Background: The study aimed to gain a comprehensive understanding of participation in a blinded antiretroviral pre-exposure prophylaxis (PrEP) clinical trial on sexual practices of men who have sex with men (MSM) and transgender women.
Methods: The study utilized both quantitative and qualitative methodology. Quantitative data relied on questionnaires from the parent study, Pre-exposure Prophylaxis Initiative (iPrEx) in Chiang Mai, conducted between 2009 and 2014. Data included reported PrEP medication adherence and sexual risk among all 114 study participants. Forty-six participants took part in the qualitative data collection, with 32 interviewed, and 14 participating in one of three focus group discussions. A semi-structured guide explored experiences with study medication and sexual lifestyles. For quantitative data analysis, average study medication adherence was calculated. Change in sexual risk was based on number of sex partners and incidents of sex without a condom. For qualitative data, content analysis was used to identify repeated normative themes, some of which arose spontaneously from interview interaction and some in response to open-ended questioning.
Results: The quantitative data indicated that on the whole, participants at the Chiang Mai site reported good adherence to the study medication. The data also suggested that the sexual risks taken by these participants were reduced at their final study visit though this was unrelated to level of adherence. While the data on sexual risk related to anal and vaginal sex needs to be regarded with caution given the low number of respondents, overall the pattern appeared to be one of reductions in partners and condomless events. Nevertheless, qualitative findings described sexual practices that were highly contextual and use of risk assessments to determine safe sex practice. Condoms were, for example, used with casual partners but not necessarily with primary partners.
Conclusions: Findings suggest that while PrEP is an exciting new development for future HIV interventions, it must be paired with behavioral interventions to fully address sexual risk among this population - interventions that provide this population with skills to negotiate condom use with their primary partners as well as in situations in which their sexual partners do not support condom use.

Download the e-Poster