The Best Predictor of Future Behavior May Be the Past

Exploring Behavior Change in Men Who Have Sex with Men Using Pre-exposure Prophylaxis in the Netherlands

Datos Bibliográficos

ID8355339
AutoresDaphne van Wees (0000-0002-6562-7029, National Institute for Public Health and the Environment, autor de correspondencia), Liza Coyer (0000-0001-5830-2982, GGD Amsterdam), Mark van den Elshout (Utrecht University), Eline Op de Coul (0000-0002-8263-9187, National Institute for Public Health and the Environment), Fleur van Aar (National Institute for Public Health and the Environment)
Año2024
Volumen53
Número7
Páginas2777-2793
Fecha de publicación2024-07-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaArchives of Sexual Behavior (JOURNAL)
Identificadores de la revistaISSN: 0004-0002 • E-ISSN: 1573-2800
EditorialSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1007/s10508-024-02863-z
PMID38709341
OpenAlexW4396670053
IdiomaEN
Citas recibidas1
Referencias citadas42

Pre-exposure prophylaxis (PrEP) use prevents HIV transmission, and may lead to changes in sexual behavior. We aimed to explore sexual behavior over time, and identify predictors of behavior change in men who have sex with men (MSM) using PrEP at sexual health centers (SHC) in the Netherlands. We used longitudinal data from the national STI surveillance database (January 2018–June 2021) of HIV-negative MSM who first initiated PrEP in the national PrEP pilot. We modelled behavior change after PrEP initiation, and identified predictors of behavior change using multi-state Markov models. The probability of stopping group sex, chemsex, use of poppers or erection stimulants, and having ≥ 10 partners in the past 6 months among included MSM (n = 4,349, n SHC visits = 21,820) was higher compared to the probability of starting with these behaviors after PrEP initiation. However, MSM who used condoms consistently during anal sex had a high probability of changing to inconsistent condom use (0.8) at the next visit, and inconsistent condom users mostly remained inconsistent (0.8). First visit, visiting the SHC more often (vs. regular), and STI diagnosis were predictors of starting or continuing with most of the behaviors associated with increased risk. Behavior change was less likely among older participants (> 34 compared to ≤ 34 years), and during COVID-19 lockdown and post-lockdown periods compared to pre-COVID-19. Although condom use decreased over time, transitions towards stopping with other behaviors associated with increased likelihood of acquiring an STI after PrEP initiation were common. This may suggest increased sexual empowerment, especially among younger MSM. Predictors of behavior change may help to identify MSM who are likely to start with or continue to engage in these behaviors in the near future and to provide suitable and timely counselling about behavior and PrEP adherence

Anal sex · Behavior change · Condom · Family medicine · Human immunodeficiency virus (HIV) · Men who have sex with men · Pre-exposure prophylaxis · Public health · Sexual behavior · Syphilis · Young adult · Clinical Psychology · Demography · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Psychology · Sex work and related issues · Social Psychology · Gerontology