Condom migration after introduction of pre-exposure prophylaxis among HIV-uninfected adolescents in South Africa: A cohort analysis

Abstract

BackgroundApproximately 3 million adolescents and young adults (AYA), between the ages of 15 years and 24 years, are living with HIV in sub-Saharan Africa. The use of pre-exposure prophylaxis (PrEP) may be a promising HIV prevention tool to bridge the high-risk years of AYA between sexual debut and adulthood.ObjectivesConcerns have been raised that the use of PrEP could lead to an increase in sexual risk behaviour and sexually transmitted infections in general and less condom use in particular among adolescents.MethodsThis study assesses condom use among South African adolescents enrolled on a demonstration PrEP study, called Pluspills, being conducted in Cape Town and Soweto. A questionnaire on sexual risk behaviour was administered at baseline and after 4, 8 and 12 weeks. Three different questions on condom use were asked at each visit. Unless all answers indicated condom use at all times, a participant was scored ‘at risk’. McNemar’s tests and a Cochran’s Q test were used to investigate changes in condom use over time.ResultsWe interviewed 148 adolescents (66% female) at baseline. Eighty-nine participants completed all visits. In this group, an increase in condom use was observed over the period of 12 weeks. Most participants who reported behavioural changes mentioned an increase in condom use.ConclusionThere was no sign of sexual risk compensation in the 12 weeks of the study. Observed increase in condom use can be explained by an increased awareness of personal HIV risk or by social desirability or recall biases. In future research, additional data including other biomarkers of unprotected sex and longer follow-up time would be useful to help understand the relationship between PrEP use, sexual risk perception and consequent behaviours, especially in adolescents.

Youth‐friendly services and a mobile phone application to promote adherence to pre‐exposure prophylaxis among adolescent men who have sex with men and transgender women at‐risk for HIV in Thailand: a randomized control trial

“…It is encouraging that approximately 50% of participants had “high” adherence based on TFV‐DP DBS concentrations of ≥700 fmol/punch and in combination with self‐reported consistent condom use increased the overall protection to 68%. This cohort showed that with service delivery of an HIV prevention package, an increase in proportion of condom use was seen, contrary to speculated concerns of PrEP reducing condom use [48]. However, it is acknowledged that condom use can only be measured by self‐report.…”

Sexual Behaviors After PrEP Discontinuation Among HIV Serodiscordant Couples in Kenya and Uganda

“…Subsequent publications have similarly shown increases in condomless sex and sexual risk after PrEP initiation among MSM. 17 , 20 , 21 Of the few studies identified among MSM that recruited couples, none assessed longitudinal changes in sexual behaviors after PrEP initiation. Cross-sectional and qualitative data from couples in the United States and Taiwan, however, indicate intention by some HIV-negative men to use condoms less often or not at all with their primary partner or other partners if they started PrEP.…”

HIV-Infections in Male Youths: Risks Associated with Alcohol Misuse

“…Ndinga-Mavumba and Pharoah (2008) state that South Africa has reached the peak of the AIDS pandemic, and sexual behavior change is non-negotiable for moving forward in tackling the disease. HIV-prevention programs aimed at empowering youths are critically needed as young adults are disproportionally at higher risk of HIV infection (Maljaars et al, 2017). LoveLife (2020) advocates the holistic engagement of youths in HIV-prevention programs by addressing issues such as leadership, activism, agency, self-awareness, poverty, gender inequality, positive role models and effective communication.…”

“…Moreover, in understanding youths, it is also vital to recognize that many developmental milestones converge at this stage of their life such as increased cognitive development, psychological, social and structural transitions (Maljaars et al, 2017). Van Dyk, Tlou and Van Dyk (2017) point out that as youths develop; they need support in building their decisionmaking skills, especially given the peer pressure and personal stress they encounter.…”

“…This was three years after PrEP had been endorsed in the United States (Eaton, Driffin, Bauermeister, Smith & Conway-Washington, 2015) which indicates that South Africa is not far behind it its prevention interventions when compared to more developed countries. The addition of PrEP as a new prevention tool marked a new era in HIV prevention in high-risk populations such as youths (Maljaars et al, 2017). PrEP involves the administration of ARV's in HIV negative individuals as a form of prevention (Eaton et al, 2015;Maljaars et al, 2017).…”