A unique study has shown condom use among men who have sex with men (MSM) has declined sharply.
The report published in The Lancet found consistent condom use with casual partners had declined in Australia’s two biggest cities, Melbourne and Sydney.
There were many reasons found for the decline, including the increased use of PrEP (pre-exposure prophylaxis). PrEP is a daily pill that people can take and is proven to be highly effective at preventing HIV transmission.
Titled ‘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’, was released this week.
It found that even though MSM were still pretty good at engaging in effective HIV preventative measures.
Condom use in the state, New South Wales (NSW), dropped from 46% in 2013 to 31% in 2017. But condom use was still relatively high among MSM at 70%.
The access to PrEP in Australia has grown rapidly over the past few years as state governments run local trials of the medication. In April, the Federal Government also agreed to subsidize PrEP to make it more affordable and accessible.
New HIV cases in Australia and especially in NSW have been on the decline in the past few years. There has been a jump among some populations, including Aboriginal and Torres Strait Islander people in northern Australia.
PrEP isn’t the only reason condom use has declined
Authors of the study found there were multiple reasons that MSM were using condoms less.
They noted ‘fatigue’ from ongoing sexual health vigilance since the start of the HIV/AIDS epidemic was one cause.
But MSM were engaging in a number of HIV prevention methods including testing regularly. There was also a greater understanding of ‘U=U’, resulting in less condom use. U=U is the fact that people living with HIV whose viral loads were undetectable were not able to pass on HIV to sexual partners.
STIs, PrEP and condom use
Two of Australian’s leading HIV organizations condemned media reports that PrEP was to blame for the rising rate of STIs.
ACON and AFAO (Australian Federations of AIDS organizations) spoke out about a number of misconceptions.
They said data has shown there to be little change in the incidence of STIs in people on PrEP, apart from a slight increase in chlamydia.
‘The increases in STI notifications are likely to be due to a combination of a real increase in infections as well as improved testing rates,’ ACON and AFAO said in a statement.
‘Improved testing helps identify people with undiagnosed STIs who may otherwise go untreated, and potentially transmit their infection.
‘Testing and diagnosis can lead to an increase in people with STIs who are notified and treated, and in turn notify, their sexual partners to interrupt the spread of STIs.’
Keep using PrEP
ACON applauded gay men for their ‘continued use of condoms more than 30 years into the HIV epidemic’. That was especially ‘at rates that exceed that of the general population’.
But the organization warned that fear mongering around PrEP had to stop.
‘To not utilise PrEP as a new prevention tool for fear of triggering an increase in STIs would be bad public health policy,’ ACON said.
‘Studies have consistently shown that PrEP is extremely effective at preventing HIV transmission, and trials… have continued to demonstrate excellent public health outcomes.
‘What is important is that gay men continue to use a HIV prevention strategy every time. In a contemporary response, this includes the use of PrEP. HIV is incurable and life long – driving down HIV transmissions is a key public health priority.’