UPrEP
Research type
Research Study
Full title
Understanding the relationship between HIV pre-exposure prophylaxis, sexually transmitted infections and antibiotic resistance in Wales.
IRAS ID
281194
Contact name
Adam D N Williams
Contact email
Sponsor organisation
Cardiff University
Duration of Study in the UK
1 years, 11 months, 30 days
Research summary
Research Summary
HIV pre-exposure prophylaxis (PrEP) is used for preventing the infection of HIV and is currently provided to all high-risk individuals in Wales. Some clinicians and academics have theorised that PrEP will lead to an increase in sexually transmitted infections and in turn, increase antibiotic resistance through decreased condom use. Stage one of this project aims to look at the longitudinal trends in sexually transmitted infections and antibiotic resistance among gay and bisexual men in Wales over the past 5 years. This epidemiological study will use secondary data from Public Health Wales. The data is routinely collected from GUM clinics across Wales and sent to Public Health Wales for examination. The data is identified anonymised by clinic reference numbers. An interrupted time series analysis will be used comparing both PrEP users and non-PrEP users before and after PrEP was introduced. Some previous studies have identified potential increases in sexually transmitted infections due to PrEP but have been criticised for not accounting for biases within the data. These biases include sample bias and surveillance bias which this study will adjust for in its analysis.Summary of Results
HIV pre-exposure prophylaxis (PrEP) prevents the acquisition of HIV. There are concerns around PrEP provision due to risk compensation (RC), a theory that suggests people become less careful when they feel safe. The argument suggests that using PrEP provision could lead to people engaging in higher-risk sexual behaviours, increasing other sexually transmitted infections (STIs), which would exacerbate antimicrobial resistance (AMR) through increased antimicrobial requirements. This PhD explores the influence of PrEP on sexual behaviour among men who have sex with men (MSM) in Wales, with a focus on the impact of the transmission of STIs and AMR. This was achieved using a mixed-methods design with insights from relevant literature.
Interviews were conducted with MSM to explore the relationship between PrEP, STIs, and AMR and to gain an understanding of behaviour changes after PrEP adoption. Anonymous sexual health records and AMR data were analysed to identify trends in PrEP and non-PrEP using MSM. The findings from these two studies, within the context of existing literature, informed the development of the conceptual framework, presenting the relationship between the variables. In response to the COVID-19 pandemic, a survey exploring sexual behaviour during lockdown was conducted with input from the interviews.
Results show that PrEP has had little to no statistical effect on STI rates, with rates reducing among most STIs since PrEP’s introduction. The data available does not allow a detailed examination of AMR. Qualitative findings indicate a range of behaviours in response to PrEP uptake. A detailed account of RC is presented, identifying how the previous examinations may have been incomplete. COVID-19 restrictions were adhered to at the beginning of the pandemic, but over time, more people engaged in sexual behaviours with others despite social distancing measures still in force.
Behaviour change is complicated to measure, but what is known is that behaviour is often stable and change difficult, that RC fails to acknowledge. PrEP provision is necessary to protect all populations at risk of HIV. With STI AMR levels increasing, there is a need for greater focus on the identification and prevention of bacterial STIs. There is a need to change the discourse of concern regarding HIV and other STIs.REC name
N/A
REC reference
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