Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
Universidad Complutense de Madrid, Madrid, Spain.
PLoS One. 2021 Feb 4;16(2):e0245925. doi: 10.1371/journal.pone.0245925. eCollection 2021.
Since the recent introduction of preexposure prophylaxis (PrEP), several studies have reported a decrease in the use of condoms and a rise in STIs among users. This rise in risk behavior associated with the advent of PrEP is known as "risk compensation." The aim of this study is to measure clinical and behavioral changes associated with the introduction of PrEP by analyzing condom use for anal intercourse, number of sexual partners, sexualized drug use and STI incidence.
We performed a retrospective descriptive study of PrEP users followed every 3months over a 2-year period spanning 2017-2019 in a referral clinic specializing in STI/HIV in Madrid, Spain. One hundred ten men who have sex with men and transgender women underwent regular screening for STIs and hepatitis C virus (HCV) infection. Sociodemographic, clinical, and behavioral data were gathered for all subjects studied.
The risk compensation observed in this study consisted primarily of a lower rate of condom use, while the number of sexual partners and recreational drug consumption remained stable. We observed a very high incidence of STIs in this sample, particularly rectal gonorrhea and chlamydia. The factors shown to be independently associated with the presence of an STI on multivariate analysis were age below 30 years and over 10 sexual partners/month.
The incidence of STI acquisition was higher than expected, indicating a need for strategies to minimize this impact, particularly among younger individuals with a higher number of sexual partners.
自最近引入暴露前预防（PrEP）以来，几项研究报告称，使用者中避孕套的使用减少，性传播感染（STI）上升。随着 PrEP 的出现，这种与风险行为相关的上升被称为“风险补偿”。本研究旨在通过分析肛交时避孕套的使用、性伴侣数量、性化药物使用和 STI 发生率，来衡量 PrEP 引入后与临床和行为相关的变化。
我们对 2017 年至 2019 年间在西班牙马德里的一家专门治疗性传播感染/艾滋病毒的转诊诊所接受 PrEP 治疗的 110 名男男性行为者和跨性别女性进行了回顾性描述性研究。所有研究对象均定期接受性传播感染和丙型肝炎病毒（HCV）感染筛查。对所有研究对象收集社会人口学、临床和行为数据。
本研究观察到的风险补偿主要表现为避孕套使用率降低，而性伴侣数量和娱乐性药物使用保持稳定。我们在该样本中观察到 STI 发病率非常高，尤其是直肠淋病和衣原体感染。多变量分析显示，与 STI 存在相关的独立因素为年龄低于 30 岁和每月性伴侣超过 10 个。
性传播感染的发病率高于预期，表明需要采取策略来最小化这种影响，特别是在年轻人群中，他们的性伴侣数量更多。
