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Sex on PrEP
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Qualitative findings from the iPrEx Open Label Extension (OLE) in the US
Kimberly Koester, Rivet Amico, Albert Liu, Vanessa McMahon, Sybil Hosek, Kenneth Mayer, Robert Grant
Reported by Jules Levin
20th International AIDS Conference, July 20-25, 2014, Melbourne
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Results of the iPrEx open-label extension (iPrEx OLE) in men and transgender women who have sex with men: PrEP uptake, sexual practices, and HIV incidence....IAC study report: Ole, Pre-Exposure Prohylaxis (PrEP) Initiative: Open Label Extension - "Adherence Has To Be Good, Not Perfect," Say MSM PrEP Study Researchers....."Comparing HIV incidence in participants who started PrEP with those not taking PrEP, the iPrEx team calculated a 100% risk reduction among people who took at least 4 to 6 tablets weekly.....4 to 6 tablets and 7 tablets results combined 95% CI: 86% to 100%"
......http://natap.org/2014/IAC/IAC_71.htm
webcast: http://pag.aids2014.org/flash.aspx?pid=4961
The slide presentation/study from the Ole Extension above presented at IAC was simultaneously published in Lancet Infectious Diseases ......
http://natap.org/2014/HIV/072314_02.htm
and this extensive expert report written for NATAP discusses as part of the report PrEP findings reported at IAC:
IAC: HIV Prevention at AIDS 2014 - PrEP, TasP, PMTCT, Key Populations - Jared Baeten, MD PhD Kenneth Ngure, PhD, MPH Connie Celum, MD MPH University of Washington & Jomo Kenyatta University of Agriculture and Technology - (07/31/14)
Here is a French study reporting at IACon PrEP adherence:
IAC: Early Data Show Good Adherence to Intermittent PrEP by MSM in French Trial
Here is NY Magazine published article on PrEP:
PrEP Article in New York Magazine published July 13 2014/ new WHO Recommendation/ new CDC Recommendation - (07/16/14)
and the newly announced -
NYS PrEP Plan - (07/16/14)
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Program abstract
Background: One of the major concerns about the use of pre-exposure prophylaxis (PrEP) is that the protective benefits may be negated by increases in other behaviors that offset these benefits (risk compensation). Others argue that taking PrEP may increase behaviors that promote protection of sexual health (prevention synergy). To better understand sexual behavior in the context of PrEP, we undertook a qualitative study of sexual experiences among iPrEx OLE participants in the US.
Methods: We conducted in-depth interviews (IDIs) with a purposeful sample of iPrEx OLE participants (MSM and transwomen). Interviews were audio recorded and transcribed. We analyzed the data using the principles of grounded theory.
Results: From April-September 2012, we conducted 60 IDIs (20 SF, 19 Boston, 21 Chicago) with participants on PrEP (mean age =36 51% white; 43% black, 6% other). Pre-PrEP sexual practices ranged from occasionally foregoing condoms characterized as "slip ups" to routinely foregoing condoms with friends/partners and finally, those who rarely used condoms. Overall, participants did not report significant changes to their sexual behaviors once they began taking PrEP. Rather, participants experienced a sense of relief or reprieve from HIV-related stress. Specifically, participants described feeling "more carefree", "more comfort" and a "relaxed attitude", versus pre-PrEP experiences of anxiety and fear after sexual encounters, even those with low risk. This unburdening of fear did not appear to lead to condomless sex. A subset of participants described a greater awareness of their behaviors and an increase in HIV prevention practices.
Conclusions: OLE participants on PrEP felt a sense of security and less free-floating fear of HIV. These qualitative data support quantitative analyses showing no increase in risk taking among PrEP users. No longer living under the threat of HIV is a significant benefit that has not been adequately explored in prevention research.
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One of the other reasons I went on the pill... I, as opposed to a lot of random hook ups I actually have a core of like three to four guys that I'm pretty regular with. And I always wanted to bareback with them but I wouldn't do it. Even though I know they're negative and we're really conscious about... We're very safe all the time. I thought, given how I've known them for like two or three years and I know what they do, I'll bareback with. I'll have this pill. We've yet to do it. It just hasn't happened. It was a nice idea. I don't know if it's ever going to happen. Terry, 55 year old White
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