MSM on PrEP Are Using Condoms Less Frequently

Increased use of human immunodeficiency virus pre-exposure prophylaxis (HIV PrEP) may be associated with lower rates of condom use among gay and bisexual men, according to new research.

These findings emerged from a study of data from the Melbourne and Sydney Gay Community Periodic Surveys (GCPS), which were geared toward adult gay and bisexual men (N = 27,011) in Melbourne, Australia (n = 13,051), and Sydney, Australia (n = 13,960). Surveys were completed between January 1, 2013, and March 31, 2017.
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Respondents were 16 to 18 years or older and identified as male. Transgender participants who identified as male were included. All men included in the study had had sex with another man within the previous 5 years or identified as gay, bisexual, or both.

Trends in condom use, condomless anal intercourse with casual partners (CAIC), and PrEP use in this cohort were examined via multivariate logistic regression.

A total of 16,827 respondents reported having had sex with casual male partners in the 6 months prior to the survey and were included in the present analysis.

After analyzing the data, Martin Holt, PhD, of the Centre for Social Research in Health at the University of New South Wales in Sydney, Australia, and colleagues found that while PrEP use had increased rapidly among gay and bisexual men in Melbourne and Sydney, consistent condom use had decreased equally rapidly.

Ultimately, 26 (1%) of 2692 men reported CAIC, were HIV-negative, and were using PrEP in 2013, compared with 167 (5%) of 3660 men in 2016, and 652 (16%) of 4018 men in 2017.

A total of 1360 (46%) of 2692 men reported consistent condom use in 2013, compared with 1523 (42%) of 3660 men in 2016, and 1229 (31%) of 4018 men in 2017.

In this cohort, 800 (30%) of 2692 HIV-negative or untested men who were not using PrEP reported CAIC in 2013, compared with 1118 (31%) of 3660 men in 2016, and 1166 (29%) of 4018 in 2017. However, the researchers noted that this trend was not significant.

"I think that PrEP users are well aware that they don't necessarily need to use a condom - they know that PrEP is effective in preventing HIV if taken as directed," said Dr Holt via email. "The more interesting point is whether other men (those not using PrEP) perceive that it is okay to not use condoms as much, now that other people are using PrEP. Our data suggest but don't prove that."

With these data in mind, the researchers concluded that "other jurisdictions should consider the potential for community-level increases in CAIC when modelling the introduction of PrEP and in monitoring its effect."

—Christina Vogt

Reference:

Holt M, Lea T, Mao L, et al. Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: results of repeated behavioral surveillance in 2013–17 [Published online June 6, 2018]. Lancet HIV. https://doi.org/10.1016/S2352-3018(18)30072-9.