PrEP Use Among Female Sex Workers: No Evidence for Risk Compensation.
Adolescent
Adult
Benin
Biomarkers
DNA
/ analysis
Female
Genes, Y-Linked
HIV Infections
/ prevention & control
Humans
Pre-Exposure Prophylaxis
Prospective Studies
Prostate-Specific Antigen
Safe Sex
Self Report
Sex Workers
Sexual Behavior
Sexually Transmitted Diseases
/ diagnosis
Unsafe Sex
/ statistics & numerical data
Young Adult
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
01 11 2019
01 11 2019
Historique:
pubmed:
30
7
2019
medline:
15
5
2020
entrez:
30
7
2019
Statut:
ppublish
Résumé
Little is known about risk compensation among female sex workers (FSW) on HIV pre-exposure prophylaxis (PrEP), and self-report of sexual behaviors is subject to bias. Prospective observational PrEP demonstration study conducted among FSW in Cotonou, Benin. Over a period of 24 months, we assessed and compared trends in unprotected sex as measured by self-report (last 2 or 14 days), by detection of sexually transmitted infections (STIs), and by vaginal detection of prostate-specific antigen and Y-chromosomal DNA, 2 biomarkers of semen exposure in the last 2 or 14 days, respectively. Trends were assessed and compared using a log-binomial regression that was simultaneously fit for all unprotected sex measures. Of 255 participants, 120 (47.1%) completed their follow-up. Prevalence of STI decreased from 15.8% (95% confidence interval: 11.8% to 21.0%) at baseline to 2.1% (95% confidence interval: 0.4% to 10.2%) at 24 months of follow-up (P-trend = 0.04). However, we observed no trend in self-report of unprotected sex in the last 2 (P = 0.42) or 14 days (P = 0.49), nor in prostate-specific antigen (P = 0.53) or Y chromosomal DNA (P = 0.25) over the same period. We observed no statistically significant difference between trends in self-report of unprotected sex and trends in biomarkers of semen exposure in the last 2 days (P = 0.14) or in the last 14 days (P = 0.29). We observed no evidence of risk compensation, and a decrease in STI among FSW on PrEP. PrEP intervention may be an opportunity to control STI among FSW. Future studies should assess risk compensation with biomarkers of semen exposure when possible.
Sections du résumé
BACKGROUND
Little is known about risk compensation among female sex workers (FSW) on HIV pre-exposure prophylaxis (PrEP), and self-report of sexual behaviors is subject to bias.
SETTING
Prospective observational PrEP demonstration study conducted among FSW in Cotonou, Benin.
METHODS
Over a period of 24 months, we assessed and compared trends in unprotected sex as measured by self-report (last 2 or 14 days), by detection of sexually transmitted infections (STIs), and by vaginal detection of prostate-specific antigen and Y-chromosomal DNA, 2 biomarkers of semen exposure in the last 2 or 14 days, respectively. Trends were assessed and compared using a log-binomial regression that was simultaneously fit for all unprotected sex measures.
RESULTS
Of 255 participants, 120 (47.1%) completed their follow-up. Prevalence of STI decreased from 15.8% (95% confidence interval: 11.8% to 21.0%) at baseline to 2.1% (95% confidence interval: 0.4% to 10.2%) at 24 months of follow-up (P-trend = 0.04). However, we observed no trend in self-report of unprotected sex in the last 2 (P = 0.42) or 14 days (P = 0.49), nor in prostate-specific antigen (P = 0.53) or Y chromosomal DNA (P = 0.25) over the same period. We observed no statistically significant difference between trends in self-report of unprotected sex and trends in biomarkers of semen exposure in the last 2 days (P = 0.14) or in the last 14 days (P = 0.29).
CONCLUSIONS
We observed no evidence of risk compensation, and a decrease in STI among FSW on PrEP. PrEP intervention may be an opportunity to control STI among FSW. Future studies should assess risk compensation with biomarkers of semen exposure when possible.
Identifiants
pubmed: 31356468
doi: 10.1097/QAI.0000000000002134
pmc: PMC6798737
doi:
Substances chimiques
Biomarkers
0
DNA
9007-49-2
Prostate-Specific Antigen
EC 3.4.21.77
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
257-264Références
Soc Sci Med. 2013 Oct;94:115-23
pubmed: 23597916
Int J STD AIDS. 2007 Jan;18(1):33-8
pubmed: 17326860
J Int AIDS Soc. 2018 Nov;21(11):e25208
pubmed: 31291057
Psychol Bull. 1990 Nov;108(3):339-62
pubmed: 2270232
AIDS Behav. 2017 Jul;21(7):2141-2146
pubmed: 27224979
Sex Transm Dis. 2015 Mar;42(3):160-1
pubmed: 25668649
AIDS Behav. 2013 Feb;17(2):728-36
pubmed: 22893195
Trop Med Int Health. 2008 May;13(5):659-79
pubmed: 18266784
Sex Transm Dis. 2013 Jun;40(6):447-52
pubmed: 23677018
Sex Transm Dis. 2006 Jan;33(1):22-5
pubmed: 16385218
Am J Epidemiol. 2009 Oct 1;170(7):918-24
pubmed: 19741042
Clin Infect Dis. 2018 Aug 16;67(5):676-686
pubmed: 29509889
Contraception. 2013 Dec;88(6):749-57
pubmed: 24028752
J Acquir Immune Defic Syndr. 2015 Mar 1;68 Suppl 2:S171-9
pubmed: 25723982
Inj Prev. 2000 Jun;6(2):82-90
pubmed: 10875661
Sex Transm Infect. 2014 Sep;90(6):479-84
pubmed: 24627289
Open Forum Infect Dis. 2019 Jan 09;6(2):ofz010
pubmed: 30746385
AIDS Behav. 2010 Dec;14(6):1287-93
pubmed: 19680799
Sex Transm Dis. 2006 Aug;33(8):476-9
pubmed: 16865047
Sex Transm Dis. 2013 Feb;40(2):105-10
pubmed: 23321990
JAMA. 2006 Aug 16;296(7):863-5
pubmed: 16905792
Contraception. 1999 Mar;59(3):195-201
pubmed: 10382083
Contraception. 2015 Dec;92(6):560-6
pubmed: 26079469
Stat Methods Med Res. 2014 Feb;23(1):42-59
pubmed: 22523185
AIDS. 2016 Jul 31;30(12):1973-83
pubmed: 27149090
Sex Transm Dis. 2018 Jan;45(1):28-34
pubmed: 28876295
PLoS Med. 2017 Nov 21;14(11):e1002444
pubmed: 29161256
Sex Transm Dis. 2005 Feb;32(2):90-4
pubmed: 15668614
J Fam Plann Reprod Health Care. 2005 Oct;31(4):285-7
pubmed: 16274550
Arch Sex Behav. 1998 Apr;27(2):155-80
pubmed: 9562899
Sex Transm Dis. 2013 Jun;40(6):462-8
pubmed: 23680902