{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T09:13:52Z","timestamp":1789982032981,"version":"4.0.1"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,9,20]],"date-time":"2017-09-20T00:00:00Z","timestamp":1505865600000},"content-version":"vor","delay-in-days":262,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1084416"],"award-info":[{"award-number":["OPP1084416"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID\u2010674\u2010A\u201012\u201000034"],"award-info":[{"award-number":["AID\u2010674\u2010A\u201012\u201000034"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:p><jats:bold>Introduction<\/jats:bold><jats:bold>:<\/jats:bold> Oral pre\u2010exposure prophylaxis (PrEP) is a promising new prevention approach for those most at risk of HIV infection. However, there are concerns that behavioural disinhibition, specifically reductions in condom use, might limit PrEP's protective effect. This study uses the case of female sex workers (FSWs) in Johannesburg, South Africa, to assess whether decreased levels of condom use following the introduction of PrEP may limit HIV risk reduction.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We developed a static model of HIV risk and compared HIV\u2010risk estimates before and after the introduction of PrEP to determine the maximum tolerated reductions in condom use with regular partners and clients for HIV risk not to change. The model incorporated the effects of increased STI exposure owing to decreased condom use. Noting that condom use with regular partners is generally low, we also estimated the change in condom use tolerated with clients only, to still achieve 50 and 90% risk reduction on PrEP. The model was parameterized using data from Hillbrow, Johannesburg. Sensitivity analyses were performed to ascertain the robustness of our results.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Reductions in condom use could be tolerated by FSWs with lower baseline condom use (65%). For scenarios where 75% PrEP effectiveness is attained, 50% HIV\u2010risk reduction on PrEP would be possible even with 100% reduction in condom use from consistent condom use as high as 70% with clients. Increased exposure to STIs through reductions in condom use had limited effect on the reductions in condom use tolerated for HIV risk not to increase on PrEP.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> PrEP is likely to be of benefit in reducing HIV risk, even if reductions in condom use do occur. Efforts to promote consistent condom use will be critical for FSWs with high initial levels of condom use, but with challenges in adhering to PrEP.<\/jats:p>","DOI":"10.7448\/ias.20.1.21744","type":"journal-article","created":{"date-parts":[[2017,9,27]],"date-time":"2017-09-27T15:13:44Z","timestamp":1506525224000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["When are declines in condom use while using PrEP a concern? Modelling insights from a Hillbrow, South Africa case study"],"prefix":"10.1002","volume":"20","author":[{"given":"Hannah","family":"Grant","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zindoga","family":"Mukandavire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn","family":"Eakle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Prudden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"B Gomez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Rees","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Watts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,9,20]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"188","article-title":"Gender power imbalance on women's capacity to negotiate self\u2010protection against HIV\/AIDS in Botswana and South Africa.","volume":"5","author":"Langen TT.","year":"2007","journal-title":"Afr Health Sci"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.2307\/3583277"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001145"},{"key":"e_1_2_9_5_1","unstructured":"MartinM MockP CurlinM VanichseniS SuntharasamaiP SangkumUet al.Enrollment and preliminary follow\u2010up of injecting drug users receiving pre\u2010exposure prophylaxis in Bangkok [abstract].22nd Conference on Retroviruses and Opportunistic Infections. Seattle Washington2015Feb 23\u201026"},{"key":"e_1_2_9_6_1","volume-title":"Characteristics and oral PrEP adherence in the TDF2 open\u2010label extension in Botswana.","author":"Henderson F","year":"2015"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(14)70937-5"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(14)70847-3"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1202614"},{"key":"e_1_2_9_10_1","volume-title":"MTN Statement on decision to discontinue use of oral tenofovir tablets in VOICE, a major HIV prevention study in women","author":"Chirenje Z","year":"2011"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3283543e83"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.7196\/SAMJ.6937"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMe1207438"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-012-0317-8"},{"issue":"3","key":"e_1_2_9_15_1","first-page":"9","article-title":"PrEParing the way [online].","volume":"9","author":"Murphy D.","year":"2011","journal-title":"HIV Aust"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-013-0675-x"},{"issue":"3","key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"19157","DOI":"10.7448\/IAS.17.3.19157","article-title":"The importance of choice in the rollout of ARV\u2010based prevention to user groups in Kenya and South Africa: a qualitative study","volume":"17","author":"Mack N","year":"2014","journal-title":"J Int AIDS Soc"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-005717"},{"key":"e_1_2_9_19_1","unstructured":"GlazekC.Why is no one on the first treatment to prevent H.I.V.?New Yorker.2013. [cited 2015 Jan 5]. [online]. Available at: Available from:http:\/\/www.newyorker.com\/tech\/elements\/why\u2010is\u2010no\u2010one\u2010on\u2010the\u2010first\u2010treatment\u2010to\u2010prevent\u2010h\u2010i\u2010v"},{"key":"e_1_2_9_20_1","volume-title":"Guidance on oral pre\u2010exposure prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV: recommendations for use in the context of demonstration projects","author":"World Health Organization.","year":"2012"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60137-9"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-015-1030-1"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-015-1055-5"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ778"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302816"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)90002-2"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/SMJ.0000000000000010"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011595"},{"key":"e_1_2_9_29_1","unstructured":"UCSF Anova Health Institute & WRHI South African Health Monitoring Study (SAHMS) Final report: the integrated biological and behavioural survey among female sex workers South Africa 2013\u20102014.2015"},{"key":"e_1_2_9_30_1","first-page":"20404","article-title":"High utilization of health services and low ART uptake among female sex workers (FSW) in three South African cities: results from the South Africa health monitoring study (SAHMS\u2010FSW)","volume":"18","author":"Lane T","year":"2015","journal-title":"J Int AIDS Soc"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1071\/SH07024"},{"key":"e_1_2_9_32_1","volume-title":"National strategic plan for HIV prevention, care and treatment for sex workers.","author":"South African National AIDS Council.","year":"2013"},{"key":"e_1_2_9_33_1","unstructured":"Department of Health Republic of South Africa.National policy on HIV Pre\u2010exposure Prophylaxis (PrEP) and Test and Treat (T&T). Final draft 2016 May 11."},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.4102\/sajhivmed.v17i1.455"},{"key":"e_1_2_9_35_1","volume-title":"The South African national sex worker HIV Plan, 2016\u20102019.","author":"South African National AIDS Council.","year":"2016"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200305230-00015"},{"key":"e_1_2_9_37_1","first-page":"500","article-title":"Strategies for limiting the spread of HIV in developing countries: conclusions based on studies of the transmission dynamics of the virus.","volume":"9","author":"Garnett GP","year":"1995","journal-title":"J Acquir Immune Defic Syndr"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-199001000-00007"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4899-1878-9_2"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/00042560-199911010-00010"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2008.032458"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/00126334-200309010-00011"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000216"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000351"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-014-0148-z"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0083736"},{"key":"e_1_2_9_47_1","unstructured":"DelanyS.Summary of behavioural and epidemiological data from Hillbrow sex\u2010worker intervention.Reproductive Health Research Unit (Now Witwatersrand Reproductive Health and HIV Unit). Forthcoming2001."},{"key":"e_1_2_9_48_1","volume-title":"National strategic plan for HIV prevention, care and treatment for sex workers.","author":"South Africa National AIDS Council (SANAC).","year":"2013"},{"key":"e_1_2_9_49_1","unstructured":"Department of Health: Republic of South Africa.Guidelines for expanding combination prevention and treatment options for sex workers: oral Pre\u2010Exposure Prophylaxis (PrEP) and Test and Treat (T&T).Final draft: 2016 May 11"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011595"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000218974.77208.cc"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir684"},{"key":"e_1_2_9_53_1","first-page":"194","article-title":"National HIV incidence measures\u2010new insights into the South African epidemic","volume":"97","author":"Rehle T","year":"2007","journal-title":"South Afr Med J"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.7448%2FIAS.20.1.21744","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.7448\/IAS.20.1.21744","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.7448\/IAS.20.1.21744","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.7448\/IAS.20.1.21744","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T13:35:45Z","timestamp":1695562545000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.7448\/IAS.20.1.21744"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1]]},"references-count":52,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017,1]]}},"alternative-id":["10.7448\/IAS.20.1.21744"],"URL":"https:\/\/doi.org\/10.7448\/ias.20.1.21744","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1]]},"assertion":[{"value":"2016-12-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-08-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-09-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"21744"}}