Is PrEP Really Causing a Fall in Condom Use?

New figures show that while the HIV prevention drug, PrEP, is working as well as promised, there has been a significant rise in men shunning condoms. Are the two related?

The research, published this month in The Lancet, involved 17,000 gay and bisexual men from the Victoria and New South Wales areas of Australia. The participants completed questionnaires on their sexual activities including details of whether they were taking PrEP and whether they used condoms.

Between 2013 and 2017, the numbers of HIV-negative people taking PrEP to protect themselves when they had an encounter rose from just two percent up to 24 percent. The researchers also observed that the numbers of men on PrEP who were having casual sexual encounters involving anal sex went up from one percent to 16 percent.

At the same time, the numbers of men reporting using a condom fell substantially, going from 46 percent at the start of the study to just 31 percent by its end.

“PrEP has been heralded as a game-changer for HIV,” said research leader Professor Martin Holt of the University of New South Wales. “But declining condom use may impede its long-term population-level effectiveness. Our findings suggest that the rapid uptake of PrEP disrupted condom use at a community level.”

The situation is more complex than PrEP being solely to blame.

PrEP probably has led to some men feeling they no longer need to use condoms when they have casual sexual encounters. However, many countries across the West have noted that condom use among men who have sex with men has been falling.

Indeed, in 2016 research  revealed that regardless of PrEP availability in America, condom use was on the decline, and the data tells us this trend was present before PrEP was even transitioning to the market.

One reason is that, thanks to modern anti-retrovirals, people living with HIV can now have virus levels that are undetectable. When that happens, they can no longer pass on the virus. As a result, some men may feel they no longer need to use condoms precisely because they know their HIV status and know that they can have sex without being a transmission risk.

Another reason may also be that, to put it bluntly, HIV isn’t seen as a big deal anymore. As tends to happen, as new generations grow up and older generations fade from the public sphere, the crises of yesterday get forgotten or at least softened.

The AIDS crisis is now considered a thing of history, and to an extent it is precisely because modern treatments mean HIV is not a death sentence. Of course, HIV management is a serious, and at times debilitating health concern. All this said, PrEP may indeed be another reason for falling condom use and that is  a problem.

Why do condoms even matter now?

Part of the problem that sexual health advocates have is that condoms and HIV prevention have become so intertwined in people’s minds. Because of PrEP and other treatment options that reduce HIV’s effects in our lives, some may no longer see the need to use condoms.

However, as rising rates of STIs demonstrate, that is not the case. PrEP, through no fault of its own, cannot protect against diseases caused by infections like syphilis and gonorrhea.

Falling condom use and a rise in STIs may precipitate another problem: the rise of un-treatable bacterial infections.

Our over-reliance on antibiotics has produced bacteria that are now resistant to our front line, and in some cases even our last line of treatments. Cases of so-called super gonorrhea and other “superbugs” are now popping up with alarming frequency.

What’s more, PrEP doesn’t guard against all HIV subtypes. As a result, it can’t fully protect people who are having frequent, risky sex.

What appears to be needed here is a wholesale rethink of how to communicate just how vital condoms are to our sexual and physical health. At the same time, though, PrEP’s effectiveness is truly “game changing” for the purpose it was designed to achieve, and it is critical that we do not allow these problems with condom use to eclipse that fact. Ultimately, PrEP may save thousands of people from HIV infection.

We should ignore the scary headlines around this topic but acknowledge that this kind of research is crucial, so we can modify our approach to HIV prevention messaging and sexual healthcare. It’s only by using PrEP in tandem with other measures, like condoms, that we are really going to control–and eventually eradicate–sexually transmitted infections.

Photo credit: Thinkstock.

32 comments

Lisa M
Lisa M4 months ago

Thanks.

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Lisa M
Lisa M4 months ago

Thanks.

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Dave fleming
Dave fleming4 months ago

TFS

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Richard B
Richard B4 months ago

thanks

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pam w
pam w4 months ago

Unfortunately, condoms prevent more than AIDS and pregnancy. And, although PrEp is a great drug...it's inadequate against other STDs.

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Janis K
Janis K4 months ago

Thanks for sharing.

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Leo Custer
Leo Custer4 months ago

Thank you for sharing!

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Winn A
Winn Adams4 months ago

Noted

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Jenn C
Jenn C4 months ago

You can always count on men to be selfish in the sex department. They are very good at separating the sex act from love, compassion and caring.

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Chad Anderson
Chad Anderson4 months ago

Thank you.

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