PEP for sexual exposure to HIV doesn't lead to more risky sex

Michael Carter
Published: 06 April 2004

Providing individuals with post-exposure prophylaxis (PEP) against HIV infection after high-risk activities such as unprotected sex or injecting drug use does not lead to an increase in risk-taking behaviour, according to a study conducted in San Francisco and published in the March 25th edition of AIDS. The investigators conclude that PEP, including both antiretroviral medication and risk-reduction counselling, should be routinely considered for all individuals following a potential high-risk sexual exposure.

Provision of PEP for non-occupational exposure to HIV is becoming more widespread in both the US and Europe. However, concern has been expressed in some quarters that the availability of PEP after risky sex or drug use could lead to more unsafe activity and requests for repeat supplies of PEP.

Investigators in San Francisco designed a one year study to see if individuals provided with PEP after a high-risk sexual or drug use incident requested further prescriptions. The investigators also assessed changes in risk behaviour after PEP use, HIV seroconversion rates, and acquisition of new sexually transmitted infections (STIs).

A four-week course of PEP was provided to 397 HIV-negative individuals, 334 (92%) of whom were gay men, 29 were heterosexual men and 34 were women. Structured interviews were conducted when PEP was initially prescribed and at months six and twelve to determine baseline risky behaviour and changes in such behaviours after the use of PEP. Repeat HIV tests were performed at the both the month six and month twelve visits. Five counselling sessions designed to equip individuals with HIV risk-reduction skills were also provided during the four weeks when PEP was being taken.

Within the twelve months of the study, it was possible for individuals to request up to four repeat administrations of PEP.

Within a year of the initial PEP prescription and counselling sessions, 83% of individuals did not request a repeat course of PEP. A total of 55 individuals (17%) did request further PEP. Depression, greater numbers of sexual partners, and a lower level of education were all independently associated with requesting further courses of PEP (data not published).

Overall, however, the investigators noted that individuals who received PEP reduced their HIV risk-taking behaviour in the year after receiving PEP. At the month six interview, 77% of gay men reported a reduction in high-risk sexual behaviour from their baseline interview, 15% reported no change, and only 8% reported an increase (p<0.001). At the month twelve interview, 76% of gay men reported a reduction in risk behaviour since baseline, 11% no change, and 13% an increase (p<0.001).

The investigators also found that the provision of PEP was unrelated to the acquisition of sexually transmitted infections (STIs). In the twelve months of the study, 85% of individuals had no change in their incidence of STIs, 8.5% had an increase, and 6.8% had a reduction. This pattern was observed in gay men, heterosexual men, and women.

A total of four individuals (three gay men and one woman) became HIV-positive during the twelve months of the study. All these individuals were HIV-negative at their month six study visit, suggesting that their infection was neither the result of their initial HIV exposure leading to the request for PEP or the failure of this course of PEP. The HIV incidence rate for gay men in the study was 1.2 per 100 person years of follow-up, comparable to the annual incidence rates for HIV for gay men in San Francisco which were 1.04 per 100 person years in 1997 and 2.2 per 100 person years in 2000.

“The most substantial concern about PEP for non-occupational exposures is whether its availability will encourage high-risk behaviour and repeated demands for PEP,” note the investigators. However, they add that their study “dispels this concern and demonstrates that most individuals do not experience sexual behaviour disinhibition after receipt of PEP that includes both antiretroviral medication and risk-reduction counselling.” The investigators conclude, “We believe that PEP, comprising both antiretroviral medication and risk reduction counselling, should be routinely considered following high-risk sexual exposures.”

Further information on this website

Reference

Martin JN et al. Use of post-exposure prophylaxis against HIV infection following sexual exposure does not lead to increases in high-risk behaviour. AIDS 18: 787-792, 2004.

Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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