Change In Number Of Partners Research Articles

Sexual Risk Compensation in a Pre-exposure Prophylaxis Demonstration Study Among Individuals at Risk of HIV.

A public health concern regarding HIV pre-exposure prophylaxis (PrEP) is sexual risk compensation (ie, increased unsafe sex among PrEP users that may undermine prevention efforts). This demonstration study (NCT#01761643; initiated in 2013) included 398 men who have sex with men who initiated PrEP and were followed over 48 weeks at 4 sites in Southern California. Wilcoxon signed-rank tests compared previous 30-day number of sex partners and condomless insertive anal sex and receptive anal sex (CIAS and CRAS, respectively) acts at weeks 4, 12, 24, 36, and 48 to baseline. At 2 sites, PrEP users were also compared with a lagged, comparison group of 99 men who have sex with men who did not receive PrEP over 24 weeks using linear regression models, adjusting for age, race/ethnicity, education, and respective baseline scores. Logistic regression compared week 24 sexually transmitted infection (STI) rates. Over 48 weeks in the PrEP group, there were significant decreases in the number of unknown HIV status sex partners and increases in CRAS at all study visits; there was no consistent change in number of HIV+ sex partners or CIAS. Among participants at 2 sites, there were no significant differences between PrEP and non-PrEP users in change in number of partners, CIAS, CRAS, or STI rates at week 24. Among early adopters of PrEP, there is some evidence for sexual risk compensation. Results support current guidelines of regular STI screening and behavioral risk reduction and adherence counseling with the provision of PrEP.

Behavioral Changes Following Uptake of HIV Pre-exposure Prophylaxis Among Men Who Have Sex with Men in a Clinical Setting.

We describe changes in sexual behaviors among men who have sex with men (MSM) following initiation of pre-exposure prophylaxis (PrEP) in a clinic-based sample of MSM initiating PrEP in Providence, Rhode Island. Data were collected at baseline, 3, and 6months following PrEP initiation including total number of anal sex partners and condom use. A longitudinal mixed effects model assessed changes in number of partners and condom use over time, adjusting for age, race, and education. There was no statistically significant difference in total number of partners over time. There was a significant increase in number of condomless anal sex partners at the 6-month visit compared to baseline (mean change +1.31 partners, 95% confidence interval 0.09-2.53, P=0.035). As condomless anal sex may increase following PrEP uptake, adherence counseling and efforts to retain patients in PrEP care, especially during periods of non-condom use, are important as PrEP is more widely implemented.

Using Integrative Data Analysis to Examine Changes in Alcohol Use and Changes in Sexual Risk Behavior Across Four Samples of STI Clinic Patients.

Patients in sexually transmitted infection (STI) clinics report high levels of alcohol use, which are associated with risky sexual behavior. However, no studies have examined how changes in alcohol use relate to changes in sexual risk behavior. We used parallel process latent growth modeling to explore how changes in alcohol use related to changes in sexual behavior across four samples of clinic patients. Patients participating in HIV prevention trials from urban clinics in the Northeastern and Midwestern USA (N = 3761, 59% male, 72% Black) completed measures at 3-month intervals over 9-12months. Integrative data analysis was used to create composite measures of alcohol use across samples. Sexual risk measures were counts of partners and unprotected sex acts. Parallel process models tested whether alcohol use changes were correlated with changes in the number of partners and unprotected sex. Growth models with good fit showed decreases that slowed over time in sexual risk behaviors and alcohol use. Parallel process models showed positive correlations between levels of (rs = 0.17-0.40, ps < 0.001) and changes in (rs = 0.21-0.80, ps < 0.05) alcohol use and number of sexual partners across studies. There were strong associations between levels of (rs = 0.25-0.43, ps < 0.001) and changes in (rs = 0.24-0.57, ps < 0.01) alcohol use and unprotected sex in one study recruiting hazardous drinkers. Across four samples of clinic patients, reductions in alcohol use were associated with reductions in the number of sexual partners. HIV prevention interventions may be strengthened by addressing alcohol use.

Measuring change in sexual behavior: Concordance between survey measures

Measuring change in sexual behavior as reliably as possible is a crucial methodological issue in evaluation research. We compared two methods of assessing behavior change: the retrospective change method, which asks respondents about change explicitly by asking whether they have made any changes in their sexual behavior in a past time period, and the longitudinal or panel method, which asks respondents at two different times about their sexual behavior and compares the two sets of answers. Among heterosexual men and women (N = 962) in the AIDS in Multi‐Ethnic Neighborhoods (AMEN) Cohort Survey, the two methods of measuring change in condom use agreed, with a kappa of 0.38. The same was true among gay men (N = 596) where kappa for agreement was 0.35. However, among both heterosexuals and gay men, the two methods of measuring change in number of partners had a small but significant level of disagreement. Among heterosexuals, kappa was ‐0.14; among gay men, kappa was ‐0.16. Where the two types of change measures disagree, the data do not permit us to say which measure is more valid. Further research on concordance between measures of change in sexual behavior and on validity of change measures is recommended.