Older, better-educated gay men who use
sexual networking sites and have sex outside the context of committed
relationships may be appropriate targets for intermittent pre-exposure
prophylaxis (PrEP), US research published in the online edition of the Journal of Acquired Immune Deficiency
The investigators found that individuals
with this profile were more likely to plan their sexual encounters and to have
anal sex fewer than three times per week.
“Our study serves to better characterize
MSM [men who have sex with men] who may most benefit from event-based
intermittent PrEP,” comment the authors.
The iPrEX study involving gay and other MSM
showed that PrEP significantly reduced the risk of acquiring infection with
However, adherence is a major barrier to
the success of PrEP. There are also concerns about its cost and potential side-effects.
Intermittent dosing has been proposed as a way of overcoming these limitations. A recently published study showed that adherence was also challenging when an intermittent dosing strategy was used.
This treatment strategy involves taking a
dose of antiretroviral therapy before a risky sexual encounter, with a second
dose taken shortly after.
This strategy will only be suitable for people who engage in risky sex fewer than three times per week, and who
plan their sexual encounters.
Investigators in the US wished to establish
a better understanding of the characteristics of gay men and other MSM who fulfilled
HIV-negative gay men were recruited to the
study using social networking sites in late 2010. All were sexually active
(defined as anal sex within the previous month). The men supplied demographic
data, as well as information about their sexual risk behaviour, how they
planned their sexual encounters, their use of sexual networking media and their
A total of 1013 men participated in the
research. Their median age was 28 years. Most (56%) participants reported that
their last anal sex was unprotected.
When asked about their sexual activity in
the previous week, 49% of men reported that they had had no sex, 27% said they
had had sex once and 9% reported sex on two days. The remaining 15% of men said
they had had sex on three or more days.
Half the men reported that their last
sexual encounter involved no advance planning, and for 8% of men planning
consisted of a few minutes notice before the event. The remaining men reporting planning sex hours
(22%), one to three days (11%), or more than three days (8%) in advance.
In all, 31% of men reported both less
frequent sex and planning sex and were therefore potential candidates for
Factors associated with less frequent sex
and its planning were older age (median 30 vs 27 years, p < 0.001), higher
likelihood of completing a college education (46 vs 32%, p < 0.001), an
HIV test within the past twelve months (54 vs 47%, p = 0.033), use of sexual
networking sites at least once a week (55 vs 44%, p = 0.001) and last sexual
encounter with a non-committed partner (60 vs 38%, p < 0.001).
knowledge regarding sexual frequency and planning will be crucial in
identifying MSM who may benefit from this intervention [intermittent PrEP]”,
conclude the investigators. “With use of tenofovir/FTC as PrEP, daily dosing
will still remain necessary for the majority of high-risk MSM who report more
frequent sexual activity or less planning.”