The following article is a part of conference coverage from the American Academy of PAs 2021 Conference (AAPA 2021), held virtually from May 23 to May 26, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading PAs. Check back for more from AAPA 2021


Patients on PrEP are more likely to engage in risky sexual behavior than patients not on PrEP. This correlation is also true for members of the LGBTQ community in New York City, according to a poster presented at the American Academy of PAs 2021 Conference (AAPA 2021).

While PrEP does provide protection against HIV, it does not prevent the transmission of sexually transmitted infections (STIs) such as herpes, gonorrhea, or syphilis. Patients “may feel a sense of security while on PrEP, but we want to provide the necessary resources in order to help patients be as safe as possible,” reported Kathryn Bacci, a PA student at Wagner College in Staten Island and coauthor of the poster.

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The purpose of the study was to determine if a difference exists in risky sexual behavior of New York City LGBTQ individuals who use PrEP compared with individuals not on PrEP. Since its approval by the Food and Drug Administration in 2012, the literature has shown that PrEP use is related to increased risky sexual tendencies among its users and, consequently, increased transmission of STIs. However, assessment of PrEP users’ risky sexual behaviors within the NYC LGBTQ community has not been extensively researched.

The research team generated an electronic survey that was distributed via a shared link on social media. The survey consisted of 14 demographic items, 23 risky sexual behavior items, and 22 Likert-scale questions regarding PrEP stigma. Of the 100 respondents, 53% had never taken PrEP, 38% were currently using the PrEP, and 9% reported taking PrEP in the past but were not currently using it. Survey participants were 18 years and older, self-identify as a member of the LGBTQ population, and lived in New York City.

Statistically significant moderate negative correlations between PrEP use and variables on the Sexual Risk Survey were found, indicating that those who have never taken PrEP participate in risky sexual behaviors less frequently than those who currently take PrEP. When asked how many sexual partners have you had in the past 6 months, nearly 20% of patients taking PrEP reported ≥10 compared with 5% of patients who have not taken PrEP.

The study also demonstrated a correlation between PrEP stigma and sexual orientation. When asked whether people would think that using PrEP “is a sign of personal failure,” 61 out of 63 men (97%) who identified as gay either strongly disagreed or disagreed. This compared with 22 out of 25 persons (88%) who identified as bisexual and 5 out of 8 persons (63%) who identified as lesbian.

“As PAs, we really want to focus on implementing comprehensive patient education plans that involve multiple levels of the health care team. Whether a patient is on PrEP or not, guiding patients on ways to engage in safer sex can help reduce unwanted outcomes of unsafe sex,” said Bacci.  

The results around PrEP use and stigma should also be addressed, Bacci said. The study demonstrated a statistically significant correlation between PrEP stigma and sexual orientation. “PrEP stigma [outside of the LGBTQ community] isn’t necessarily talked about on a large scale,” Bacci said. “I think as health care providers we do a good job of educating our patients, but the presence of stigma still exists. Going forward we should make efforts in reducing stigma and destructing barriers to PrEP use.” 

Additional research is needed to more accurately assess risky sexual behaviors in this population, the study concluded.

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Bacci K, Behar T, Berwick A, et al. Relationship between risky sexual behavior and PrEP use within the NYC LGBTQ community. Poster presented at: American Academy of PAs 2021 Conference, May 23-26, 2021. Poster 167.