Reported sexual risk behavior modifications among Persistent HIV Pre-Exposure Prophylaxis clients in the Dominican Republic

Abstract

Background: Many studies of PrEP implementation have been evaluating the impact on reducing new HIV diagnoses across the globe, however, just recently more data has coming from Latin-American countries. High sexual partners turn-around and risky behaviors has been associated to HIV acquisition and other STIs. During the first implementation PrEP pilot in the Dominican Republic we analyzed behavioral changes variables, and biological markers of STIs infection.

Materials and Methods: Self-identified MSM and Transgendered women attending an outpatient clinic in the capital city were invited to receive PrEP. All participants were screened for substantial risk and behaviors regarding HIV infection by the psychology department and those qualifying were screened for HIV and other STIs. Only individuals with over 6 months of uninterrupted PrEP use were included in the study. A comparison between self-reported behaviors before initiating PrEP and during follow-up appointments are reported.

Results: A total of 145 patients enrolled in PrEP services where assessed. Population was composed of 96% (n=139) MSM and 4% (n=6) TGF clients. Assessment of sexual orientation was self-reported homosexuals made up 70% (n=102), and heterosexuals 5% (n=7), bisexuals 20% (n=30) and Pansexual users 1% (n=1). Alcohol consumption (more than 3 times/week) was the most common reported behavior risk with a baseline report of 22% (n=32) of users and 10% (n=15) after 6 months of PrEP use. After 6 months of PrEP use sexual work decreased from 12% of users to 4% of the users. Mean number of partners during the previous 3 months at baseline was calculated at 9.5 partners while at 6 months follow-up was at 2.5 partners per client. PrEP use was significantly associated with an increase report of regular condom use during the first 3 months (p<0001) and 6 months (p=0.007). PrEP use was associated with a decrease in reported sexual partners by a mean of 6,4 less partners after 6 months (p=0.001). PrEP use is significantly associated with decreased report of sexual contact with TRSX after 6 months (p<0.001).

Conclusions: Psychological assessment and follow-up to behaviour modification strategies is key to reduce the risks of HIV infection after PrEP cessation. Despite the negative impression that PrEP increases risk sexual contacts, and STIs diagnosis “PrEP whores”, this data did not sustain these statements. Persistance in PrEP also provides an opportunity to intervine in the provision of comprehensive care packages.