February 5, 2001
The case-controlled data that suggest that PEP has utility in occupational exposures has led many to advocate a similar approach to high-risk sexual or non-occupational needle exposure. This prospective study evaluated whether an educational intervention consisting of five counseling sessions, in addition to provision of PEP for one month, would have an impact on subsequent unprotected sexual exposures, repeated exposures and demands for PEP and an increase in other STDs.
To be eligible the exposure had to have occurred less than 72 hours earlier as a result of sexual activity or sharing needles for injecting drugs. 401 persons were enrolled, of whom 91% were men, 69% Caucasian, and 94% as the result of sexual exposure. Of the 375 persons reporting unprotected sex, 256 reported receptive (153) or insertive (103) anal intercourse, with a much smaller number reporting receptive (30) or insertive (18) vaginal intercourse. Decreases in unprotected sex among 76% of men who have sex with men were noted at 6 and 12 months after PEP, but 8 and 13% reported increased unsafe sex at 6 and 12 months, respectively. 71% and 70% of women reported decreased unsafe sex at the same intervals, whereas only 55% and 58% of men engaging in heterosexual sex reported decreased risky behavior at 6 and 12 months. A multivariate analysis of risks for repeated courses of PEP identified age between 36-45 and some college education as protective; a higher score on a standard depression index as well as having more than two high risk partners in the prior three months were highly significantly associated with repeated courses of PEP. Four individuals seroconverted, three men who have sex with men and one woman.
Although the availability of PEP was not associated with significant disinhibition of sexual behavior, it is important to recognize that 23-45% (depending on the type of sexual practice) of persons either had no change or increased unprotected sexual activity after receiving PEP and a targeted counseling program. It is incumbent upon all clinicians to hammer away at the safe sex message repeatedly in patient interactions to provide a continued stimulus for safe sexual behaviors.
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