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Give PrEP a chance: moving on from the “risk compensation” concept
INTRODUCTION: While bio‐behavioural interventions (BIs) for sexually transmitted infections (STIs) and HIV prevention have shown their effectiveness (e.g. treatment for syphilis, HPV vaccination or pre‐exposure prophylaxis [PrEP]), they have also aroused major concerns regarding behavioural changes...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6715948/ https://www.ncbi.nlm.nih.gov/pubmed/31468693 http://dx.doi.org/10.1002/jia2.25351 |
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author | Rojas Castro, Daniela Delabre, Rosemary M Molina, Jean‐Michel |
author_facet | Rojas Castro, Daniela Delabre, Rosemary M Molina, Jean‐Michel |
author_sort | Rojas Castro, Daniela |
collection | PubMed |
description | INTRODUCTION: While bio‐behavioural interventions (BIs) for sexually transmitted infections (STIs) and HIV prevention have shown their effectiveness (e.g. treatment for syphilis, HPV vaccination or pre‐exposure prophylaxis [PrEP]), they have also aroused major concerns regarding behavioural changes that could counteract their benefit. Risk compensation (RC) fears concerning BIs in the HIV/STIs prevention field are intimately linked to representations, judgements and social control on sexual behaviour. With an increasing number of PrEP studies describing a rise in STIs due to RC, this paper argues for a shift away from the focus on RC and proposes a more constructive approach to respond to the needs of people living with HIV and populations most at risk. DISCUSSION: The concept of RC, stemming from road safety and derived from economic theory, relies on rational theoretical models of human behaviour. Although widely applied in several contexts its use has been reasonably questioned. Major methodological issues regarding RC have been raised within HIV/AIDS literature. Although behavioural changes (e.g. condomless sex and number of sexual partners) are often erroneously assimilated with RC, there is no evidence that behavioural changes have undermined the effectiveness of previous and current BIs. Still, PrEP has not escaped RC concerns. Increases in condomless sex within the context of growing uptake of PrEP signals a continued need for integrated and innovative HIV and STI prevention strategies and a comprehensive sexual health approach. Routine HIV/STI testing, peer‐led counselling, and identification of sexual health needs within the PrEP model of care could become a gold standard in the sexual health field for all populations. CONCLUSIONS: RC remains a frequent argument against the availability and provision of prevention methods for vulnerable populations. Individuals should be able to benefit from the full panel of BIs options available, to find and adapt methods according to their needs. Current, past and future PrEP users, with other stakeholders, may provide valuable insight into innovative solutions and programmes to control HIV and other STIs. |
format | Online Article Text |
id | pubmed-6715948 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-67159482019-09-04 Give PrEP a chance: moving on from the “risk compensation” concept Rojas Castro, Daniela Delabre, Rosemary M Molina, Jean‐Michel J Int AIDS Soc Debate INTRODUCTION: While bio‐behavioural interventions (BIs) for sexually transmitted infections (STIs) and HIV prevention have shown their effectiveness (e.g. treatment for syphilis, HPV vaccination or pre‐exposure prophylaxis [PrEP]), they have also aroused major concerns regarding behavioural changes that could counteract their benefit. Risk compensation (RC) fears concerning BIs in the HIV/STIs prevention field are intimately linked to representations, judgements and social control on sexual behaviour. With an increasing number of PrEP studies describing a rise in STIs due to RC, this paper argues for a shift away from the focus on RC and proposes a more constructive approach to respond to the needs of people living with HIV and populations most at risk. DISCUSSION: The concept of RC, stemming from road safety and derived from economic theory, relies on rational theoretical models of human behaviour. Although widely applied in several contexts its use has been reasonably questioned. Major methodological issues regarding RC have been raised within HIV/AIDS literature. Although behavioural changes (e.g. condomless sex and number of sexual partners) are often erroneously assimilated with RC, there is no evidence that behavioural changes have undermined the effectiveness of previous and current BIs. Still, PrEP has not escaped RC concerns. Increases in condomless sex within the context of growing uptake of PrEP signals a continued need for integrated and innovative HIV and STI prevention strategies and a comprehensive sexual health approach. Routine HIV/STI testing, peer‐led counselling, and identification of sexual health needs within the PrEP model of care could become a gold standard in the sexual health field for all populations. CONCLUSIONS: RC remains a frequent argument against the availability and provision of prevention methods for vulnerable populations. Individuals should be able to benefit from the full panel of BIs options available, to find and adapt methods according to their needs. Current, past and future PrEP users, with other stakeholders, may provide valuable insight into innovative solutions and programmes to control HIV and other STIs. John Wiley and Sons Inc. 2019-08-30 /pmc/articles/PMC6715948/ /pubmed/31468693 http://dx.doi.org/10.1002/jia2.25351 Text en © 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Debate Rojas Castro, Daniela Delabre, Rosemary M Molina, Jean‐Michel Give PrEP a chance: moving on from the “risk compensation” concept |
title | Give PrEP a chance: moving on from the “risk compensation” concept |
title_full | Give PrEP a chance: moving on from the “risk compensation” concept |
title_fullStr | Give PrEP a chance: moving on from the “risk compensation” concept |
title_full_unstemmed | Give PrEP a chance: moving on from the “risk compensation” concept |
title_short | Give PrEP a chance: moving on from the “risk compensation” concept |
title_sort | give prep a chance: moving on from the “risk compensation” concept |
topic | Debate |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6715948/ https://www.ncbi.nlm.nih.gov/pubmed/31468693 http://dx.doi.org/10.1002/jia2.25351 |
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