual contact structure and natural history of infection, to provide robust and plausible predictions about the effectiveness of targeted vaccination. Models were informed by an observational cohort study among MSM in Amsterdam, 2010–2013. Parameters on sexual behavior and HPV16 infections were obtained by fitting the models to data from 461 HIV-negative study participants, considered representative of the local MSM population. We assumed 85% efficacy of vaccination against future HPV16 infections as reported for HIV-negative MSM, and age-specific uptake rates similar to those for hepatitis B vaccination among MSM in the Netherlands. Targeted vaccination was contrasted with vaccination of 12-year-old boys at 40% uptake in base-case scenarios, and we also considered the effectiveness of a combined strategy. Offering vaccine to MSM without age restrictions resulted in a model-averaged 27.3% reduction (90% prediction interval [PI] 11.9%–37.5%) in prevalence of anal HPV16 infections, assuming similar uptake among MSM as achieved for hepatitis B vaccination. The predicted reduction improved to 46.1% (90% PI 21.8%–62.4%) if uptake rates among MSM were doubled. The reductions in HPV16 infection prevalence were mostly achieved within 30 years of a targeted immunization campaign, during which they exceeded those induced by vaccinating 40% of preadolescent boys, if started simultaneously. The reduction in anal HPV16 prevalence amounted to 74.8% (90% PI 59.8%–93.0%) under a combined vaccination strategy. HPV16 prevalence reductions mostly exceeded vaccine coverage projections among MSM, illustrating the efficiency of prophylactic immunization even when the HPV vaccine is given after sexual debut. Mode of protection was identified as the key limitation to potential effectiveness of targeted vaccination, as the projected reductions were strongly reduced if we assumed no protection against future infections in recipients with prevalent infection or infection-derived immunity at the time of immunization. Unverified limitations of our study include the sparsity of data to inform the models, the omission of oral sex in transmission to the penile or anal site, and the restriction that our modeling results apply primarily to HIV-negative MSM. Conclusions Our findings suggest that targeted vaccination may generate considerable reductions in anogenital...

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“…Sexual behaviors of PrEP users have mainly been studied in the context of formal PrEP use, in particular in the context of clinical trials and demonstration projects, such as ANRS-IPERGAY [48], AMPrEP [49], iPrEx [16], and PROUD [22]. However, clinical trials may give a biased view of changes in sexual behavior, because of the selection of participants (i.e.…”

Section: Sexual Behavior and Well-beingmentioning

confidence: 99%

“…Therefore, we also explored the sexual behavior of informal PrEP users in this study. A commonly reported change in sexual behavior after initiation of PrEP use is an increase in condomless anal intercourse [49]. Studies of formal PrEP use have also highlighted reduced fear of HIV, and improved sexual satisfaction and well-being [17,50].…”

Section: Sexual Behavior and Well-beingmentioning

confidence: 99%

Socio-Sexual Experiences and Access to Healthcare Among Informal PrEP Users in the Netherlands

et al. 2020

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The aim of this qualitative study was to explore the experiences of informal PrEP users regarding access to PrEP and PrEP-related healthcare, community responses, sexual behavior and well-being. We interviewed 30 men who have sex with men (MSM) in semi-structured online interviews between March and August 2018. Interviews were analyzed using interpretive description. Informal PrEP users were well informed about the use of PrEP, but sometimes did not make use of renal testing. Participants reported a lack of PrEP knowledge among healthcare providers, which limited their access to PrEP and put them at risk, as they received incorrect information. Although some participants reported negative reactions from potential sex partners, most received positive reactions and were sometimes seen as more desirable sex partners. PrEP healthcare services should not only be accessible to formal PrEP users, but also to PrEP users who procure PrEP informally.

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Change in sexual risk behaviour after 6 months of pre-exposure prophylaxis use

Cited by 71 publications

References 14 publications

Chemsex among men who have sex with men living outside major cities and associations with sexually transmitted infections: A cross-sectional study in the Netherlands

Chemsex among men who have sex with men living outside major cities and associations with sexually transmitted infections: A cross-sectional study in the Netherlands

Potential effectiveness of prophylactic HPV immunization for men who have sex with men in the Netherlands: A multi-model approach

Socio-Sexual Experiences and Access to Healthcare Among Informal PrEP Users in the Netherlands

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