Learning about additional HIV prevention methods doesn’t undermine gay men’s intentions to use condoms

Health promotion interventions can combine information about condoms and alternative biomedical prevention methods without undermining attitudes and intentions to use condoms, according to an experimental study published in the September issue of AIDS & Behavior.

“Our results are inconsistent with risk compensation theory, which posits that use of a biomedical prevention approach will lead to less positive attitudes, intentions, and use of condoms,” comment the authors.

Typically, health education messages encourage individuals to take a single course of action, without considering alternative options. However a ‘combination prevention’ approach may involve advocacy of more than one possible course of action. There has been little previous research on how receiving multiple prevention messages affects attitudes and intentions to use condoms. Condoms remain a particularly cheap and effective way of preventing HIV transmission in those who are happy to use them.

The researchers therefore conducted an experiment in which HIV-negative gay men would watch information videos about different prevention topics. Four HIV-prevention videos were developed, each one focusing solely on either condoms, PrEP (pre-exposure prophylaxis), PEP (post-exposure prophylaxis) or rectal microbicides. Each video had a similar style, delivering a similar range of factual information about the method’s financial cost, effectiveness at preventing infection, mode of operation, side-effects and impact on sexual pleasure.

Study participants were randomised to see either a single video, a combination of two videos, or all four videos together.

Afterwards, the researchers asked men about their likelihood of using the prevention method(s) they had just been given information about. In addition, the respondents were asked about the advantages and disadvantages of sex with and without condoms.

A sample of 803 HIV-negative gay men was recruited through targeted Facebook advertising in the United States. Of note, men in this sample reported relatively high rates of condom use – four in five said they had always used condoms with casual partners in the past year.

The researchers wanted to check that hearing about alternative prevention options wouldn’t make people feel less favourably towards condoms. The results were very reassuring – there were no significant differences in participants’ intention of using condoms, or their assessment of condoms’ costs and benefits, according to the videos that had been seen.

This was also the case for intentions to use PEP, PrEP or rectal microbicides. Seeing information about additional options either made no difference to men’s intention to use a specific method (e.g. a microbicide), or it was associated with a greater intention to use them (PEP, PrEP).

The results were consistent for men who reported unprotected sex with casual partners, and men who did not.

 “In summary, our results suggest no differences in attitudes and intentions towards condom use or unprotected sex when MSM [men who have sex with men] received brief messages about condoms and multiple biomedical prevention approaches,” the researchers conclude. The results should encourage those who plan to disseminate information about biomedical prevention options, they comment.