Tripathi Avnish, Whiteside Y Omar, Duffus Wayne A
From the Division of Internal Medicine, Department of Medicine, University of Mississippi School of Medicine, Jackson, and the Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
South Med J. 2013 Oct;106(10):558-64. doi: 10.1097/SMJ.0000000000000010.
Preexposure prophylaxis (PrEP) is a promising strategy to prevent human immunodeficiency virus (HIV) infection, especially among high-risk individuals such as seronegative partners; however, many caveats such as the potential risk of sexual disinhibition and noncompliance need to be considered. We explored the sociodemographic and behavioral factors associated with the adoption of PrEP among HIV seronegative men who have sex with men and heterosexual partners.
A prepiloted self-administered survey was conducted among seronegative partners in a Ryan White HIV/AIDS Clinic in South Carolina from 2010 to 2011. Bivariate and multivariable analyses were used to explore the data.
The survey was completed by 89 seronegative partners. The median age was 42 years (interquartile range 32-50) and a majority was men (56%), black (70%), and heterosexual (74%). A majority (94%) was willing to use PrEP if available; however, 26% of subjects suggested that they would be more likely to have unprotected sex with an HIV-positive partner while using PrEP, and 27% suggested that it would be difficult to take a daily dose of PrEP and consistently use condoms. The multivariable results suggest that the belief that a condom is no longer needed while taking PrEP was more likely among those who did not use a condom during their last sexual intercourse (adjusted odds ratio 7.45; 95% confidence interval 1.57-35.45) and among those with a higher HIV knowledge score (adjusted odds ratio 0.43; 95% confidence interval 0.23-0.78).
Overall, these results suggest high acceptability of PrEP among seronegative partners to lower the risk of HIV transmission; however, there is a substantial risk of sexual disinhibition and noncompliance while using PrEP that may be reduced by ongoing education.
暴露前预防（PrEP）是预防人类免疫缺陷病毒（HIV）感染的一种有前景的策略，尤其是在血清学阴性伴侣等高风险个体中；然而，需要考虑许多注意事项，如性抑制和不依从的潜在风险。我们探讨了与男男性行为者和异性恋伴侣中血清学阴性的HIV感染者采用PrEP相关的社会人口学和行为因素。
2010年至2011年在南卡罗来纳州一家瑞安·怀特HIV/艾滋病诊所对血清学阴性伴侣进行了一项预试验的自我管理调查。采用双变量和多变量分析来探索数据。
89名血清学阴性伴侣完成了调查。中位年龄为42岁（四分位间距32 - 50岁），大多数为男性（56%）、黑人（70%）和异性恋者（74%）。大多数人（94%）表示如果有PrEP愿意使用；然而，26%的受试者表示在使用PrEP时更有可能与HIV阳性伴侣进行无保护性行为，27%的受试者表示难以每日服用PrEP并持续使用避孕套。多变量结果表明，在上次性行为中未使用避孕套的人（调整后的优势比7.45；95%置信区间1.57 - 35.45）以及HIV知识得分较高的人（调整后的优势比0.43；95%置信区间0.23 - 0.78）中，更有可能认为服用PrEP时不再需要避孕套。
总体而言，这些结果表明血清学阴性伴侣对PrEP降低HIV传播风险的接受度较高；然而，使用PrEP时存在性抑制和不依从的重大风险，持续教育可能会降低这种风险。
