PrEP gives health options to men who report high-risk behavior, rather than undermining condom use

Surveys of gay men in the Netherlands and Australia suggest that some would use condoms less frequently if they were taking PrEP – but that these men are generally not using condoms consistently anyway. The data, presented to the 20th International AIDS Conference in Melbourne last week, suggest that PrEP may give men at higher risk of infection a way to protect their health, rather than undermining consistent condom use.

Researchers in the Netherlands and Australia conducted separate surveys of HIV-negative men, with around 500 men participating in each study. In addition, the Dutch researchers explored motivations and barriers to PrEP use during in-depth interviews with 20 of their participants. PrEP is not yet licensed in either country.

There was some awareness of PrEP among survey participants, but knowledge was limited. Few respondents rejected the idea of taking PrEP out of hand but the proportion with a strong interest was limited – 13% of Dutch respondents had a high intention of using PrEP. In Australia, 26% agreed and 11% strongly agreed that they would want to use PrEP as soon as it becomes available in the country.

Dutch men classified as having a high risk of HIV (more than five casual partners, unprotected sex with a casual partner or an STI in the last six months) were four times more likely than other men to have a high intention of using PrEP. Australian men who reported unprotected anal intercourse with casual partners were 1.5 times more likely to want to use PrEP than other men.

The Australian men were asked if they would prefer to take PrEP so as not to need to use condoms. Whereas 38% of those who already practiced unprotected anal intercourse with casual partners agreed with this statement, only 14% of consistent condom users did.

Broadly similar findings were reported in the Dutch study. Furthermore, during in-depth interviews one man commented, “Effectiveness of 44% is more than what I have now.” Another man explained his interest in PrEP:

“Because I always try to have sex as safe as possible, but yes, there are times that you just had too much to drink or the passion is just too strong that you forget… PrEP would offer me a bit more freedom and I would worry a bit less.”

Read more…