A pill that protects people from the AIDS virus may be driving down use of condoms, Australian researchers reported Wednesday.
They found that as more people used the daily pill, called PrEP, the less likely they were to use condoms.
It’s not clear what this means, the researchers wrote in the Lancet medical journal. But the fears are that availability of the pills could feed a false sense of security, and that dropping condom use will help fuel the already widening epidemics of other sexually transmitted infections (STIs) such as syphilis and gonorrhea.
There are also fears that rates of new HIV infections could go back up if people stop using condoms and do not use PrEP consistently.
But some activists said it’s a positive trend and will help remove the stigma surrounding gay and bisexual sex.
PrEP stands for pre-exposure prophylaxis. Researchers found that taking HIV drugs can protect people who are not infected from acquiring HIV. The most common brand name is Truvada, a once-a-day pill.
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PrEP can reduce the risk of catching HIV by 90 percent if people use it consistently. It's been on the market since 2012 and has been recommended by the Centers for Disease Control and Prevention since 2014.
“PrEP has been heralded as a game-changer for HIV, but declining condom use may impede its long-term population-level effectiveness,” Martin Holt at the University of New South Wales in Sydney said in a statement.
Holt and colleagues surveyed nearly 17,000 gay and bisexual men in Sydney and Melbourne between 2013 and 2017, before and after a large campaign to encourage PrEP use.
By 2017, 24 percent of HIV-negative men were using PrEP, they found.
Between 2013 and 2017, the consistent use of condoms fell from 46 percent of men in 2013 to 31 percent in 2017.
“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,” Holt and colleagues wrote.
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Their findings fit with other research done, especially a 2016 study in San Francisco that found similar trends.
“The long-term consequences of this shift in community practice are unknown (eg, the potential for HIV transmission to rebound in HIV-negative and untested men not using PrEP).”
The human immunodeficiency virus (HIV) infects 36 million people globally and it has killed 35 million people since it began spreading in the 1970s, according to the World Health Organization.
In the United States, more than 1.2 million people have HIV, and about 50,000 people are newly infected each year.
It killed 1 million people last year, WHO says. The virus, which has no cure, is spread via sex and blood, and from mother to child at birth.
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For decades, the only way to prevent its spread sexually was with consistent condom use. It ravaged gay and bisexual communities in the developed world, including the U.S., while killing mostly heterosexuals in the developing world.
PrEP is changing that. Actor Charlie Sheen's admission in 2016 that he was HIV positive and was using HIV drugs to control the infection and protect his sex partners also sparked strong interest in HIV prevention.
But studies are beginning to show that the more people know about and use PrEP, the less likely they are to use condoms.
Jim Pickett, senior director of prevention advocacy at the AIDS Foundation of Chicago, welcomes this shift.
“Let’s be frank. Lots of people don’t use condoms all the time,” Pickett told NBC News.
“This is why the U.S. government has spent billions upon billions of dollars to develop technologies that prevent HIV. Condom use is not the norm for most people in the world.”
Fears are that when people stop using condoms, STIs will spike. And statistics show that the U.S. is going through an epidemic of STIs, many of them developing resistance to antibiotics.
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But Pickett says it’s likely not PrEP users who are involved in this explosive spread.
“PrEP users are seeing a clinician four times a year,” he said. “Those visits include a thorough STI screening. People on PrEP are getting excellent sexual health care.”
Frequent testing and treatment show control the spread of STIs, he said.
“If someone is on PrEP, I am very happy. That is very safe sex. It was never meant to prevent all other STIs.”
Another worry is that people will lose their fear of becoming infected with HIV, and will be more likely to have unprotected sex even if they are not using PrEP. Pickett dismisses this worry.
“Everyone is responsible for their own prevention,” he said. “No one should be relying on someone else’s behavior to protect them. If you think PrEP is protective, then you should be on PrEP.”
Cultural producer and community mobilizer Elijah McKinnon agrees. He says PrEP has helped remove the fear and stigma about HIV and the LGBTQ community.
“If someone is on PrEP, I am very happy. That is very safe sex. It was never meant to prevent all other STIs.”
“As a PrEP user myself, one thing I am very interested in is reclaiming my sexuality,” McKinnon said.
McKinnon, who is 26, was not alive to see the devastation HIV wrought before the introduction of antiretroviral drugs that control the virus. But he said he is glad to see some of the fear removed.
“For the first time, I hear people being able to breathe easy,” McKinnon said.
“While condoms are an incredibly important tool in the kit, they are just one tool — just like PrEP is just one tool,” he added. “We are entering in a time when people are becoming more sexually liberated and more comfortable in seeking out the tools they need.”