Prescribing PreP to prevent HIV does not increase risky sexual behaviours

Prescribing pre-exposure prophylaxis (PrEP) to prevent the spread of HIV does not to lead to patients engaging in more risky sexual behaviours, a study has found. Even if that was the case, most providers think this is not a reason to discontinue PrEP or limit its access.

PrEP is a preventive treatment which involves people who are at very high risk of HIV infection – such as sexually active gay or bisexual men – taking a combination of HIV medicines sold under the name Truvada, on a daily basis.

The treatment works by stopping the virus from taking hold and spreading throughout the body. It has a track record of helping prevent people from contracting the virus via sexual or needle-based contact with somebody who is HIV-positive.

If people take the pills everyday as instructed, the method can lower the risk of getting HIV from sex by more than 90% and from injection drug use by more than 70%.

PrEP is offered in several countries already, ranging from South Africa, the US, Canada and France but roll-out has been slow. In the UK, NHS England had previously refused to fund Truvada but the High Court recently ruled that it had to offer it to patients.

An important argument put forward by critics – and which NHS England used – is that the treatment encourages people to abandon condoms and to engage in risky sexual behaviours. Some argued that people at risk of being infected should instead be encouraged to practice safe-sex.

The study now published in the journal AIDS Patient Care and STDS has shown that this is not the case. Providers in the US who prescribed PrEP did not see widespread increases in risky sexual behaviour among their patients as a result.

Attitudes to PrEP

The authors of the study wanted to better understand the attitudes and experiences of medical providers who prescribe PrEP and so they interviewed 18 U.S.-based healthcare providers with experience prescribing the preventive treatment. This only a small study but it highlights a number of interesting findings.

First, the researchers found that a majority of providers thought that the benefits of PrEP outweigh any potential increase in patients' risky behaviours. They saw their main role as supporting patients in making informed sexual health decisions, and reported no widespread increase in risky sexual behaviours.

Finally, they also thought that outside the healthcare community, PrEP and those taking it were often unduly stigmatised.

"As public awareness about PrEP increases and more at-risk individuals actively seek out PrEP from their healthcare providers, there is an urgent need to prepare providers to respond appropriately," the authors write. "This includes not only enhancing providers' comfort and competence prescribing PrEP or referring patients elsewhere for PrEP care but also educating providers about reacting to patient inquiries in a sensitive and professional way."