Pre-exposure prophylaxis (PrEP) prevents HIV infection among men who have sex with men (MSM) and transgender women (TGW) who are the groups that presents the high incidence risk in Brazil. This cross-sectional secondary analysis describes possible risk compensation, attitudes, and beliefs regarding the use of PrEP among 723 MSM and TGW evaluated in the PrEP Brazil study pre-screening phase. Possible risk compensation was reported by 31.6% individuals. In the multivariate model, factors that increased the likelihood of possible risk compensation were: self-referring as white vs. Black (AOR 2.05; CI 1.09, 3.85), perceiving high likelihood of getting HIV in next 12 months (AOR 1.78; CI 1.23, 2.56), being less afraid of HIV infection if using PrEP (AOR 1.93; CI 1.19, 3.14), feeling liberated to have more partners if using PrEP (AOR 2.93; CI 1.92, 4.49), and believing closest friends would use PrEP (AOR 2.51; CI 1.1, 5.71). We found that possible risk compensation was more common among individuals who presented high-risk perception for HIV infection, probably reflecting they feel at risk and could benefit from PrEP use.
de Sousa Mascena VerasMACa lazansGJde Almeida RibeiroMCS, et al.High HIV prevalence among men who have sex with men in a time-location sampling survey, São Paulo, Brazil. AIDS Behav2015; 19: 1589–1598.
KerrLKendallCGuimarãesMDC, et al.HIV prevalence among men who have sex with men in Brazil: results of the 2nd national survey using respondent-driven sampling. Medicine (Baltimore)2018; 97: S9–S15.
5.
BaralSDPoteatTStrömdahlS, et al.Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis2013; 13: 214–222.
6.
GrinsztejnBJalilEMMonteiroL, et al.Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro, Brazil. Lancet HIV2017; 4: e169–e176.
7.
McCormackSDunnDTDesaiM, et al.Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet2016; 387: 53–60.
8.
BaetenJMDonnellDNdaseP, et al.Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med2012; 367: 399–410.
9.
GrantRMLamaJRAndersonPL, et al.Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med2010; 363: 2587–2599.
10.
LuzPMOsherBGrinsztejnB, et al.The cost-effectiveness of HIV pre-exposure prophylaxis in men who have sex with men and transgender women at high risk of HIV infection in Brazil. J Int AIDS Soc2018; 21: e25096.
11.
YiSTuotSMwaiGW, et al.Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis. J Int AIDS Soc2017; 20: 1–27.
12.
TorresTS , De BoniRBDe VasconcellosMTL, et al.Characteristics of Brazilian MSM using apps for sexual encounters: awareness of prevention strategies and willingness to use PrEP. JMIR Public Heal Surveill2018; 4(1): e11.
13.
GaleaJTKinslerJJSalazarX, et al.Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations. Int J STD AIDS2011; 22(5):256–262. DOI: 10.1258/ijsa.2009.009255.
14.
HoaglandBDe BoniRBMoreiraRI, et al.Awareness and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men and transgender women in Brazil. AIDS Behav2017; 21: 1278–1287.
15.
ZalazarVAristeguiIKerrT, et al.High willingness to use hiv pre-exposure prophylaxis among transgender women in Argentina. Transgender Heal2016; 1(1): 266–273. DOI: 10.1089/trgh.2016.0033.
16.
HoaglandBMoreiraRIDe BoniRB, et al.High pre-exposure prophylaxis uptake and early adherence among men who have sex with men and transgender women at risk for HIV Infection: the PrEP Brasil demonstration project. J Int AIDS Soc2017; 20: 1–14.
17.
LiuAGliddenD V.AndersonPL, et al.Patterns and Correlates of PrEP drug detection among MSM and transgender women in the global iPrEx study. JAIDS J Acquir Immune Defic Syndr2014; 67: 528–537.
18.
WheelockAEisingerichABAnanworanichJ, et al.Are Thai MSM willing to take PrEP for HIV prevention? An analysis of attitudes, preferences and acceptance. PLoS One2013; 8: e54288.
19.
MugwanyaKKDonnellDCelumC, et al.Sexual behaviour of heterosexual men and women receiving antiretroviral pre-exposure prophylaxis for HIV prevention: a longitudinal analysis. Lancet Infect Dis2013; 13: 1021–1028.
20.
NguyenV-KGreenwaldZRTrottierH, et al.Incidence of sexually transmitted infections before and after pre-exposure prophylaxis for HIV. AIDS2017; 32: 1.
21.
TraegerMWCornelisseVJAsselinJ, et al.Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among individuals at high risk of HIV infection. JAMA2019; 321: 1380–1390.
22.
MolinaJ-MCapitantCSpireB, et al.On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med2015; 373: 2237–2246.
23.
NewcombMEMoranKFeinsteinBA, et al.Pre-exposure prophylaxis (PrEP) use and condomless anal sex. JAIDS J Acquir Immune Defic Syndr2018; 77(4): 358–364.
24.
TraegerMWSchroederSEWrightEJ, et al.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. Clin Infect Dis2018; 67: 676–686.
25.
LalLAudsleyJMurphyDA, et al.Medication adherence, condom use and sexually transmitted infections in Australian preexposure prophylaxis users. AIDS2017; 31: 1709–1714.
26.
OldenburgCENunnASMontgomeryM, et al.Behavioral changes following uptake of hiv pre-exposure prophylaxis among men who have sex with men in a clinical setting. AIDS and Behavior2018; 22:1075–1079.
27.
JohnSARendinaHJGrovC, et al.Home-based pre-exposure prophylaxis (PrEP) services for gay and bisexual men: an opportunity to address barriers to PrEP uptake and persistence. PLoS One2017; 12(12):e0189794. DOI: 10.1371/journal.pone.0189794.
28.
KoechlinFMFonnerVADalglishSL, et al.Values and preferences on the use of pral pre-exposure prophylaxis (PrEP) for HIV prevention among multiple populations: a systematic review of the literature. AIDS Behav2017; 21: 1325–1335.
29.
GarcíaMHarrisAL. PrEP awareness and decision-making for Latino MSM in San Antonio, Texas. PLoS One2017; 12: e0184014.
30.
MijitiPYahepuDZhongX, et al.Awareness of and willingness to use oral pre-exposure prophylaxis for HIV prevention among HIV-serodiscordant heterosexual couples: a cross-sectional survey in Xinjiang, China. PLoS One2013; 8: 1–8.
31.
Carlo HojillaJKoesterKACohenSE, et al.Sexual behavior, risk compensation, and HIV prevention strategies among participants in the San Francisco PrEP demonstration project: a qualitative analysis of counseling notes. AIDS Behav2016; 20: 1461–1469.
SilvaDSDeBoniRBLakeJE, et al.Retention in early care at an HIV outpatient clinic in Rio de Janeiro, Brazil, 2000–2013. AIDS Behav2016; 20: 1039–1048.
34.
GrinsztejnBLuzPMPachecoAG, et al.Changing mortality profile among HIV-infected patients in Rio de Janeiro, Brazil: shifting from AIDS to Non-AIDS related conditions in the HAART Era. PLoS One2013; 8(4): e59768. DOI: 10.1371/journal.pone.0059768.
35.
HoltMMurphyDACallanderD, et al.Willingness to use HIV pre-exposure prophylaxis and the likelihood of decreased condom use are both associated with unprotected anal intercourse and the perceived likelihood of becoming HIV positive among Australian gay and bisexual men. Sex Transm Infect2012; 88: 258–263.
36.
EisingerichABWheelockAGomezGB, et al.Attitudes and acceptance of oral and parenteral HIV preexposure prophylaxis among potential user groups: a multinational study. PLoS One2012; 7: e28238.
37.
R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing, 2015. https://www.R-project.org/.
38.
TorresTSKondaKAHamid Vega-RamirezE, et al.Factors associated with willingness to use pre-exposure prophylaxis in Brazil, Mexico, and Peru: web-based survey among men who have sex with men. J Med Internet Res2019; 21: e13771. DOI: 10.2196/13771.
39.
Paz-BaileyGMendozaMCBFinlaysonT, et al.Trends in condom use among MSM in the United States. AIDS2016; 30: 1985–1990.
40.
LiuAYVittinghoffEChillagK, et al.Sexual risk behavior among HIV-uninfected men who have sex with men participating in a Tenofovir preexposure prophylaxis randomized trial in the United States. JAIDS J Acquir Immune Defic Syndr2013; 64: 87–94.
41.
MontañoMADombrowskiJCDasguptaS, et al.Changes in sexual behavior and STI diagnoses among MSM initiating PrEP in a clinic setting. AIDS Behav2019; 23: 548–555.
42.
GolubSAKowalczykWWeinbergerCL, et al.Preexposure prophylaxis and predicted condom use among high-risk men who have sex with men. J Acquir Immune Defic Syndr2010; 54(5): 548–555. DOI: 10.1097/QAI.0b013e3181e19a54.
43.
HoffCCChakravartyDBircherAE, et al.Attitudes towards PrEP and anticipated condom use among concordant HIV-negative and HIV-discordant male couples. AIDS Patient Care STDS2015; 29: 408–417.
44.
GrovCWhitfieldTHFRendinaHJ, et al.Willingness to take PrEP and potential for risk compensation among highly sexually active gay and bisexual men. AIDS Behav2015; 19: 2234–2244.
45.
GrantHMukandavireZEakleR, et al.When are declines in condom use while using PrEP a concern? Modelling insights from a Hillbrow, South Africa case study. J Int AIDS Soc2017; 20(1): 21744. DOI: 10.7448/IAS.20.1.21744.
46.
GreeneGJSwannGFoughtAJ, et al.Preferences for long-acting pre-exposure prophylaxis (PrEP), daily oral PrEP, or condoms for HIV prevention among U.S. men who have sex with men. AIDS Behav2017; 21: 1336–1349.
47.
BrooksRALandovitzRJReganR, et al.Perceptions of and intentions to adopt HIV pre-exposure prophylaxis among black men who have sex with men in Los Angeles. Int J STD AIDS2015; 26: 1040–1048.
48.
WareNCWyatt1MAHabererJE, et al.What’s love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis (PrEP) for HIV Serodiscordant couples. J Acquir Immune Defic Syndr2012; 59: 463–468. DOI: 10.1097/QAI.0b013e31824a060b.
49.
KumarSHaderxhanajLTSpicknallIH. Reviewing PrEP’s effect on STI incidence among men who have sex with men—balancing increased STI screening and potential behavioral sexual risk compensation. AIDS Behav. 2020. DOI: 10.1007/s10461-020-03110-x.
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