High-Risk Sexual Behavior Is Associated with Postexposure Prophylaxis Nonadherence among Men Who Have Sex with Men Enrolled in a Combination Prevention Intervention
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 ( ). This secondary analysis sought to determine whether 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 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. 1. Introduction In the United States, men who have sex with men (MSM) exhibit disproportionately high incidence and prevalence of HIV infection. MSM represent an estimated 4.7–9.2% of the total United States (US) population [1] yet, in 2009, accounted for 61% of all new HIV infections in the US [2]. Risk factors for HIV infection have been widely documented and among MSM in the US include unprotected anal intercourse, high number of male partners [3], and methamphetamine use [4, 5]. Postexposure prophylaxis (PEP) is a biomedical intervention intended to reduce the likelihood of HIV seroconversion after exposure to the virus. Combination prevention approaches combine biomedical interventions like PEP with behavioral (e.g., cognitive behavioral therapy, motivational interviewing) and/or structural (e.g., needle exchange, condom distribution) interventions, thereby optimizing the likelihood of proper adherence to the PEP medication while also reducing the risk factors placing participants at risk for HIV seroconversion. 1.1. Combination Prevention Interventions Combination prevention interventions integrate
References
[1]
D. W. Purcell, C. Johnson, A. Lansky et al., “Calculating HIV and syphilis rates for risk groups: estimating the national population size of men who have sex with men,” in Proceedings of the National STD Prevention Conference, Latebreaker #22896, Atlanta, Ga, USA, March 2010.
[2]
CDC (Centers for Disease Control and Prevention), “HIV among gay and bisexual men,” Fact Sheet, Centers for Disease Control and Prevention, Atlanta, Ga, USA, 2012, http://www.cdc.gov/hiv/topics/msm.
[3]
C. Beyrer, S. D. Baral, F. van Griensven et al., “Global epidemiology of HIV infection in men who have sex with men,” The Lancet, vol. 380, no. 9839, pp. 367–377, 2012.
[4]
M. W. Plankey, D. G. Ostrow, R. Stall et al., “The relationship between methamphetamine and popper use and risk of HIV seroconversion in the multicenter AIDS cohort study,” Journal of Acquired Immune Deficiency Syndromes, vol. 45, no. 1, pp. 85–92, 2007.
[5]
S. Shoptaw and C. J. Reback, “Associations between methamphetamine use and HIV among men who have sex with men: a model for guiding public policy,” Journal of Urban Health, vol. 83, no. 6, pp. 1151–1157, 2006.
[6]
A. E. Kurth, C. Celum, J. M. Baeten, S. H. Vermund, and J. N. Wasserheit, “Combination HIV prevention: significance, challenges, and opportunities,” Current HIV/AIDS Reports, vol. 8, no. 1, pp. 62–72, 2011.
[7]
White House Office of National AIDS Policy, National HIV/AIDS Strategy for the United States, 2012, http://www.whitehouse.gov/administration/eop/onap/nhas.
[8]
A. A. Leibowitz, A. C. Mendes, and K. Desmond, “Public funding of HIV/AIDS prevention, treatment, and support in California,” Journal of Acquired Immune Deficiency Syndromes, vol. 58, no. 1, pp. e11–e16, 2011.
[9]
CDC (Centers for Disease Control and Prevention), Strategy for and AIDS-Free Generation, 2012, http://www.cdc.gov/globalaids/Global-HIV-AIDS-at-CDC/interventions.html.
[10]
C. J. Reback, S. Shoptaw, and C. E. Grella, “Methamphetamine use trends among street-recruited gay and bisexual males, from 1999 to 2007,” Journal of Urban Health, vol. 85, no. 6, pp. 874–879, 2008.
[11]
D. G. Fisher, G. L. Reynolds, M. R. Ware, and L. E. Napper, “Methamphetamine and viagra use: relationship to sexual risk behaviors,” Archives of Sexual Behavior, vol. 40, no. 2, pp. 273–279, 2011.
[12]
D. W. Forrest, L. R. Metsch, M. LaLota, G. Cardenas, D. W. Beck, and Y. Jeanty, “Crystal methamphetamine use and sexual risk behaviors among HIV-positive and HIV-negative men who have sex with men in South Florida,” Journal of Urban Health, vol. 87, no. 3, pp. 480–485, 2010.
[13]
P. Freeman, B. C. Walker, D. R. Harris, R. Garofalo, N. Willard, and J. M. Ellen, “Methamphetamine use and risk for HIV among young men who have sex with men in 8 US cities,” Archives of Pediatrics and Adolescent Medicine, vol. 165, no. 8, pp. 736–740, 2011.
[14]
R. Rajasingham, M. J. Mimiaga, J. M. White, M. M. Pinkston, R. P. Baden, and J. A. Mitty, “A systematic review of behavioral and treatment outcome studies among hiv-infected men who have sex with men who abuse crystal methamphetamine,” AIDS Patient Care and STDs, vol. 26, no. 1, pp. 36–52, 2012.
[15]
CDC (Centers for Disease Control and Prevention), “Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services,” Morbidity and Mortality Weekly Report, vol. 54, no. 2, pp. 1–20, 2005.
[16]
R. J. Landovitz and J. S. Currier, “Postexposure prophylaxis for HIV infection,” The New England Journal of Medicine, vol. 361, no. 18, pp. 1768–1775, 2009.
[17]
M. E. Roland, T. B. Neilands, M. R. Krone et al., “A randomized noninferiority trial of standard versus enhanced risk reduction and adherence counseling for individuals receiving post-exposure prophylaxis following sexual exposures to HIV,” Clinical Infectious Diseases, vol. 53, no. 1, pp. 76–83, 2011.
[18]
C. Tsai, P. Emau, K. E. Follis et al., “Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIV(mne) infection depends critically on timing of initiation and duration of treatment,” Journal of Virology, vol. 72, no. 5, pp. 4265–4273, 1998.
[19]
J. O. Kahn, J. N. Martin, M. E. Roland et al., “Feasibility of postexposure prophylaxis (PEP) against human immunodeficiency virus infection after sexual or injection drug use exposure: the San Francisco PEP study,” Journal of Infectious Diseases, vol. 183, no. 5, pp. 707–714, 2001.
[20]
G. J. B. Sonder, J. M. Prins, R. M. Regez et al., “Comparison of two HIV postexposure prophylaxis regimens among men who have sex with men in Amsterdam: adverse effects do not influence compliance,” Sexually Transmitted Diseases, vol. 37, no. 11, pp. 681–686, 2010.
[21]
R. J. Landovitz, J. B. Fletcher, G. Inzhakova, J. E. Lake, S. Shoptaw, and C. J. Reback, “A novel combination HIV prevention strategy: post-exposure prophylaxis with contingency management for substance abuse treatment among methamphetamine-using men who have sex with men,” AIDS Patient Care and STDs, vol. 26, no. 6, pp. 320–328, 2012.
[22]
J. N. Martin, M. E. Roland, T. B. Neilands et al., “Use of postexposure prophylaxis against HIV infection following sexual exposure does not lead to increases in high-risk behavior,” AIDS, vol. 18, no. 5, pp. 787–792, 2004.
[23]
C. J. Reback, S. Larkins, and S. Shoptaw, “Changes in the meaning of sexual risk behaviors among gay and bisexual male methamphetamine abusers before and after drug treatment,” AIDS and Behavior, vol. 8, no. 1, pp. 87–98, 2004.
