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Give PrEP a chance: moving on from the "risk compensation" concept
Daniela Rojas Castro1,2, Rosemary M Delabre1, Jean-Michel Molina3,4
1Coalition PLUS, Community-based Research Laboratory, Pantin, France.
Journal of the International AIDS Society
|August 31, 2019
Summary
Concerns about risk compensation (RC) in HIV/STI prevention are often overstated. Evidence does not support that behavioral changes undermine bio-behavioral interventions (BIs), highlighting a need for comprehensive sexual health approaches.
Area of Science:
- Public Health
- Epidemiology
- Behavioral Science
Background:
- Bio-behavioral interventions (BIs) for HIV/STI prevention are effective but raise concerns about risk compensation (RC).
- RC fears link to social judgments on sexual behavior, potentially counteracting BI benefits.
- Existing studies on PrEP show rising STIs, fueling RC debates.
Purpose of the Study:
- To critically evaluate the concept and application of risk compensation in HIV/STI prevention.
- To argue for a shift from focusing on RC to a more constructive approach for at-risk populations.
- To propose integrated strategies for comprehensive sexual health and HIV/STI control.
Main Methods:
- Literature review and critical analysis of risk compensation theory in HIV/AIDS research.
- Examination of behavioral changes in relation to bio-behavioral interventions effectiveness.
- Synthesis of findings to propose innovative prevention strategies.
Main Results:
- Methodological issues question the validity of RC in HIV/AIDS literature.
- No conclusive evidence shows behavioral changes have undermined BI effectiveness.
- Increased condomless sex with PrEP uptake necessitates integrated prevention and sexual health approaches.
Conclusions:
- Risk compensation arguments hinder access to prevention methods for vulnerable groups.
- Individuals should have access to diverse BIs tailored to their needs.
- Engaging PrEP users and stakeholders can yield innovative HIV/STI control solutions.
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