Investigators in Brighton conducted interviews with 15 gay men who were currently taking, or had recently completed, a course of post-exposure prophylaxis after unprotected anal intercourse. They found that prior to accessing this treatment, the men generally had a poor understanding of what post-exposure prophylaxis involved.

The investigators also found that although the men described the sexual encounter leading to the accessing of post-exposure prophylaxis as unusual, they could almost all describe other circumstances where their risk behavior was such that treatment with post-exposure prophylaxis would have been warranted. Furthermore, the interviews suggested that the men attempted to distance themselves from their risk behavior, attributing it to the use of drugs and alcohol or in some way blaming their sexual partner.

Post-exposure prophylaxis (a short course of treatment with antiretroviral drugs after possible exposure to HIV) is becoming increasing available for individuals reporting sexual risk behavior. The number of gay men presenting for such treatment has increased following targeted advertising campaigns and the publication of professional guidelines.

There is robust evidence that post-exposure prophylaxis can prevent infection with HIV. But there have been reports of HIV infection despite its use following possible sexual exposure to the virus. In many instances these infections can be attributed to ongoing sexual risk behavior.

Investigators wished to gain a better understanding of the factors and rationale leading gay men to access post exposure prophylaxis. They were hopeful that the results of their study could lead to the development of health promotion campaigns targeting men who are not accessing this treatment after possible exposure to HIV.

Between January 2007 and January 2008 investigators in Brighton conducted semi-structured interviews with 15 gay men who were currently taking or had recently completed a course of post-exposure prophylaxis. Generally, the men had a scanty knowledge of what this treatment involved before accessing it. They knew that such treatment was available and that it had the potential to prevent infection with HIV. However, it was only after accessing treatment that the men became aware that post-exposure prophylaxis needs to be started within 72 hours of possible HIV exposure to be effective; that it involved taking a combination of anti-HIV drugs; the duration of treatment; and the potential for treatment failure.

One participant told the investigators: “{I knew that} there was a treatment available. But yet the actual mechanism of it I wasn’t aware of.” Another described his shock at discovering the post-exposure prophylaxis involved therapy with antiretroviral drugs: “I got home and read through the leaflets and basically realized that it was a medication designed for people with HIV…It was a bit of a slap around the face reading that.”

Unprotected anal intercourse was the main behavior leading to the accessing of post-exposure prophylaxis. The men generally described this behavior as being “rare” or a “one-off” and mentioned it within the context of drug or alcohol use. Such risk behavior was also described as being out of character and the men generally considered themselves as having a low risk of infection with HIV.

For example, one individual told the investigators: “I had just separated recently, so it {unprotected anal sex} was kind of a way of me trying to react, I don’t know, trying to just forget about it, just have fun, you know do drugs and get drunk.”

Another common theme was linking unusual risk behavior with sexual partners who were in some way unusual or “other”. The men commonly attributed a number of risky characteristics to partners with whom they had had unprotected sex, such as sexually transmitted infections, promiscuity, “adventurous sex”, and a habit of having unprotected sex. Universally, the men did not believe that they also had such risky characteristics.

Most of the men however were able to describe other circumstances when the use of post-exposure prophylaxis would have been warranted but was not sought. Generally, the sexual behavior and partner was not perceived as being of sufficient risk. The investigators suggest that this is consistent with the “othering” of the incident and partner leading to the eventual accessing of treatment.

The investigators are therefore concerned that gay men often fail to access post-exposure prophylaxis because they do not perceive a sexual encounter to have been high risk enough, despite the fact that it carried a high risk of HIV exposure.

There was no indication that use of post-exposure prophylaxis increased sexual risk behavior or that it was thought of as a replacement for other methods of HIV prevention. Indeed, the idea that such treatment was a kind of a “morning after pill” was abhorrent. However, there was a willingness to attribute such beliefs to other gay men, which the investigators believe is further evidence of willingness to “other” sexual risk behavior.

In their discussion of their findings, investigators note that most of the men could identify occasions when the use of post-exposure prophylaxis would have been warranted but was not accessed because the sexual risk behavior was not perceived as being sufficiently “unusual”. They write “this begs the question; how many other MSM are involved in similar exposure events and yet do not have the same triggers for presenting to clinic? Extra work needs to be targeted at {post-exposure prophylaxis} understanding among men who have sex with men and improving accuracy of subjective calculations.”

They also suggest that certain men with high-risk sexual behavior should be provided with post-exposure prophylaxis information and treatment “started packs”

To read the complete article, you can find it in: http://www.aidsmap.com 

Reference
Sayer C et al. Will I, won’t I ? Why do MSM present for PEPSE? Sex Transm Infect (online edition), 2008.

The research found that individuals with anal warts are seven times as likely to acquire HIV. Such a result indicates the need for an increase in screening for anal sexually transmitted infections in gay and bisexual men as a means for HIV prevention.

Most of previous studies on sexually transmitted infections (STIs) have been conducted among heterosexual's men and not in the gay and bisexual population. Furthermore, they have not examined the full range of sexually transmitted infections that are common in gay and bisexual men. In particular, genital and anal warts have often been overlooked, and many of the studies have not distinguished between genital and anal infections. This study highlights the need for a more aggressive screening and treatment of these infections as a preventative measure of HIV transmission. Nevertheless in this study Herpes infections did not emerge as significant factor in the transmission of HIV.

To read the complete article, you can find it in:
http://www.aidsmap.com/en/news/145E6293-8F81-4499-BE33-CEF4477027C5.asp

Reference
Jin F et al. Anal sexually transmitted infections and risk of HIV infection in homosexual men. . J Acquir Immune Defic Syndr, published online ahead of print, 2009. doi: 10.1097/QAI.0b013e3181b48f33