Tuesday, May 12, 2009

HIV prophylaxis programs "not working" - Australian study

via 6minutes.com.au, by Michael Woodhead

Programs that offer gay men access to anti-HIV drugs for postexposure prophylaxis after high risk sexual behaviour are not working, an Australian study has found.

While homosexual men tended to use prophylaxis appropriately, they do not modify their high risk behaviour in the longer term and do not use prophylaxis for all episodes of unprotected intercourse, a prospective five year study in Sydney has shown.

Published in the journal AIDS (online 4 May), the findings from the National Centre in HIV Epidemiology and Clinical Research show that almost all the 1427 participants had heard of non-occupational post-exposure prophylaxis (NPEP). Usage of prophylaxis increased over the duration of the study, and was mostly used after unprotected intercourse. In 80% of participants it was used only once.

However, the use of prophylaxis did not result in any change in risk behaviour, a finding the researchers said was ‘disappointing’ given that behavioural counseling was always provided when prophylaxis was dispensed.

The study also found that over the five year study period prophylaxis was only used by men on 7% of high risk periods such as unprotected intercourse, and that users had three-fold higher rate of seroconversion to HIV.

“This study paints a picture of increasing and mainly appropriate use of [prophylaxis] among homosexual men in Sydney,” the authors write.

But given the lack of impact of prophylaxis on either HIV risk behaviour or HIV incidence, there is a need to redesign the programs and improve the interventions to reduce personal HIV risk, they say.


David Phillips said...

It's interesting read these supposedly well-intended reports that, whether the writers recognize it or not, carry an undertone of moral horror and exemplify an ignorance regarding the tight linkage between risk and desire.

Dog Brook said...

This is very fatalistic journalism. The aim of PEP is not to change your future sexual behaviour so saying its 'not working' when it doesn't seems frankly misguided.

It's the behavioural counselling that might be said not to work, but even that is a leap of faith from this study.

The aim of a PEP intervention is to prevent sero-conversion ON THIS OCCASION. Deferring sero-conversion is a worth while aim in populations with high incidence.

The study said MSM used PEP appropriately. 80% of users had used it once in 5 yrs. These are positive findings. We should be finding more ways to make PEP available to men exposed to HIV, not damning it for fialing to solve all our problems. Of course users are going to have a higher rate of sero-conversion. They use PEP cause they are at risk. Use does not eliminate risk.

This article seems to fall into the woebegone trap of "The intervention didn't solve the epidemic, so it failed". I think this is both is irresponsible and unhelpful.

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