Estimating HIV Protective Effects of Method Adherence With Combinations of Preexposure Prophylaxis and Condom Use Among African American Men Who Have Sex With Men

Background Prevention of sexually acquired HIV infection now includes both consistent condom use and daily use of oral antiretroviral preexposure prophylaxis (PrEP). Persons at substantial HIV risk can now use one or both prevention methods, but a combined HIV protective effect has not been assessed. Methods We use deterministic models to examine the impact of method adherence and rates of PrEP and male condom use on number of anticipated HIV infections. Analyses were based on hypothetical cohorts of 10,000 African American men who have sex with men (AAMSM), a population with the highest HIV incidence in the United States. Parameters used in the model (condom effectiveness, PrEP effectiveness, HIV incidence) were based on published findings. Results Among AAMSM who never use PrEP, an estimated 323 annual HIV infections would occur among those who always use condoms, 1007 among sometimes condom users, and 1094 among never condoms users. Among AAMSM who never (or inconsistently) use condoms, 295 (272) infections would occur among those who report at least 90% PrEP adherence and 744 (684) infection occur with less than 50% adherence. Among AAMSM who are consistently (or sometimes) taking PrEP, the highest protection is seen with consistent condom use, 87 (220) HIV infections and 92.0% (79.9%) prevention effectiveness. Discussion Among AAMSM with inconsistent or never condom use, the addition of PrEP at either modest or high adherence can increase HIV protection. For consistent condom users, any PrEP use can increase HIV protection. These analyses provide an approach for rethinking HIV risk management by calculating combined HIV protective effects of using one or more effective prevention methods.

[1]  Megha L Mehrotra,et al.  Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. , 2014, The Lancet. Infectious diseases.

[2]  Laura Kann,et al.  Youth risk behavior surveillance--United States, 2013. , 2014, MMWR supplements.

[3]  S. Golub.  Tensions Between the Epidemiology and Psychology of HIV Risk: Implications for Pre-exposure Prophylaxis , 2014, AIDS and Behavior.

[4]  T. Kirby,et al.  Uptake of PrEP for HIV slow among MSM , 2014, The Lancet.

[5]  J. Herbst,et al.  Title: Condom Effectiveness for HIV Prevention by Consistency of Use among Men Who Have Sex with Men (MSM) in the U.S. , 2014 .

[6]  J. Dovidio,et al.  The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access , 2014, AIDS and Behavior.

[7]  D. Glidden,et al.  No Evidence of Sexual Risk Compensation in the iPrEx Trial of Daily Oral HIV Preexposure Prophylaxis , 2013, PloS one.

[8]  S. Braunstein,et al.  HIV incidence among men with and those without sexually transmitted rectal infections: estimates from matching against an HIV case registry. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  D. Donnell,et al.  O11.2 Sexual Behaviour of Heterosexual Men and Women Receiving Antiretroviral Pre-Exposure Prophylaxis For HIV Prevention: Post-Unblinding Analysis of the Partners PrEP Study , 2013, Sexually Transmitted Infections.

[10]  C. Hendrix,et al.  Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial , 2013, The Lancet.

[11]  K. Sepkowitz,et al.  Knowledge and Use of Pre-Exposure Prophylaxis Among an Online Sample of Young Men Who Have Sex with Men in New York City , 2013, AIDS and Behavior.

[12]  Madison,et al.  U.S. Selected Practice Recommendations for Contraceptive Use, 2013: adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd edition. , 2013, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[13]  W. Mosher,et al.  Current contraceptive use in the United States, 2006-2010, and changes in patterns of use since 1995. , 2012, National health statistics reports.

[14]  J. Carey,et al.  Development of a Clinical Screening Index Predictive of Incident HIV Infection Among Men Who Have Sex With Men in the United States , 2012, Journal of acquired immune deficiency syndromes.

[15]  John T Brooks,et al.  Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. , 2012, The New England journal of medicine.

[16]  James D. Campbell,et al.  Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. , 2012, The New England journal of medicine.

[17]  R. Geskus,et al.  Less decrease in risk behaviour from pre-HIV to post-HIV seroconversion among MSM in the combination antiretroviral therapy era compared with the pre-combination antiretroviral therapy era , 2012, AIDS.

[18]  M. Rotheram-Borus,et al.  A US policy perspective on oral preexposure prophylaxis for HIV. , 2011, American journal of public health.

[19]  Ruiguang Song,et al.  Estimated HIV Incidence in the United States, 2006–2009 , 2011, PloS one.

[20]  L. Torian,et al.  HIV/AIDS Complacency and HIV Infection Among Young Men Who Have Sex With Men, and the Race-Specific Influence of Underlying HAART Beliefs , 2011, Sexually transmitted diseases.

[21]  Travis Sanchez,et al.  Reasons for Not HIV Testing, Testing Intentions, and Potential Use of an Over-the-Counter Rapid HIV Test in an Internet Sample of Men Who Have Sex With Men Who Have Never Tested for HIV , 2011, Sexually transmitted diseases.

[22]  P. Halkitis,et al.  Sexual Behaviors of Adolescent Emerging and Young Adult Men Who Have Sex With Men Ages 13–29 in New York City , 2011, Journal of acquired immune deficiency syndromes.

[23]  Robin A. Jeffries,et al.  Behaviors of Recently HIV-Infected Men Who Have Sex With Men in the Year Postdiagnosis: Effects of Drug Use and Partner Types , 2011, Journal of acquired immune deficiency syndromes.

[24]  Increase in newly diagnosed HIV infections among young black men who have sex with men--Milwaukee County, Wisconsin, 1999-2008. , 2011, MMWR. Morbidity and mortality weekly report.

[25]  W. Mcfarland,et al.  Behavior, Intention or Chance? A Longitudinal Study of HIV Seroadaptive Behaviors, Abstinence and Condom Use , 2011, AIDS and Behavior.

[26]  David V Glidden,et al.  Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. , 2010, The New England journal of medicine.

[27]  J. Fortenberry,et al.  Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States. , 2010, The journal of sexual medicine.

[28]  T. Peterman,et al.  Condom use in the year following a sexually transmitted disease clinic visit , 2009, International journal of STD & AIDS.

[29]  M. Hogben,et al.  Disinhibition and risk compensation: scope, definitions, and perspective. , 2008, Sexually transmitted diseases.

[30]  M. Hogben,et al.  Internet partner notification: another arrow in the quiver. , 2008, Sexually transmitted diseases.

[31]  Else Smith.  [Condom effectiveness in reducing heterosexual HIV transmission]. , 2002, Ugeskrift for laeger.

[32]  Family.  Selected practice recommendations for contraceptive use , 2002 .

[33]  J L Collins,et al.  Youth Risk Behavior Surveillance--United States, 1997. State and Local YRBSS Coordinators. , 1998, The Journal of school health.