Increases in Pre-exposure Prophylaxis Use and Decreases in Condom Use: Behavioral Patterns Among HIV-Negative San Francisco Men Who have Sex with Men, 2004–2017
Using data from the National HIV Behavioral Surveillance of men who have sex with men (MSM), we estimated the prevalence of sexual behaviors among HIV-negative San Francisco MSM between 2004 and 2017. We estimate a recent increase in the 1-year prevalence of pre-exposure prophylaxis (PrEP) use, from 9.8% in 2014 to 44.9% in 2017. Over that same period, we estimate a decrease in the prevalence of consistent condom use, from 18.5 to 9.4%, and an increase in the percent of individuals with multiple condomless anal intercourse partners. We conclude that while risks for HIV infection may be decreasing among San Francisco MSM due, in part, to increases in PrEP use, the population faces increased risks for other sexually transmitted infections (STIs). Because PrEP alone does not protect against other STIs, we strongly recommend that PrEP users use condoms when possible, routinely screen for STIs, and disclose infections with sexual partners.
KeywordsMen who have sex with men (MSM) Pre-exposure prophylaxis (PrEP) Condomless anal intercourse Serosorting Seroadaptive behaviors
This study was funded by CDC (Grant Number NU62PS005077).
Compliance with Ethical Standards
Conflict of interest
All authors declare no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 9.San Francisco Department of Public Health. HIV Epidemiology Annual Report 2016. San Francisco: San Francisco Department of Public Health; 2017.Google Scholar
- 10.San Francisco Department of Public Health. San Francisco Monthly STD Report. https://www.sfdph.org/dph/files/reports/StudiesData/STD/STD122015.pdf.
- 11.San Francisco Department of Public Health. San Francisco Monthly STD Report. https://www.sfdph.org/dph/files/reports/StudiesData/STD/STD122017.pdf.
- 12.World Health Organization. Growing antibiotic resistance forces updates to recommended treatment for sexually transmitted infections. http://www.who.int/mediacentre/news/releases/2016/antibiotics-sexual-infections/en/. Published August 30, 2016.
- 14.US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2014 clinical practice guideline. 2014.Google Scholar