Official websites use. Share sensitive information only on official, secure websites. Multivariable regression models with a Bayesian modeling framework were used to estimate associations between area-level PrEP coverage and seven sexual behavior outcomes number of total, main, and casual male partners [network degree]; count of one-time partnerships; consistent condom use in one-time partnerships; and frequency of casual partnership anal sex total and condomless , controlling for individual PrEP use.
PrEP coverage ranged from Total degree was highest in Miami 1. Without adjustment for individual PrEP use, these associations strengthened. However, some residual associations remained after controlling for individual PrEP use, suggesting that PrEP coverage may partially drive community-level differences in sexual behaviors. The prevention of human immunodeficiency virus HIV remains a major public health challenge both globally and in the US.
Empirical effects are weaker than projections by mathematical models estimating incidence by PrEP coverage level [ 6 ]. Gaps between projected and actual HIV rates in the context of PrEP coverage may be attributable to racial and ethnic disparities in PrEP use [ 3 ], which are driven by social and structural factors, such as inequitable access to healthcare and medical mistrust resulting from mistreatment in the healthcare system [ 7 , 8 ].
A recent systematic review found broad evidence for increased condomless sex after participants commence PrEP [ 11 ]. Further, behavioral changes increase the risk of acquiring other sexually transmitted infections STIs [ 11 ]. With the continually increasing scale-up of PrEP, changes in risk behavior may also occur among individuals not using PrEP but living in cities with high PrEP coverage.
Resulting behavioral modifications could include the number of sexual partners, the frequency of partnership formation, or the use of condoms. Behavioral changes among PrEP non-users may be akin to unvaccinated individuals feeling indirectly protected from vaccine-preventable diseases if vaccinated community members are protected [ 13 ].
