New Study in Lancet HIV Journal Ties PrEP to Drop in Condom Use

In Featured, News by Rachel Mills

Research study of gay and bisexual men done in Australia (2013-2017) concluded:
“A rapid increase in PrEP use by gay and bisexual men in Melbourne and Sydney was accompanied by an equally rapid decrease in consistent condom use.”

As STD rates explode in the US and elsewhere among young people and men-who-have-sex-with-men, including strains of drug-resistant infection, AHF revisits its unanswered call— first posed in an Open Letter to the CDC in 2014—that asked, “CDC: What if You’re Wrong About PrEP?”

LOS ANGELES (June 14, 2018) A new study of gay and bisexual men taking PrEP or pre-exposure prophylaxis to prevent HIV acquisition published in the Lancet HIV Journal last week confirms long-held concerns of public health advocates affiliated with AHF: While the use of PrEP may result in a decrease in transmission of HIV, it also contributes to a decrease in the use of condoms at a time when rates of other STDs in the US and elsewhere among young people and men-who-have-sex-with-men are exploding— infections for which PrEP offers no preventive effect.

This latest PrEP study, undertaken in Melbourne and Sydney, Australia between January 1, 2013 and March 31, 2017, found that the percentage of men on PrEP who had sex with a casual partner without a condom rose from one percent to sixteen percent. There was even a nine percent jump in unprotected sex with a casual partner by men who were not on PrEP and who were HIV negative or untested. In interpreting the study in the Lancet HIV Journal, the researchers concluded:

“A rapid increase in PrEP use by gay and bisexual men in Melbourne and Sydney was accompanied by an equally rapid decrease in consistent condom use.”

Even before the FDA first approved use of Gilead’s HIV/AIDS treatment medication Truvada as pre-exposure prophylaxis (PrEP) as a tool for HIV prevention in July 2012, AHF expressed concern about the impact PrEP would have on public health prevention efforts, including concerns over patient adherence to a daily pill regimen for PrEP as well as the possible abandonment of the culture of condom use—something that appears borne out in this Australian study.

AHF’s concerns about PrEP remained so strong that in November 2014 it published “An Open Letter to the CDC: “What if You’re Wrong About PrEP?” in The Hill, a daily newspaper serving and reporting on elected officials and government staffers in Washington DC. AHF’s “CDC: What if You’re Wrong About PrEP?” ad also ran over the following ten days in newspapers and magazines in seven markets or cities nationwide: New York, Los Angeles, San Francisco, Oakland, Dallas, Washington, DC and South Florida.

“This latest study confirms the real damage being done to the culture of condom use attributed to PrEP,” said Michael Weinstein, President of AHF. “AHF saw this coming years ago and challenged the CDC in its November 2014 open letter asking the CDC to monitor, rethink and retool its messaging and policies on PrEP and prevention as, if or when studies like this came to light and were published. That challenge fell on deaf ears. Today, we renew and restate our unanswered call, again asking, ‘CDC: What if You’re Wrong About PrEP?’”

Following are select excerpts from AHF’s 2014 “CDC: What if You’re Wrong About PrEP?” letter:

  • “The Centers for Disease Control and Prevention (CDC) recently recommended (May 2014) that half a million gay men in the United States receive Truvada for the prevention of HIV.  Further, they changed their wording from “unprotected sex” to “condomless sex” (in January 2014) to describe intercourse without a condom, thus saying that sex without a condom could still be safe if accompanied by medication while ignoring the transmission of all other STDs besides HIV.
  • … Beyond the potential damage to the health of the individuals, the CDC’s ill-advised strategy of mass treatment with Truvada poses a significant risk to the condom culture, which while it has eroded, has still prevailed among gay men for three decades.
  • Studies show that the majority of gay men use condoms always or sometimes. [1] This is borne out by the fact that the current rates of infection would be far higher if they didn’t. Therefore, spreading misinformation that Truvada is an effective community-wide prevention strategy has the potential to do grave harm.
  • … The debate about safer sex goes back to the beginning of the epidemic. Every time we didn’t heed advice to protect ourselves, we paid a terrible price. AHF will do everything that we can to make sure that doesn’t happen again. However, if we are wrong, we will take responsibility for our decisions. We hope that everyone else will do the same.”

CDC Also Fails to Mention or Recognize Condoms as a Prevention Tool—Twice

  • In a CDC press release issued in February 2017 timed to coincide with that year’s annual Conference on Retroviruses and Opportunistic Infections (CROI) held in Seattle, (“New HIV infections drop 18 percent in six years” February 14, 2017), CDC officials rightly tagged treatment-as-prevention as a likely contributor to the welcome decline in infections those years, also tagged PrEP as a contributing factor (however, the PrEP prevention protocol was only available to the public for two of the six years reported on), but CDC completely failed to mention condoms as a prevention tool that might have played a role in the decline in HIV infections.
  • Similarly, in February 2016 (also timed to the annual Conference on Retroviruses and Opportunistic Infections), the CDC released a forecasting study of plans to prevent 185,000 new HIV infections by 2020. The CDC completely failed to mention condoms as a potential tool for that effort.

Regarding this latest study on PrEP, an article in the Independent (UK) newspaper noted, “PrEP has been heralded as a game-changer for HIV,” said Professor Martin Holt at the University of New South Wales, Sydney, who led the research published in the Lancet HIV journal. “But declining condom use may impede its long-term population-level effectiveness.”

[1] Rosenberger JG et al. (2012). Condom use during most recent anal intercourse event among a US sample of men who have sex with men. Journal of Sexual Medicine, 9(4): 1037-1047.



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