Behavioral Compensation Among Black Men Who Have Sex with Men (MSM) Enrolled in HIV Prevention Trials Network Study 073

Background:While HIV infections among men who have sex men (MSM) has started to decline in the United States, Black MSM (BMSM) continue to experience disproportionate rates of HIV infection. The nationwide decline has been attributed to both a strong emphasis on comprehensive HIV prevention interventions and advances in biomedical primary and secondary HIV prevention. Risk compensation has been widely studied in HIV prevention trials, yet behavioral compensation has received less focus in the adoption of HIV prevention strategies. The purpose of this secondary analysis is to examine influence of behavioral on different HIV risk reduction strategies (condom use and pre-exposure prophylaxis [PrEP] use) used by BMSM from HPTN 073.

Methods: The secondary data analysis was conducted with data from HPTN 073 participants. Demographic characteristics, substance use, sexual behavior, depression symptomology, and HIV testing history data were captured from the psychosocial ACASI surveys measured at baseline, week 13, week 26, week 39, and week 52. PrEP adherence was measured used dried blood spot (DBS) collected at week 8, week 26, and week 52. For the analysis, matched data (26 and 52 weeks) from both data sources were used. We tested both bivariate and multivariate associations between risk compensation and biomedical prevention strategy outcomes (condomless anal sex with main and casual partners) and PrEP adherence using generalized estimation equation model for time-variant repeated measures controlling for site.

Results:HIV risk perception was not predictive of PrEP adherence (OR = 1.01; p = .75). Risk perception for HIV was not predictive of condom use with a main partner (OR = .93; p = .11). However, HIV risk, perception was predictive of condomless sex with casual partner(s) (OR = 1.12 = p < .01).

Conclusion:The study demonstrated high levels of PrEP use, inconsistent engagement in behavioral compensation, and irregular condom use among BMSM. The findings illustrate the need to distinguish between behavioral compensation and risk compensation in future research.