US: Clinician Recommendations Regarding Condom Use Are Not Uniform

Despite recent research revealing that antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) both greatly reduce the chances of HIV transmission, the “Undetectable Equals Untransmittable” message is not being promoted by all providers who work with HIV patients or those at risk of HIV.

In October 2017, investigators based at the University of Nebraska Medical Center in Omaha conducted a survey of practitioners who had attended a continuing education activity sponsored by the International Antiviral Society-USA. Out of 3238 attendees surveyed about their views on condomless sex and its safety, the team received 478 responses. Slightly more than half (51%) of respondents believe that evidence proves, strongly supports, or supports the claim that condomless sex with someone who has HIV but is virally suppressed will not result in disease transmission. More than three-quarters (76%) of respondents usually or always tell patients to use condoms. Even fewer respondents expressed full confidence in PrEP, with 42% agreeing that evidence proves, strongly supports, or supports the idea that condomless sex involving a person who takes PrEP will not result in disease transmission; 81% usually or always suggest condom use in these situations.

Why are so many practitioners sticklers for condom use even though ART and PrEP have proven effective at preventing HIV transmission? The answer may lie with other sexually transmitted infections (STIs). “We know that there is a high incidence of STIs among patients with HIV and among patients on PrEP, and condoms are the only way to prevent STIs other than HIV,” Sara Bares, MD, assistant professor at the University of Nebraska Medical Center and the lead author of the study, told Contagion. Read more via Contagion