title: Sexual Behavior, Risk Compensation, and HIV Prevention Strategies Among Participants in the San Francisco PrEP Demonstration Project: A Qualitative Analysis of Counseling Notes.
abstract: Pre-exposure prophylaxis (PrEP) is a viable HIV prevention strategy but risk compensation could undermine potential benefits. There are limited data that examine this phenomenon outside of clinical trials. We conducted a qualitative analysis of counseling notes from the San Francisco site of the US PrEP demonstration project to assess how men who have sex with men used PrEP as a prevention strategy and its impact on their sexual practices. Four major themes emerged from our analysis of 130 distinct notes associated with 26 participants. Prevention strategy decision-making was dynamic, often influenced by the context and perceived risk of a sexual encounter. Counselors noted that participants used PrEP in conjunction with other health promotion strategies like condoms, asking about HIV status of their sex partners, and seroadaptation. With few exceptions, existing risk reduction strategies were not abandoned upon initiation of PrEP. Risk-taking behavior was 'seasonal' and fluctuations were influenced by various personal, psychosocial, and health-related factors. PrEP also helped relieve anxiety regarding sex and HIV, particularly among serodiscordant partners. Understanding sexual decision-making and how PrEP is incorporated into existing prevention strategies can help inform future PrEP implementation efforts.
authors.affiliation: Department of Community Health Systems, School of Nursing, University of California, San Francisco, 2 Koret Way, N505, San Francisco, CA, 94143, USA. carlo.hojilla@ucsf.edu.
authors.forename: J
authors.initials: J
authors.lastname: Carlo Hojilla
authors.affiliation: Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Koester
authors.affiliation: Disease Prevention and Control, San Francisco Department of Public Health, San Francisco, CA, USA.|Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Cohen
authors.affiliation: Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Buchbinder
authors.affiliation: San Francisco Department of Public Health, San Francisco, CA, USA.
authors.forename: Deawodi
authors.initials: D
authors.lastname: Ladzekpo
authors.affiliation: San Francisco Department of Public Health, San Francisco, CA, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Matheson
authors.affiliation: Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA.
authors.forename: Albert Y
authors.initials: AY
authors.lastname: Liu
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003376:Counseling; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D065129:Pre-Exposure Prophylaxis; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D012495:San Francisco; D012725:Sexual Behavior; D012747:Sexual Partners / Q000523:psychology
keywords: HIV prevention; HIV/AIDS; Men who have sex with men; Pre-exposure prophylaxis; Risk compensation
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