Changes in self-reported risky sexual behaviour indicators among adults receiving regular risk reduction counselling and optional initiation of pre-exposure prophylaxis in an HIV vaccine preparedness study in Masaka, Uganda

ABSTRACT

Background

HIV risk reduction counselling may reduce risk-taking behaviours. Yet, concerns remain about risk compensation among individuals initiating pre-exposure prophylaxis (PrEP).

Objective

We assessed changes in risky sexual behaviour indicators among HIV vaccine preparedness study participants who received regular risk reduction counselling and referral for PrEP in Masaka, Uganda.

Methods

Adults (18–39 years) at high risk of HIV infection were enrolled in the study between July 2018 and December 2021. Data were collected on socio-demographic factors (baseline) and self-reported sexual risk behaviours (baseline, six monthly). HIV testing and risk-reduction counselling and referral for PrEP were done quarterly. Participants who had completed at least 1 year of follow-up were included in the analysis. Proportional differences and McNemar chi-square tests were used to assess changes in the prevalence of self-reported risky sexual behaviour indicators between baseline and 1 year. Logistic regression was used to assess the predictors of unchanged/increased HIV risk at 1 year.

Results

Three hundred participants [132 (44%) females, 152 (51%) aged ≤24 years] were included in this analysis. Eighty-one (27%) participants initiated PrEP at 1 year. Compared to baseline, there were significant reductions in the prevalence of the following self-reported HIV risk indicators at 1 year (overall, among non-PrEP initiators, and among PrEP initiators): transactional sex, ≥6 sexual partners, unprotected sex with ≥3 partners, sex while drunk, and sexually transmitted infection diagnosis/treatment. Percentage differences ranged from 10% for individuals reporting at least six sexual partners to 30% for those reporting unprotected sex with three or fewer sexual partners. There was weak evidence of association between female gender and unchanged/increased HIV risk at 1 year (adjusted OR: 1.35, 95% CI (0.84–2.17)). No other indicators, including PrEP use, were associated with unchanged/increased HIV risk at 1 year.

Conclusion

Regular risk-reduction counselling may reduce risky sexual behaviour, while PrEP initiation may not lead to risk compensation.

KEYWORDS:

• Risky sexual behaviour
• HIV
• pre-exposure prophylaxis
• risk reduction counselling

Responsible Editor Jennifer Stewart Williams

Responsible Editor Jennifer Stewart Williams

Acknowledgments

We thank all the participants and staff at the MRC/UVRI and LSHTM Uganda Research Unit Masaka clinical research site and acknowledge the support of the PrEPVacc Study Group.

Author contributions

All authors [JK, SK (Sheila Kansiime), SK (Sylvia Kusemererwa), MO, BN, AK, JOM, PK, ER] contributed to the conception and design of the work, review, and approval of the manuscript to be published.

JK: Interpretation of data, drafting manuscript, revising it critically for important intellectual content, agreement to be accountable for all aspects of the work and ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; SK (Sheila Kansiime): Analysis and interpretation of data for the work; ER: Interpretation of data for the work, revising it critically for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work and ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

The PrEPVacc registration cohort study protocol was approved by the Uganda Virus Research Institute Research Ethics Committee (GC/127/18/03/637), the Uganda National Council for Science and Technology (HS2339), and London School of Hygiene & Tropical Medicine Ethics Committee (26494-1). Written informed consent was obtained from participants before any study procedures were conducted.

Paper context

Evidence on the impact of counselling on risky sexual behaviour remains inconclusive. There are also concerns that the use of PrEP for HIV prevention may cause risk compensation. We observed a reduction in high-risk sexual behaviour indicators among participants who received regular person-centred risk reduction counselling, without evidence of risk compensation among participants who initiated PrEP. Regular individualised risk-reduction counselling should be considered for individuals at high risk of HIV acquisition in addition to PrEP.

Members of the PrEPVacc study group

Glenda Gray Nishanta Singh, Zakir Gaffoor, Neetha Morar, Thandiwe Sithole, Kubashni Woeber, Samantha Siva, Eldinah Hwengwere, Sinqobile Nzama, Mlungisi Zwane, Hlobisile Gumede, Nompumelelo Ngcobo, Thasha Gounden, Vumile Gumede, Nokwazi Ntuli, Elizabeth Spooner, Ncengani Mthethwa, Sibusiso Nhleko, Veronica Chamane, Olive Gumede, Rabia Imamdin, Kerusha Chunderduri, Tamon Cafun-Naidoo, Victoria Mathenjwa, Clifford Gcwensa, Ilesh Jani, Edna Viegas, Isabel Remane, Odete Bule, Edna Nhacule, Patricia Ramgi, Raquel Chissumba, Eduardo Namalango, Yolanda Manganhe, Carmelia Massingue, Igor Capitine, Jorge Ribeiro, Lucas Maganga, Wiston William, Emmanuel Kapesa, Elizabeth Danstan, Doreen Pamba, Marco Missanga Amani Kway, Abisai Kisinda, Lilian Njovu, Lwitiho Sudi, Revocatus Kunambi, Jane Ambindwile, Nhamo Chiwerengo, Said Aboud, Patricia Munseri, Eligius Lyamuya, Frank Msafiri, Agricola Joachim, Edith Tarimo, Diana Faini Tumaini Nagu, Deus Buma, Muhammad Bakari, Moses Lufundya, Moshi Bilingo, Colman Mchau, Helen Mtui, Rujeko Samanthia Chidawanyika, Nteboheleng Mahapa, Phindile Khanyile, Londiwe Shandu, Silindile Zulu, Pontiano Kaleebu, Berna Kalanzi, Freddie Mukasa Kibengo, Ayoub Kakande, Jennifer Serwanga, Janet Seeley, Rachael Kawuma, Christian Holm Hansen, Sheila Kansiime, Eugene Ruzagira, Sylvia Kusemererwa, Sylvia Masawi, Vincent Basajja, Tobias Vudriko, Peter Hughes, Shamim Nabukenya, Gertrude Mutonyi, Rita Nakiboneka, Susan Mugaba, Ubaldo Bahemuka, Ben Gombe, Jane Nabbuto, Phiona Kaweesi, Wilson Kakeeto, Dorothy Abigaba, Bridget Muhofa, Kyeyune Mugagga, Jonathan Kitonsa, Lhwanzu Kitooke, Sylvia Masawi, Jonathan Weber, Cherry Kingsley, Tom Miller, Julie Fox, Sheena McCormack, Angela Crook, David Dunn, Henry Bern, Aminata Sy, Liz Brodnicki, Anna Griffiths, Simona Salomone, Sarah Joseph, Claire Wenden, Arianna Marini, Jonathan Hare, Claire Streafield, Kundai Chinyenze, Ansuya Naidoo, Jacqueline Musau, Mabela Matsoso, Mary Amondi, Paramesh Chetty, Anne Gumbe, Brian Kabuubi, Tabitha Wambugu, Giuseppe Pantaleo, Song Ding, Charlotta Nilsson, Arne Kroidl, Chriss Geldmacher, Kathrin Held, Gustavo Doncel, Allison Matthews, Jim Rooney, Alex Kintu, Carter Lee, Vineeta Gulati, Merlin Robb.

Data availability statement

Data supporting the conclusions of this article can be retrieved through the link: https://doi.org/10.17037/DATA.00003403.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2023.2242672.

Additional information

Funding

This study was funded through The Second European & Developing Countries Clinical Trial Partnership (EDCTP2) [Grant reference: RIA2016-1644].