Decreased condom use with casual partners of gay and bisexual participants in the VicPrEp study is associated with belief in the efficacy of PrEP

Stream: Critical Perspectives on Pre-Exposure Prophylaxis (PReP)
Date: Friday, 1 April 2016
Time: 2.00 pm – 3.45 pm


Objective: Pre-exposure prophylaxis (PrEP) decreases HIV risk among uninfected people, but risk compensation may affect prevention benefits. PrEP trials found no decrease in condom use, but included extensive prevention education. We investigated condom use with casual partners in the VicPrEP study of PrEP implementation.

Methods: Gay/bisexual men were recruited from three GP clinics and one sexual health centre in Melbourne. Participants consented to using daily Truvada and completing clinical evaluations and self-report behavioural surveys at study-entry and three-monthly intervals.

Results: Study-entry questionnaires were completed by 93 gay/bisexual men, 81 men completed three-month follow-up and 70 men completed 6 month follow-up. At study entry 67.7% were university educated and 75.3% were Australian-born; mean age was 37.7 years. The majority (>85%) of men had anal sex with casual partners in the three months before survey (no significant changes). Mean frequency of anal sex acts with casual partners remained stable. Mean perceived frequency of condom-protected anal sex acts (5-point scale: 1=none, 2=some, 3=half, 4=most, 5=all) decreased significantly (Wilks' Lambda F(53,2)=3.26; p<.05), from 3.1 at study entry to 2.6 and 2.5 at three and six months follow-up, respectively. Decrease in condom use was significantly associated with belief in the efficacy of PrEP (Wilks' Lambda F(55,2)=3.25; p<.05), but not condom attitude.

Conclusion: This study is amongst the first to document risk compensation amongst HIV-negative gay/bisexual men using PrEP. Decreased condom use with casual partners signals a change in HIV-protection strategies, reflecting confidence in PrEP. Reduced risk for HIV is contingent on adherence to PrEP.


John de Wit (Presenter), Centre for Social Research in Health
John de Wit is Professor and Director of the Centre for Social Research in Health. He has been undertaking and leading behavioural and social research regarding HIV, STI and sexual health for over 25 years, and his expertise and interest is especially with theory-informed research into the individual, social and structural factors that shape effective prevention, diagnosis and treatment. John is passionate about the translation of research into policies, programs and services. John has published widely across a range of topics and in esteemed peer-reviewed journals. He also is actively involved in various national and international advisory and organising committees.

Dean Murphy, Centre for Social Research in Health
Dr Dean Murphy is a Research Fellow at the Centre for Social Research in Health.

Luxshimi Lal, Burnet Institute

Jennifer Audsley, Doherty Institute for Immunity and Infection

Norman Roth, Prahran Market Clinic

BK Tee, Centre Clinic

Richard Moore, Northside Clinic

Timothy Read, Melbourne Sexual Health Centre

Edwina Wright, Department of Infectious Diseases, The Alfred Hospital