Does pre‐exposure prophylaxis for HIV prevention in men who have sex with men change risk behaviour? A systematic review

Aims and Objectives To review the literature regarding PrEP and sexual behaviour change in MSM. Background Pre‐exposure prophylaxis for HIV has been available since 2012. Even so, pre‐exposure prophylaxis has not been widely accepted among healthcare providers and men who have sex with men some of whom are convinced that pre‐exposure prophylaxis decreases condom use and increases sexually transmitted infections. Design A systematic review of the state of the evidence regarding the association of pre‐exposure prophylaxis with condom use, sexually transmitted infection incidence and change in sexual risk behaviours in men who have sex with men. A structured search of databases resulted in 142 potential citations, but only 10 publications met inclusion criteria and underwent data abstraction and critical appraisal. Methods An adapted Cochrane Collaboration domain‐based assessment tool was used to critically appraise the methodological components of each quantitative study, and the Mixed Methods Appraisal Tool was used to critically appraise qualitative and mixed‐methods studies. Results Condom use in men who have sex with men using pre‐exposure prophylaxis is influenced by multiple factors. Studies indicate rates of sexually transmitted infections in treatment and placebo groups were high. Pre‐exposure prophylaxis did not significantly change sexually transmitted infection rates between baseline and follow‐up. Reporting of sexual risk improved when questionnaires were completed in private by clients. Our review found that pre‐exposure prophylaxis may provide an opportunity for men who have sex with men to access sexual health care, testing, treatment and counselling services. We did not find any conclusive evidence that pre‐exposure prophylaxis users increase sexual risk behaviours. Conclusion The perception among healthcare providers that pre‐exposure prophylaxis leads to increased sexual risk behaviours has yet to be confirmed. In order to provide effective sexual health services, clinicians need to be knowledgeable about pre‐exposure prophylaxis as an HIV prevention tool. Relevance to clinical practice In an era where HIV prevention methods are rapidly improving, strategies for sexually transmitted infection testing, treatment, counselling and prevention remain vital to improve health. All healthcare providers are uniquely positioned to promote sexual health through the dissemination of accurate information.