Effects of Pre-exposure Prophylaxis for the Prevention of Human Immunodeficiency Virus Infection on Sexual Risk Behavior in Men Who Have Sex With Men: A Systematic Review and Meta-analysis

Abstract

Findings highlight the importance of efforts to minimize STIs among PrEP users and their sexual partners. Monitoring of risk compensation among MSM in the context of PrEP scale-up is needed to assess the impact of PrEP on the sexual health of MSM and to inform preventive strategies.

HIV pre‐exposure prophylaxis and the ‘problems’ of reduced condom use and sexually transmitted infections in Australia: a critical analysis from an evidence‐making intervention perspective

“…A recent systematic review of PrEP studies found that condom use tends to fall and STI incidence rises among PrEP users over time, as they become more comfortable relying on the intervention (Traeger et al . ). The optimistic scenarios outlined here remain an unproven future, much like the scenarios expressed by those who were concerned about PrEP.…”

“…So far, a reduction in STIs has not been observed among PrEP users or in international jurisdictions that have embraced PrEP (Centers for Disease Control and Prevention, , The Kirby Institute, , Traeger et al . ). However, there is growing evidence for the optimistic position that PrEP can engage users in regular sexual health care and significantly reduce the fear of HIV (Hughes et al .…”

“…, Traeger et al . ), antibiotic resistance is rare in Australia and among PrEP users (Australian Commission on Safety and Quality in Health Care, ). The fear of uncontrolled or untreatable STI epidemics and the potential threat to public health underpinned this problematisation, drawing on a conceptual logic in which future, worst case scenarios must be imagined and countered (Adams et al .…”

“…The concerned and alarmed approach gave primacy to rare and unusual clinical presentations of STIs, implying it was inevitable that PrEP use and reduced condom use would lead to more STIs and antibiotic resistance. While research has found that PrEP users use condoms infrequently and are diagnosed with STIs at high rates (Fonner et al 2016, Traeger et al 2018, antibiotic resistance is rare in Australia and among PrEP users (Australian Commission on Safety and Quality in Health Care, 2017). The fear of uncontrolled or untreatable STI epidemics and the potential threat to public health underpinned this problematisation, drawing on a conceptual logic in which future, worst case scenarios must be imagined and countered (Adams et al 2009).…”

Daily and event‐driven pre‐exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence

“…Another concern raised in relation to PrEP refers to “risk compensation,” or a shift towards more risky sexual behaviour triggered by perceptions of decreased HIV risk . A systematic review and meta‐analysis of seventeen open‐label studies found that PrEP among MSM was associated with a decrease in overall condom use but no increase in HIV . However, these changes in sexual behaviour may increase the chances of acquiring STIs other than HIV .…”