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Brief Report

Changes in Behavior After PrEP Initiation Among Australian Gay and Bisexual Men

Prestage, Garrett PhDa; Maher, Lisa PhDa; Grulich, Andrew PhDa; Bourne, Adam PhDb; Hammoud, Mohamed BPsycha; Vaccher, Stefanie BSca; Bavinton, Benjamin PhDa; Holt, Martin PhDc; Jin, Fengyi PhDa

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1, 2019 - Volume 81 - Issue 1 - p 52–56
doi: 10.1097/QAI.0000000000001976
Prevention Research

Introduction: HIV pre-exposure prophylaxis (PrEP) has been increasingly adopted by gay and bisexual men (GBM). Little is known about whether individual GBM change their sexual behavior after PrEP initiation.

Methods: Following Lives Undergoing Change (Flux) is a national, online, prospective observational study among Australian GBM. Using McNemar statistics, we compare rates of sexual behaviors before and coincident with PrEP initiation among 1518 non–HIV-positive men recruited between August 2014 and July 2017 who had not commenced PrEP at baseline and who completed at least one 6-monthly follow-up surveys by July 2018.

Results: The proportion of men using PrEP rose to 24.2% over time. In total, 348 men initiated PrEP during follow-up. PrEP initiators were more likely to report particular sexual behaviors during the follow-up period that they commenced PrEP compared with the period immediately prior: receptive condomless anal intercourse with casual partners increased from 31.0% to 48.9% (McNemar < 0.001); mean partner number increased from 21.96 partners to 34.55 partners (p-trend < 0.001). Among the 1170 men who did not initiate PrEP, prevalence of these behaviors remained lower and stable. Sexual sensation-seeking and gay social engagement were both higher among men who commenced PrEP.

Conclusions: GBM tended to increase their engagement in “adventurous” sexual behaviors after PrEP initiation. Sexual behaviors among men who did not initiate PrEP were less common and did not change over time.

aThe Kirby Institute, UNSW Sydney, New South Wales, Australia;

bAustralian Research Centre in Sex Health and Society, La Trobe University, Melbourne, Victoria, Australia; and

cThe Centre for Social Research in Health, UNSW Sydney, New South Wales, Australia.

Correspondence to: Garrett Prestage, PhD, Level 6, Wallace Wurth Building, The Kirby Institute, UNSW Sydney, Kensington, Sydney, NSW 2052, Australia (e-mail:

Supported by the Australian Research Council (ARC), ARC Grant number: DP140102483, and by a Gilead Research Fellowship. The Kirby Institute, the Australian Research Centre in Sex Health & Society, and Centre for Social Research in Health receive funding from the Australian Government Department of Health. L.M. and A.G. are supported by National Health and Medical Research Council Research Fellowships.

Presented in part at 4th International Conference of the Association for the Social Sciences and Humanities in HIV; July 23, 2018; Amsterdam, the Netherlands.

The authors have no conflicts of interest to disclose.

Received August 26, 2018

Accepted December 20, 2018

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