Sexual Behavior Patterns and PrEP Dosing Preferences in a large sample of North American Men who have Sex with Men

Pre-exposure prophylaxis (PrEP), taken as a single daily co-formulated pill containing tenofovir-emtricitabine, is a promising intervention to reduce the likelihood of HIV acquisition in at-risk individuals, including men who have sex with men (MSM). Little is known about the acceptability of less than daily, intermittent PrEP (iPrEP) regimens. 

We conducted an online survey of North American MSM to characterize their sexual frequency and planning behaviors and correlate these with PrEP dosing preferences. Of the 3,217 respondents who completed the survey, 46% reported engaging in unplanned condomless anal intercourse (CAI) at least once in the prior 3 months and 8% reported engaging in CAI more than once per week. 

In multivariable analysis, reporting unplanned CAI was associated with lower educational level, identifying as homosexual/gay as compared to bisexual, being in a monogamous relationship, having a higher self-perceived risk of HIV acquisition, higher income, engaging in CAI more than five times in the last 3 months, and not having visited a healthcare provider in the previous year. 

Frequent CAI (>1x/week) was associated with being younger, 

• identifying as homosexual/gay as compared to bisexual, 
• being in a monogamous relationship, 
• and having a higher self-perceived risk of HIV. 

Having had only planned sex over the last 3 months was associated with a preference for event-based PrEP, while having frequent or unplanned CAI was associated with a preference for daily or time-driven PrEP regimens, respectively. 

Our findings suggest that preferences for different PrEP regimens are associated with the sexual frequency and planning behaviors of potential users.

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By: Stack C1, Oldenburg C, Mimiaga M, Elsesser SA, Krakower D, Novak DS, Egan J, Stall R, Safren S, Mayer KH.

• 11Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 2Department of Epidemiology, Harvard School of Public Health, Boston, MA 3Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI 4The Fenway Institute, Fenway Health, Boston, MA 5Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 6On-Line Buddies, Cambridge, MA 7Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA 8Department of Psychology, University of Miami, Coral Gables, FL.