A pill that protects people from HIV may also lead to more

first_img When seat belt laws went into effect, some studies suggested drivers became more likely to speed or drive recklessly—a phenomenon called “risk compensation.” Is the same thing happening among people at risk of HIV, now that they can take antiretroviral drugs to protect themselves from the virus? A new study of condom use among gay and bisexual men in Australia suggests the answer is yes.The study, published in The Lancet HIV today, surveyed nearly 17,000 men who have sex with men in Sydney and Melbourne between 2013 and 2017. Use of pre-exposure prophylaxis, or PrEP—daily antiretroviral pills taken by uninfected people—during the study years jumped from 2% of the HIV-negative participants to 24%. In the same time frame, “consistent” condom use dropped from 46% to 31% in men who reported having anal sex with casual partners. But just as seat belts can save lives even if risk compensation occurs, PrEP is so effective that it may more than offset the riskier behavior.Some previous studies had found little change in condom use in people who use PrEP. Others, however, showed the introduction of PrEP has coincided with increases in sexually transmitted infections (STIs) like chlamydia and syphilis, a sign that condom use had dropped. But this, too, has been controversial because those increases could be due to increases in testing for STIs. The new study could help resolve the debate. It documents “an important trend,” says Kenneth Mayer, medical research director for lesbian, gay, bisexual, transgender, and questioning–oriented Fenway Institute in Boston. shutterstock.com/Tethys Imaging LLC By Jon CohenJun. 6, 2018 , 3:00 PM Email Sign up for our daily newsletter Get more great content like this delivered right to you! Country Click to view the privacy policy. Required fields are indicated by an asterisk (*)center_img A pill that protects people from HIV may also lead to more sex without condoms Country * Afghanistan Aland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People’s Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Vietnam Virgin Islands, British Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe “Risk compensation” may lead people who try a new HIV prevention strategy to abandon condoms. What the study does not resolve is the impact of the risk compensation. The authors note that both the Sydney and Melbourne areas saw pronounced drops in HIV transmission rates between 2016 and 2017, coinciding with the increased use of PrEP. The study’s lead author, social scientist Martin Holt of the University of New South Wales in Sydney, says this likely occurred because the first public campaigns that advocated PrEP use targeted gay and bisexual men who reported inconsistent condom use with partners they did not know. “One theory is we’ve removed this massive group of guys who otherwise would be at high risk of HIV,” Holt says. “The initial results are promising, but I’m slightly concerned about the long-term effects.”Holt says PrEP works so well that he is not much worried about the men who are using it. “There’s been a myopic focus on PrEP users and what do they do,” he says. Rather, he thinks more attention should be given to the men who are not on PrEP, whose behavior could be affected by the new sense of security among their peers. He says if condom use norms change and it “is not the default strategy used by gay men,” then HIV transmission rates could spike.Mayer says “a more nuanced approach” is needed in both HIV and STI prevention efforts because the idea of “sexual health” is evolving now that the risk of condomless sex has dropped—both from PrEP and the fact that infected people on treatment rarely transmit the virus. He says patients who don’t want to use condoms all the time should be counseled to consider both PrEP and frequent STI screening.Holt says the increasing use of PrEP around the world is essentially a “grand experiment” that is going to require adjustment in public health messaging campaigns. “The broader impact of PrEP on the community and their HIV protection needs is going to become a bigger and bigger issue.”last_img

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