Myth or Truth: Will PrEP Lead to More Risky Sexual Behavior?

Editor's Note: There are, unfortunately, many myths going around about pre-exposure prophylaxis, or PrEP  — the use of an antiretroviral drug by HIV-negative people to prevent them from being infected with HIV during sex. This month we’ll look at one myth per day and offer evidence why it’s not true.

Myth: Gay men will take more risks in their sexual behavior if they’re on PrEP.

Truth: After the multinational Preexposure Prophylaxis Initiative (iPrEx) study of Truvada as PrEP for gay and bisexual men was released in 2010, many wondered if PrEP would lead to risk compensation, that is, people engaging in risky behavior because they think they are protected (think increasing sun exposure because you’re wearing sunscreen). A 2013 analysis of the iPrEx study by other researchers concluded, “There was no evidence of sexual risk compensation in iPrEx.” Researchers saw no increase in HIV or syphilis among study participants, and nor increased engagement in receptive anal sex without a condom, all of which could be markers of increased risk-taking. “If risk compensation were occurring, those who believed they were receiving Truvada and that it was effective would be more likely to increase their sexual risk behavior,” explained Julia Marcus, PhD, MPH, the paper’s lead author. “However, our results revealed the opposite: Rates of both HIV and syphilis infections went down, and there was no increase in sexual risk behavior.” The study confirmed the original findings that Truvada as PrEP is a safe and effective tool for reducing HIV transmission and that it may also reduce risky behavior. “Hopefully fears around potential risk compensation can now be put to rest and our community can focus instead on how best to scale up this exciting intervention,” said Kyle Murphy, assistant director of communications at the National Minority AIDS Council.