Qualitative data from the PROUD study revealed that pre-exposure prophylaxis (PrEP) is an important added prevention tool to strategies already in place for men in England having frequent condomless sex, according to a recent article in AIDS and Behavior.
While approximately half of the participants indicated that they had made changes to other risk reduction strategies after starting PrEP, the other half did not alter their behaviours. In the context of sexualised drug use, online sex apps and changing social norms around sex, the authors assert that PrEP offers an important additional preventative option that can be tailored to the changing needs of men who have sex with men (MSM).
Results from the PROUD trial, published in The Lancet in 2015, indicated that PrEP reduced HIV acquisition by 86%, with no infections among participants taking PrEP at the likely time of exposure. The PROUD trial details and findings can be viewed here.
In the main trial analysis, although a larger proportion of those allocated to the immediate arm reported receptive condomless sex than those in the deferred arm, there was no statistically significant increase in STIs for those taking PrEP versus those not taking it. The conclusion from the trial was that PrEP is a highly effective tool for preventing new HIV infections and does not necessarily contribute to an increase of other STIs.
For the qualitative component of PROUD, purposive sampling identified a subset of 41 trial participants for in-depth interviews from February 2014 to January 2016. Participants were selected based on trial arm allocation (immediate or deferred), changes in self-reported risk behaviour (high risk or low/medium risk) and self-reported adherence for those in the immediate arm (high or low). Areas explored included sexual risk behaviour as well as perceptions, experiences and usage of PrEP.
By the time of the interview, 33 people were or had been using PrEP: either as a result of the trial or from other sources. Average time using PrEP was 14.3 months, with high adherence. Participants mainly came from London clinics, with some from Sheffield, Manchester and Brighton. Median age was 37.4, the majority were white and university educated. Nearly half the men reported contracting an STI in the previous year, with a median number of 10 anal sex partners. The majority (90%) had had receptive anal sex without a condom in the last 90 days.