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PrEP and Risk Compensation: Assessing Effect and Preparing for Rollout

  • Kenya
  • South Africa
National Institute of Mental Health
2011 - 2015

Since 2010, research has demonstrated the efficacy of pre-exposure prophylaxis (PrEP) in reducing HIV acquisition. The U.S. Food and Drug Administration has approved the use of Truvada for HIV prevention, and both the U.S. Centers for Disease Control and Prevention and the World Health Organization have issued guidance on using PrEP. But, a major concern with any new HIV prevention method, including PrEP, is that its users might take more sexual risks, a concept known as risk compensation.

Currently, clinical trial data document changes in sexual behavior when taking a daily investigational pill for HIV prevention, yet these data represent behaviors related to taking a pill of unknown effectiveness or a placebo pill. Research outside the clinical trial environment is needed to prepare for rollout of PrEP, now that it has been proven effective for HIV prevention.

FHI 360 experts are implementing a novel, multiphase, mixed-methods research study in Bondo, Kenya, and Soshanguve, South Africa. The study will assess how PrEP may affect decisions about sexual risk among women at higher risk for HIV infection and will identify the demographic and behavioral characteristics of women who are most likely to increase risky sexual behavior when using PrEP. The data collected will inform the integration of PrEP into HIV risk-reduction counseling guidelines that promote informed decision making on sexual health when using PrEP. Counseling will include messages on PrEP and adherence, strategies to help women understand their HIV risk and the identification of behavioral skills needed to promote overall sexual health.


Guidance for Providing Informed-Choice Counseling on Sexual Health for Women Interested in Pre-Exposure Prophylaxis (PrEP)

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