Is HIV PrEP a licence to thrill for MSM?
This month saw the publication in the Lancet of the PROUD study results from the UK. The PROUD study investigated the efficacy of HIV pre exposure prophylaxis (PrEP) in a cohort of high risk men who have sex with men(MSM) in the UK.
The paper and results are available here.
When I heard Professor Sheena McCormack present some of the data in Sydney at a meeting last month, I remember here stating that the provision of PrEP did not lead to increased risk behaviour based on interpreting a number of parameters over different time points.
I think it is important to note that in this study those persons recruited were already exhibiting high risk behaviour prior to the study and this probably continued.
If PrEP is rolled out through access programs it will be focussed on providing access to those at high risk.
I have certainly found over time that those people who have high risk sexual behaviour generally do not alter their behaviour despite intervention, counselling or the negative effect of consequences, such is STIs and HIV.
If PrEP was more widely available I expect there will be a group of people who do increase their risk behaviour because the feel protected from HIV. This may include higher risk sex, such as unprotected receptive anal sex vs insertive, more sexual partners and having sex with known HIV infected persons.
Also if more men are having more sex and more unsafe sex, the incidence of STIs might increase and this can lead to increased risk of HIV acquisition.
It is very difficult for doctors, study nurses or other health care workers to know exactly what people are up to from a sexual behaviour and risk point of view.
I think only time will tell about the long term benefits, risks, and harm of PrEP once it is implemented at a population level.
At worst we may see an increase in STIs and HIV and other medical complications of the medication.
Of course the aim of PrEP, and what has been shown so far in trials is that the incidence of HIV decreases significantly in those who are adherent to the medication regimen.