Can HIV Post-Exposure Prophylaxis Services Change the Sexual Behavior Characteristics of Men Who Have Sex with Men? A Cohort Study in Guangzhou, China

Abstract

This study examines the impact of HIV post-exposure prophylaxis (PEP) on sexual behavior changes in men who have sex with men (MSM), aiming to assess a comprehensive HIV prevention strategy integrating biomedical and behavioral interventions to maximize PEP service effectiveness. From a Guangzhou MSM cohort, participants without prior PEP experience were included. The exposed group received PEP services during follow-up (June 2019–April 2022), while controls did not. Cox proportional hazard regression models assessed PEP’s effects on sexual behavior changes. Of 411 participants (mean age: 30.72), 14.1% received PEP during follow-up. The exposed group showed a higher likelihood of reducing Internet partner-seeking (aHR: 3.58, 95%CI: 1.80–7.10, P < 0.001), decreasing anal intercourse partners (aHR: 3.81, 95%CI: 2.14–6.82, P < 0.001) in the past 6 months, lowering last week’s anal intercourse occurrences (aHR: 3.95, 95%CI: 2.33–6.68, P < 0.001), and improving condom use during past 6 months’ anal intercourse (aHR: 3.94, 95%CI: 1.75–8.90, P = 0.001) and the most recent anal intercourse (aHR: 4.96, 95%CI: 1.77–13.88, P = 0.002) compared to controls. To sum up, PEP services contribute significantly to positive sexual behavior changes in MSM. Strengthening behavioral interventions at PEP’s baseline and follow-up stages is crucial for maximizing comprehensive preventive impact on both biomedical and behavioral aspects in MSM.