%0 Journal Article
%T High-Risk Sexual Behavior Is Associated with Postexposure Prophylaxis Nonadherence among Men Who Have Sex with Men Enrolled in a Combination Prevention Intervention
%A Jesse B. Fletcher
%A Joshua A. Rusow
%A Hung Le
%A Raphael J. Landovitz
%A Cathy J. Reback
%J Journal of Sexually Transmitted Diseases
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/210403
%X Methamphetamine use among men who have sex with men (MSM) is associated with increased HIV prevalence, due to increased engagement in high-risk sexual behavior. Fifty-three HIV-negative, methamphetamine-using MSM were enrolled in a biobehavioral combination prevention intervention in Los Angeles, CA, to assess the feasibility of administering postexposure prophylaxis (PEP) in combination with contingency management (CM) to prevent HIV seroconversion. The study combined a CM behavioral intervention targeting reductions in methamphetamine use with a PEP biomedical intervention for HIV prevention. Those who reported recent exposure to HIV were initiated on tenofovir/emtricitabine- (Truvada-) based PEP ( ). This secondary analysis sought to determine whether sexual risk taking was associated with PEP adherence. Regression analyses controlling for participant sociodemographics demonstrated that, at baseline, increased number of lifetime sexually transmitted diseases (STDs; Coef. = £¿0.07; 95% CI= (£¿0.12) ¨C (£¿0.01)) and recent episodes of unprotected anal intercourse (UAI; Coef. = £¿0.01; 95% CI= (£¿.01) ¨C (£¿0.002)) were associated with reductions in medication adherence. Given these associations between baseline sexual risk and PEP adherence, providers working with high-risk MSM may look to target reductions in sexual risk taking; this will reduce direct risk of HIV infection and may work to optimize medication adherence in the case of PEP initiation. 1. Introduction In the United States, men who have sex with men (MSM) exhibit disproportionately high incidence and prevalence of HIV infection. MSM represent an estimated 4.7¨C9.2% of the total United States (US) population [1] yet, in 2009, accounted for 61% of all new HIV infections in the US [2]. Risk factors for HIV infection have been widely documented and among MSM in the US include unprotected anal intercourse, high number of male partners [3], and methamphetamine use [4, 5]. Postexposure prophylaxis (PEP) is a biomedical intervention intended to reduce the likelihood of HIV seroconversion after exposure to the virus. Combination prevention approaches combine biomedical interventions like PEP with behavioral (e.g., cognitive behavioral therapy, motivational interviewing) and/or structural (e.g., needle exchange, condom distribution) interventions, thereby optimizing the likelihood of proper adherence to the PEP medication while also reducing the risk factors placing participants at risk for HIV seroconversion. 1.1. Combination Prevention Interventions Combination prevention interventions integrate
%U http://www.hindawi.com/journals/jstd/2013/210403/