South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States.
Department of Surgery, University of California Los Angeles, Los Angeles, CA, United States.
JMIR Public Health Surveill. 2023 Oct 5;9:e45134. doi: 10.2196/45134.
Gay, bisexual, and other men who have sex with men (MSM) with a higher perceived risk of HIV are more aware of and willing to use pre-exposure prophylaxis (PrEP). PrEP is an effective HIV prevention strategy, but there is a lack of data on how PrEP use might moderate the relationship between sexual risk behavior and perceived risk of HIV. Moreover, most studies measure perceived risk of HIV via a single question.
We estimated the moderating effect of PrEP use on the association between sexual risk behavior and perceived risk of HIV, measured with the 8-item Perceived Risk of HIV Scale (PRHS), among Brazilian MSM.
A cross-sectional, web-based survey was completed by Brazilian Hornet app users aged ≥18 years between February and March 2020. We included data from cisgender men who reported sex with men in the previous 6 months. We evaluated the moderating effect of current PrEP use on the association between sexual risk behavior, measured via the HIV Incidence Risk Index for MSM (HIRI-MSM), and perceived risk of HIV, measured by the PRHS. Higher HIRI-MSM (range 0-45) and PRHS (range 10-40) scores indicate greater sexual behavioral risk and perceived risk of HIV, respectively. Both were standardized to z scores for use in multivariable linear regression models.
Among 4344 cisgender MSM, 448 (10.3%) were currently taking PrEP. Current PrEP users had a higher mean HIRI-MSM score (mean 21.0, SD 9.4 vs mean 13.2, SD 8.1; P<.001) and a lower mean PRHS score (mean 24.6, SD 5.1 vs mean 25.9, SD 4.9; P<.001) compared to those not currently taking PrEP. In the multivariable model, greater HIRI-MSM scores significantly predicted increased PRHS scores (β=.26, 95% CI 0.22-0.29; P<.001). PrEP use moderated the association between HIRI-MSM and PRHS score (interaction term β=-.30, 95% CI -0.39 to -0.21; P<.001), such that higher HIRI-MSM score did not predict higher PRHS score among current PrEP users.
Our results suggest current PrEP users have confidence in PrEP's effectiveness as an HIV prevention strategy. PrEP's effectiveness, positive psychological impact, and the frequent HIV testing and interaction with health services required of PrEP users may jointly influence the relationship between sexual risk behavior and perceived risk of HIV among PrEP users.
对于 HIV 感染风险较高的男同性恋者、双性恋者和其他与男性发生性行为的男性（MSM）来说，他们更了解并愿意使用暴露前预防（PrEP）。PrEP 是一种有效的 HIV 预防策略，但缺乏关于 PrEP 使用如何调节性行为风险与 HIV 感染风险感知之间关系的数据。此外，大多数研究通过单一问题来衡量 HIV 感染风险感知。
我们评估了 PrEP 使用对巴西 MSM 中通过 8 项 HIV 感染风险量表（PRHS）衡量的性行为风险与 HIV 感染风险感知之间关系的调节作用。
2020 年 2 月至 3 月期间，我们通过巴西 Hornet 应用程序对年龄≥18 岁的用户进行了一项横断面、基于网络的调查。我们纳入了在前 6 个月内报告与男性发生性行为的顺性别男性的数据。我们评估了当前 PrEP 使用对性行为风险（通过 MSM 的 HIV 发生率风险指数（HIRI-MSM）衡量）与 HIV 感染风险感知（通过 PRHS 衡量）之间关联的调节作用。更高的 HIRI-MSM（范围 0-45）和 PRHS（范围 10-40）分数分别表示更大的性行为风险和更高的 HIV 感染风险。两者都被标准化为 z 分数，用于多变量线性回归模型。
在 4344 名顺性别 MSM 中，448 名（10.3%）正在服用 PrEP。与未服用 PrEP 的人相比，当前服用 PrEP 的人 HIRI-MSM 评分平均值更高（均值 21.0，SD 9.4 比均值 13.2，SD 8.1；P<.001），PRHS 评分平均值更低（均值 24.6，SD 5.1 比均值 25.9，SD 4.9；P<.001）。在多变量模型中，更高的 HIRI-MSM 评分显著预测 PRHS 评分升高（β=.26，95%CI 0.22-0.29；P<.001）。PrEP 使用调节了 HIRI-MSM 和 PRHS 评分之间的关联（交互项β=-.30，95%CI -0.39 至-0.21；P<.001），这意味着在当前服用 PrEP 的人群中，更高的 HIRI-MSM 评分并不预示着更高的 PRHS 评分。
我们的研究结果表明，当前服用 PrEP 的人群对 PrEP 作为 HIV 预防策略的有效性有信心。PrEP 的有效性、积极的心理影响以及 PrEP 用户所需的频繁 HIV 检测和与卫生服务的互动，可能共同影响 PrEP 用户性行为风险与 HIV 感染风险感知之间的关系。
