Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, Amsterdam, the Netherlands.
Stichting HIV Monitoring, Amsterdam, the Netherlands.
AIDS. 2020 Dec 1;34(15):2295-2304. doi: 10.1097/QAD.0000000000002714.
To explore the frequency of and reasons for using condoms among men who have sex with men (MSM) on preexposure prophylaxis (PrEP).
We analyzed quantitative app-based diary data on daily sexual practices (August 2015-February 2019) and qualitative in-depth interviews among MSM using daily PrEP and event-driven PrEP (edPrEP) in the Amsterdam PrEP demonstration project.
Participants could report daily about sex acts, PrEP use and condom use per partner type (steady and casual partners). We examined four strategies of PrEP and condom use: PrEP only, PrEP and condoms, condoms only, and neither strategy. We compared the proportions of sex acts per strategy between PrEP regimens. In 43 in-depth interviews, we explored motives for implementing each strategy.
Three hundred and fifty-two participants reported 48 949 anal sex acts. PrEP only was the most common strategy employed with any partner type (81%, n = 39 650/48 949) and was motivated by anticipating more pleasurable sex, sexually transmitted infection's perceived curability, and habituation to condomless sex. Combining PrEP and condoms was more often chosen for sex acts with casual partners (18%, n = 6829/37 317) than with steady partners (5%, n = 614/11 632) and was linked to, for example, higher perceived vulnerability for sexually transmitted infections or HIV and avoidance of PrEP disclosure. Condoms only was uncommon but occurred particularly among edPrEP users (4%, n = 379/8695). Applying neither strategy was common among edPrEP users with steady partners (25%, n = 538/2122) and was motivated by low perceived HIV risk.
Condoms remain a viable option for PrEP users in certain settings. Condoms were applied in higher risk settings, to avoid PrEP disclosure, or as substitute for PrEP, especially among edPrEP users.
探讨男男性行为者（MSM）在暴露前预防（PrEP）中使用避孕套的频率和原因。
我们分析了阿姆斯特丹 PrEP 示范项目中使用每日 PrEP 和事件驱动 PrEP（edPrEP）的 MSM 的基于应用程序的定量每日性实践日记数据和定性深入访谈。
参与者可以报告每日性行为、PrEP 使用情况和每个伴侣类型（稳定和偶然伴侣）的避孕套使用情况。我们检查了 PrEP 和 condom 使用的四种策略：仅 PrEP、PrEP 和 condom、仅 condom 和两种策略都不采用。我们比较了每种策略下 PrEP 方案的性行为比例。在 43 次深入访谈中，我们探讨了实施每种策略的动机。
352 名参与者报告了 48949 次肛交行为。仅 PrEP 是与任何伴侣类型最常见的策略（81%，n=39650/48949），其动机是预期更愉快的性行为、性传播感染的可治愈性以及对无保护性行为的习惯。PrEP 和 condom 的联合使用在与偶然伴侣发生性行为时更为常见（18%，n=6829/37317），而与稳定伴侣发生性行为时则不太常见（5%，n=614/11632），这与性传播感染或 HIV 的更高感知易感性和避免 PrEP 披露等有关。仅使用 condom 的情况很少见，但在 edPrEP 用户中尤其常见（4%，n=379/8695）。既不采用两种策略的情况在 edPrEP 用户与稳定伴侣中很常见（25%，n=538/2122），其动机是 HIV 风险感知较低。
在某些情况下，避孕套仍然是 PrEP 用户的可行选择。避孕套在高风险环境中使用，以避免 PrEP 披露，或作为 PrEP 的替代品，特别是在 edPrEP 用户中。
