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Understanding the relationship between HIV pre-exposure prophylaxis, sexually transmitted infections, and antimicrobial resistance

Williams, Adam Dale Newman 2023. Understanding the relationship between HIV pre-exposure prophylaxis, sexually transmitted infections, and antimicrobial resistance. PhD Thesis, Cardiff University.
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HIV pre-exposure prophylaxis (PrEP) prevents the acquisition of HIV. There are concerns around PrEP provision due to risk compensation (RC), a theory that suggests people become less careful when they feel safe. The argument suggests that using PrEP provision could lead to people engaging in higher-risk sexual behaviours, increasing other sexually transmitted infections (STIs), which would exacerbate antimicrobial resistance (AMR) through increased antimicrobial requirements. This PhD explores the influence of PrEP on sexual behaviour among men who have sex with men (MSM) in Wales, with a focus on the impact of the transmission of STIs and AMR. This was achieved using a mixed-methods design with insights from relevant literature. Interviews were conducted with MSM to explore the relationship between PrEP, STIs, and AMR and to gain an understanding of behaviour changes after PrEP adoption. Anonymous sexual health records and AMR data were analysed to identify trends in PrEP and non-PrEP using MSM. The findings from these two studies, within the context of existing literature, informed the development of the conceptual framework, presenting the relationship between the variables. In response to the COVID-19 pandemic, a survey exploring sexual behaviour during lockdown was conducted with input from the interviews. Results show that PrEP has had little to no statistical effect on STI rates, with rates reducing among most STIs since PrEP’s introduction. The data available does not allow a detailed examination of AMR. Qualitative findings indicate a range of behaviours in response to PrEP uptake. A detailed account of RC is presented, identifying how the previous examinations may have been incomplete. COVID-19 restrictions were adhered to at the beginning of the pandemic, but over time, more people engaged in sexual behaviours with others despite social distancing measures still in force. Behaviour change is complicated to measure, but what is known is that behaviour is often stable and change difficult, which RC fails to acknowledge. PrEP provision is necessary to protect all populations at risk of HIV. With STI AMR levels increasing, there is a need for greater focus on the identification and prevention of bacterial STIs. There is a need to change the discourse of concern regarding HIV and other STIs.

Item Type: Thesis (PhD)
Date Type: Completion
Status: Unpublished
Schools: Medicine
Date of First Compliant Deposit: 26 January 2024
Last Modified: 26 Jan 2024 13:58

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