D Krakower , M Mimiaga, J Rosenberger, D Novak, JA Mitty, J White, K Mayer.

1. Anticipated Risk Compensation with Pre-Exposure Prophylaxis Use among North American Men who have Sex with Men Using an Internet Social Network D Krakower, M Mimiaga, J Rosenberger, D Novak, JA Mitty, J White, K Mayer.

2. PrEP can decrease HIV incidence among MSM, but risk compensation could reduce its potential benefit American men who have sex with men (MSM) at high-risk of HIV acquisition1 1Prejean 2011

3. PrEP can decrease HIV incidence among MSM, but risk compensation could reduce its potential benefit American men who have sex with men (MSM) at high-risk of HIV acquisition1 iPrEx: oral antiretroviral pre-exposure prophylaxis (PrEP) can reduce the risk of HIV acquisition among MSM2 1Prejean 2011; 2Grant 2010

4. PrEP can decrease HIV incidence among MSM, but risk compensation could reduce its potential benefit American men who have sex with men (MSM) at high-risk of HIV acquisition1 iPrEx: oral antiretroviral pre-exposure prophylaxis (PrEP) can reduce the risk of HIV acquisition among MSM2 If persons using PrEP decrease condom use with anal sex (i.e., risk compensation), net benefits of PrEP may be reduced 1Prejean 2011; 2Grant 2010

5. Our objective was to assess whether MSM anticipated decreased condom use with anal sex while using PrEP • Cross-sectional survey  members of on-line partner-seeking network for MSM • US + Canada • 1 month after iPrEx (Dec 2010-Jan 2011)

6. Our objective was to assess whether MSM anticipated decreased condom use with anal sex while using PrEP • Cross-sectional survey  members of on-line partner-seeking network for MSM • US + Canada • 1 month after iPrEx (Dec 2010-Jan 2011) • Outcome questions: • “If I used the PrEP pill, I would decrease my condom use for insertive (top) anal sex.” • “If I used the PrEP pill, I would decrease my condom use for receptive (bottom) anal sex.”

7. 5035 HIV-uninfected MSM participated in the study • Eligibility: • Biologic male • ≥18 years of age • HIV-uninfected by self-report • Able to read English/use the Internet

8. We assessed factors associated with anticipated decreases in condom use while using PrEP Descriptive statistics

9. We assessed factors associated with anticipated decreases in condom use while using PrEP Descriptive statistics Bivariate  multivariable logistic regression analyses to assess correlates of anticipated decreases in condom use

10. We assessed factors associated with anticipated decreases in condom use while using PrEP • Descriptive statistics • Bivariate  multivariable logistic regression analyses to assess correlates of anticipated decreases in condom use • Demographics • Sexual Risk Behaviors, Self-perceived Risk of HIV Acquisition • Engagement in Healthcare • Awareness, Interest and Prior Use Regarding PrEP and Post-exposure Prophylaxis (PEP) • Psychosocial Characteristics, Substance use

11. Most participants were White and self-identified as homosexual/gay

12. Participants were highly-educated and moderately affluent; depression was common PCP = primary care provider.

13. Many respondents reported high-risk behaviors, but average self-perception of risk was low-to-moderate 1Prior 3 months. UAI = unprotected anal intercourse, male partner(s).

14. Awareness of PrEP was modest, and prior use was rare; half indicated interest in using daily oral PrEP

15. A substantial minority anticipated decreases in condom use while using PrEP

16. UAI and prior drug/alcohol abuse were assoc. w/ anticipated ↓ in condom use for insertive sex 1Adjusted for Age, race/ethnicity, education, income.

17. UAI, ↑ self-perceived risk, and UAI after ≥ 5 drinks were assoc. with anticipated ↓ in condom use for receptive sex 1Adjusted for Age, race/ethnicity, education, income.

18. In summary, a substantial minority of at-risk MSM anticipate decreased condom use while using PrEP • MSM engaged in on-line networking report high-risk behaviors

19. In summary, a substantial minority of at-risk MSM anticipate decreased condom use while using PrEP • MSM engaged in on-line networking report high-risk behaviors • Interest in PrEP use exists: half would use daily PrEP

20. In summary, a substantial minority of at-risk MSM anticipate decreased condom use while using PrEP • MSM engaged in on-line networking report high-risk behaviors • Interest in PrEP use exists: half would use daily PrEP • A substantial minority of MSM anticipate risk compensation for insertive (20%) or receptive (14%) anal sex while using PrEP

21. In summary, a substantial minority of at-risk MSM anticipate decreased condom use while using PrEP • MSM engaged in on-line networking report high-risk behaviors • Interest in PrEP use exists: half would use daily PrEP • A substantial minority of MSM anticipate risk compensation for insertive (20%) or receptive (14%) anal sex while using PrEP • Recent unprotected anal sex behaviors, greater self-perceived risk for HIV acquisition, and substance abuse are associated with anticipated risk compensation

22. Clinicians who prescribe PrEP to at-risk MSM should assess for changes in risky sexual behaviors • More intensive counseling may be merited for MSM with • recent risky behaviors • increased self-perceived risk of HIV acquisition • substance abuse

23. Clinicians who prescribe PrEP to at-risk MSM should assess for changes in risky sexual behaviors • More intensive counseling may be merited for MSM with • recent risky behaviors • increased self-perceived risk of HIV acquisition • substance abuse • Studies to assess for risk compensation among persons using PrEP are needed

24. Abstract Authors • Krakower, Douglas (Harvard Medical School/Beth Israel Deaconess Medical Center) • Mimiaga, Matthew (Harvard Medical School/Massachusetts General Hospital and The Fenway Institute) • Rosenberger, Joshua (George Mason University) • Novak, David (Online Buddies, Inc., Cambridge, MA) • Mitty, Jennifer A. (Harvard Medical School/Beth Israel Deaconess Medical Center and The Fenway Institute) • White, Jaclyn (The Fenway Institute) • Mayer, Ken (Harvard Medical School/Beth Israel Deaconess Medical Center and The Fenway Institute) • Funding: Harvard T32 post-doctoral HIV Clinical Research Fellowship (NIAID AI 007433). Project support: Gilead Sciences. • Thanks to the staff of the Fenway Institute, and the study participants.

25. Abstract Authors Thank you! dkrakowe@bidmc.harvard.edu • Krakower, Douglas (Harvard Medical School/Beth Israel Deaconess Medical Center) • Mimiaga, Matthew (Harvard Medical School/Massachusetts General Hospital and The Fenway Institute) • Rosenberger, Joshua (George Mason University) • Novak, David (Online Buddies, Inc., Cambridge, MA) • Mitty, Jennifer A. (Harvard Medical School/Beth Israel Deaconess Medical Center and The Fenway Institute) • White, Jaclyn (The Fenway Institute) • Mayer, Ken (Harvard Medical School/Beth Israel Deaconess Medical Center and The Fenway Institute) • Funding: Harvard T32 post-doctoral HIV Clinical Research Fellowship (NIAID AI 007433). Project support: Gilead Sciences. • Thanks to the staff of the Fenway Institute, and the study participants.