Stability of condomless anal sex behaviours of young Black men who have sex with men: Implications for HIV prevention, including pre-exposure prophylaxis

Background: Among a sample of young Black men who have sex with men (YBMSM), this study evaluated the stability of annually assessing condomless anal receptive sex (CARS) as an indication for pre-exposure prophylaxis (PrEP) use. Further, the study determined the proportion of YBMSM engaging in CARS rarely (defined as twice or less per year) who may thus may be more efficiently protected by condom use rather than PrEP. Methods: This is a secondary analysis of data collected as part of a randomised control trial that recruited 600 YBMSM from a sexually transmissible infection (STI) clinic located in the southern US. Of these, 144 met the inclusion criteria for the present study. Only HIV-uninfected men assigned to the control condition, who completed the 12-month period of observation, were included. Results: Correlation coefficients between the baseline level of CARS were 0.16 at the first quarter and 0.09, 0.10, and 0.03 at each successive quarter. Discriminant function analysis indicated similarly weak predictive ability of the baseline measure (r = 0.215; P = 0.16). Of 106 reporting no CARS at baseline, 73 (68.9%) had summed scores of zero (no CARS) over the four follow-up assessments. Of 38 reporting any CARS at baseline, 14 (36.8%) had a summed score of zero for the observation period. Of these same 38, 27 (71.0%) had summed scores of two or fewer events of CARS for the observation period. Conclusion: Among YBMSM, CARS in not a stable behaviour over 12 months. Many YBMSM indicated for PrEP may benefit from be a program concurrently promoting condom use.