The rollout of a drug that prevents H.I.V. infection was followed by a reduction in condom use among gay and bisexual men in Australia, according to a study published in the journal Lancet H.I.V.
But so effective was the drug that H.I.V. infection rates in the study region declined anyway, the researchers concluded.
During the rapid distribution of a drug that prevents infection — a strategy called pre-exposure prophylaxis, or PrEP — among gay and bisexual men in Australia, researchers found that unprotected sex increased even among those not on PrEP, suggesting that perceptions of risk had declined in communities where the drug was widely available.
“Safe sex is basically transformed by PrEP,” said Martin Holt, a researcher at University of New South Wales in Sydney, who led the study.
“It’s great that these guys are feeling optimistic about avoiding H.I.V., but it has disrupted prevention methods at a community level.”
The daily pill is highly effective in combating H.I.V. infection and is recommended for at-risk populations, such as gay men and intravenous drug users, according to the World Health Organization. Read more via New York Times
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 behavioural surveillance in 2013–17.
Holt, Martin et al.
Background
Pre-exposure prophylaxis (PrEP) has been rapidly rolled out in large, publicly funded implementation projects in Victoria and New South Wales, Australia. Using behavioural surveillance of gay and bisexual men, we analysed the uptake and effect of PrEP, particularly on condom use by gay and bisexual men not using PrEP.
Methods
We collected data from the Melbourne and Sydney Gay Community Periodic Surveys (GCPS), cross-sectional surveys of adult gay and bisexual men in Melbourne, VIC, and Sydney, NSW. Recruitment occurred at gay venues or events and online. Eligible participants were 18 years or older (face-to-face recruitment) or 16 years or older (online recruitment), identified as male (including transgender participants who identified as male); and having had sex with a man in the past 5 years or identified as gay or bisexual, or both. Using multivariate logistic regression, we assessed trends in condom use, condomless anal intercourse with casual partners (CAIC), and PrEP use by gay and bisexual men, controlling for sample variation over time.
Findings
Between Jan 1, 2013, and March 31, 2017, 27 011 participants completed questionnaires in the Melbourne (n=13 051) and Sydney (n=13 960) GCPS. 16 827 reported sex with casual male partners in the 6 months before survey and were included in these analyses. In 2013, 26 (1%) of 2692 men reported CAIC and were HIV-negative and using PrEP, compared with 167 (5%) of 3660 men in 2016 and 652 (16%) of 4018 men in 2017 (p<0·0001). Consistent condom use was reported by 1360 (46%) of 2692 men in 2013, 1523 (42%) of 3660 men in 2016, and 1229 (31%) of 4018 men in 2017 (p<0·0001). In 2013, 800 (30%) of 2692 men who were HIV-negative or untested and not on PrEP reported CAIC, compared with 1118 (31%) of 3660 men in 2016, and 1166 (29%) of 4018 in 2017 (non-significant trend).
Interpretation
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. Other jurisdictions should consider the potential for community-level increases in CAIC when modelling the introduction of PrEP and in monitoring its effect.