Does pre-exposure prophylaxis for HIV prevention in men who have sex with men change risk behaviour? A systematic review.

The review included only 10 studies, and their designs, populations, dosing schedules, and outcome definitions varied widely. PrEP was given alongside risk reduction counselling, condoms and lubricant, so any single component's effect cannot be separated. Most risk behaviour and condom use data were self-reported, response rates were low, and participants may have reported what they thought clinicians wanted. No study asked about condom use before PrEP started, so no change could mean using condoms or not using them. STI testing and definitions of sexual risk were not uniform, and some studies did not test for anal or pharyngeal infections. Younger men who have sex with men, who may be at higher risk, were poorly represented. Mixed-methods and survey studies used hypothetical PrEP scenarios, so their findings may not reflect real-world behaviour. Partner preferences not to use condoms were not measured in many studies.

The text provided does not report funding or author conflicts. It notes that some included trials received Truvada at no cost from Gilead, and one cohort study required a copayment between 30 and 50 USD.

Do not conclude that PrEP causes increased sexual risk behaviour or STIs. Participants also received risk reduction counselling, condoms and lubricant, and the trials did not show a significant difference in STI rates between PrEP and non-PrEP groups; condom use reports were inconsistent and mostly self-reported.