Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies.

Studies investigating the effects of biologic HIV prevention technologies have been reported with promising results for slowing the spread of the disease. Although they can reduce the rate of HIV transmission at varying levels of efficaciousness, it is vital to anticipate their impact on subsequent sexual behaviors. Risk homeostasis theory posits that decreases in perceived risk, which will occur with access to HIV prevention technologies, will correspond with increases in risk-taking behavior. Here we review the literature on risk compensation in response to HIV vaccines, topical microbicides, antiretroviral medications, and male circumcision. Behavioral risk compensation is evident in response to prevention technologies that are used in advance of HIV exposure and at minimal personal cost. We conclude that behavioral risk compensation should be addressed by implementing adjunct behavioral risk-reduction interventions to avoid negating the preventive benefits of biomedical HIV prevention technologies.