Pre-Exposure Prophylaxis and Sexual Health Outcomes
Summary
Pre-exposure prophylaxis (PrEP) has revolutionised HIV prevention by offering antiretroviral medication to HIV-negative individuals at substantial risk of infection. Widespread adoption has delivered impressive reductions in new HIV diagnoses among key populations, particularly men who have sex with men (MSM). Concurrently, attention has turned to changes in sexual behaviour and the incidence of other sexually transmitted infections (STIs). While some users reduce condom use after starting PrEP, longitudinal cohorts report stable or declining rates of condomless encounters and no clear long-term rise in STI incidence solely attributable to PrEP. Success depends on integrated sexual health programmes that combine PrEP delivery with regular STI screening, tailored counselling and behavioural support. As PrEP programmes scale up internationally, evidence on optimal STI screening intervals, strategies to address periods of heightened sexual risk and measures to mitigate risk compensation is essential to safeguard both HIV and broader sexual health outcomes.
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Pre-Exposure Prophylaxis and Sexual Health Outcomes publication trend
The graph below shows the total number of articles in pre-exposure prophylaxis and sexual health outcomes across all publications each year (not limited to Nature Index journals).
Technical terms
Pre-Exposure Prophylaxis (PrEP): Preventive use of antiretroviral therapy by HIV-negative individuals to reduce the chance of HIV acquisition.
Event-Driven PrEP: Dosing strategy in which PrEP pills are taken around the time of sexual activity rather than daily, commonly known as “2-1-1” dosing.
Condomless Anal Intercourse (CAI): Anal sex without a condom, recognised as a primary route of HIV and STI transmission among MSM.
Sexually Transmitted Infection (STI): Infections transmitted via sexual contact, including chlamydia, gonorrhoea and syphilis, which remain prevalent in PrEP cohorts.
Risk Compensation: Behavioural shift in which individuals adjust their risk-taking, potentially increasing sexual risk when they feel protected by an intervention such as PrEP.
References
- HIV pre-exposure prophylaxis and its implementation in the PrEP Impact Trial in England: a pragmatic health technology assessment. The Lancet HIV (2023).
- Sexual behaviour and incidence of sexually transmitted infections among men who have sex with men (MSM) using daily and event-driven pre-exposure prophylaxis (PrEP): Four-year follow-up of the Amsterdam PrEP (AMPrEP) demonstration project cohort. PLOS Medicine (2024).
- Questioning risk compensation: pre-exposure prophylaxis (PrEP) and sexually transmitted infections among men who have sex with men, capital region of Denmark, 2019 to 2022. Eurosurveillance (2024).
- Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis. International Journal of Infectious Diseases (2023).
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