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Individual HIV Risk versus Population Impact of Risk Compensation after HIV Preexposure Prophylaxis Initiation among Men Who Have Sex with Men

Fig 3

Schematic diagram showing the feedback loop between increased risk compensation, higher behavioral indications, and PrEP uptake among a four-person network over four time steps.

At t0, Node 1 (N1) engages in condom unprotected anal intercourse (UAI) outside of a monogamous partnership (with N2 and N3), which leads to his indications for and uptake of PrEP at t1. In the risk compensation (RC) scenario, PrEP is associated with an increase in UAI (with N2), a PrEP non-user, whereas in the counterfactual no RC scenario, behavior remains the same as protected anal intercourse (PAI). At t2, N2 has engaged in UAI with N1 in the RC scenario, becomes indicated for PrEP, and uses it before initiating UAI with N4, an HIV-infected (status unknown) partner. In the No RC scenario, the PrEP uptake is delayed until t3, but N2 has already become infected by N4.

Fig 3