High-Risk Sexual Behavior Is Associated with Postexposure Prophylaxis Nonadherence among Men Who Have Sex with Men Enrolled in a Combination Prevention Intervention

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 (n = 35). 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) – (−0.01)) and recent episodes of unprotected anal intercourse (UAI; Coef. = −0.01; 95% CI= (−.01) – (−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.