Taking PrEP “on demand” may offer an appealing approach when compared to daily PrEP for HIV prevention. However, on-demand PrEP depends on the ability to predict sex accurately, so that the first dose can be taken no less than two hours before a sex act occurs. This study looks at the predictive capabilities of young MSM in the U.S., to determine whether they might be successful using on-demand PrEP.
About This Study
“Prediction of Sex and the Potential Use of On-Demand PrEP Among Young Men Who Have Sex With Men in the U.S.” was published online on April 29, 2023, in Journal of Acquired Immune Deficiency Syndromes. The lead author is Bryce F. Stamp, M.P.H., of the Department of Epidemiology at the Gillings School of Global Public Health of the University of North Carolina at Chapel Hill, N.C.
Key Research Findings
The study assessed how well on-demand oral PrEP–which requires taking medication 2 to 24 hours before sex–might work for young MSM. One hundred twenty men aged 16 to 24 years completed daily online surveys about the likelihood of anal sex within the next 24 hours, and then reported actual sexual acts, position, and partner characteristics. Median age of participants was 21 years and 56% were men of color.
The question regarding likelihood of anal sex could be answered on a scale from “not at all likely” to “very likely.” Researchers classified a “not at all likely” or “somewhat unlikely” response the day before a sexual encounter—in addition to not anticipating the encounter more than 2 hours in advance—as an “unpredicted, spontaneous” encounter.
During the 8-week study period, there were 854 encounters with 952 anal sex acts; 73% of acts were condomless. Overall, 69% of participants reported at least one unpredicted, spontaneous encounter. Thirty-two percent of all encounters were with an anonymous partner and 41% of these were unpredicted, spontaneous encounters.
Discussion Highlights and Implications for Practice
The reported study limitations included participants’ demographic characteristics (97% lived in metropolitan areas and only 10% had a high school education or less) and the hypothetical nature of the inquiry. The authors cautioned that being able to predict an encounter may not translate into successfully using on-demand PrEP, although they observed that not being able to predict it precludes HIV protection from non-daily PrEP.
Results suggest that daily PrEP may be a more feasible strategy for young MSM, the authors wrote. (They did not mention the potential option of long-acting injectable PrEP.) They called for further research into specific characteristics that could predict successful on-demand PrEP in this population.
By Barbara Jungwirth
Source : TheBodyPro
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