High-risk Sexual Behavior is Associated with Post-Exposure Prophylaxis Non-adherence among Men who have Sex with Men Enrolled in a Combination Prevention Intervention

Jesse B Fletcher, Joshua A Rusow, Hung Le, Raphael J Landovitz, Cathy J Reback, Jesse B Fletcher, Joshua A Rusow, Hung Le, Raphael J Landovitz, Cathy J Reback

Abstract

Methamphetamine use among men who have sex with men (MSM) is associated with increased HIV prevalence, due to increased engagement in high-risk sexual behavior. Fifty-three HIV-negative, methamphetamine-using MSM were enrolled in a biobehavioral combination prevention intervention in Los Angeles, CA, to assess the feasibility of administering postexposure prophylaxis (PEP) in combination with contingency management (CM) to prevent HIV seroconversion. The study combined a CM behavioral intervention targeting reductions in methamphetamine use with a PEP biomedical intervention for HIV prevention. Those who reported recent exposure to HIV were initiated on tenofovir/emtricitabine- (Truvada)-based PEP (n=35). This secondary analysis sought to determine whether recent and/or lifetime sexual risk taking was associated with PEP adherence. Regression analyses controlling for participant sociodemographics demonstrated that, at baseline, increased number of lifetime sexually transmitted diseases (STDs; Coef.=-0.07; 95% CI=(-0.12) - (-0.01)) and recent episodes of unprotected anal intercourse (UAI; Coef.=-0.01; 95% CI= (-.01) - (-0.002)) were each associated with reductions in medication adherence. Given these associations between baseline sexual risk and PEP adherence, providers working with high-risk MSM may look to target reductions in sexual risk taking; this will reduce direct risk of HIV infection and may work to optimize medication adherence in the case of PEP initiation. Clinicaltrials.gov identifier: NCT00856323.

Keywords: HIV; MSM; Post-exposure prophylaxis; methamphetamine; sexual risk; sexually transmitted diseases (STDs).

Figures

Figure 1
Figure 1
Proposed causation model.

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