New HIV notifications have continued to fall alongside reduced condom use with casual partners among gay and bisexual men as PrEP trials come to a close.

A new paper published in medical journal The Lancet, drawing on regular periodic surveys of gay and bisexual men in Melbourne and Sydney, has reported that PrEP use is increasingly the HIV prevention strategy of choice.

ACON CEO Nicolas Parkhill noted that the paper refers to data that is over a year old, and said that it’s too soon to properly assess the effect of rising PrEP use on new HIV notifications.

“Consistent condom use among gay and bisexual men in NSW declined from 46 per cent in 2013 to 31 per cent in 2017,” Parkhill said.

“However, while consistent condom use with casual partners has declined, the overall use of HIV prevention methods, including condoms and PrEP, among gay and bisexual men remains at close to 70%.

“Annual 2017 NSW HIV data report shows the lowest number of new diagnoses among gay and bisexual men on record. This decline has continued in the first quarter of 2018.”

NSW Health and Kirby Institute data indicate that among PrEP trial participants in NSW there was little change in the incidence of STIs aside from a slight increase in chlamydia.

“The increases in STI notifications are likely to be due to a combination of a real increase in infections as well as improved testing rates,” said Parkhill.

“Improved testing helps identify people with undiagnosed STIs who may otherwise go untreated, and potentially transmit their infection.

“Testing and diagnosis can lead to an increase in people with STIs who are notified and treated, and in turn notify, their sexual partners to interrupt the spread of STIs.

“We reject that gay men, as has been reported by some media outlets, are complacent, when it comes to managing their, and their sexual partners, sexual health.

“Just like in the general population, not every gay man will use a condom every time. What is important is that gay men continue to use a HIV prevention strategy every time.”

Rates of HIV infection in NSW have halved over the past five years, while the infection rate has declined 16 per cent in Victoria.

The Lancet paper suggested that “other jurisdictions should consider the potential for community-level increases in CAIC (condomless anal intercourse with casual partners) when modelling the introduction of PrEP and in monitoring its effect.”

“PrEP, in combination with other prevention strategies such as condoms and having an undetectable viral load, gives us the tools to finally deliver significant reductions in HIV transmissions,” said AFAO CEO Daryl O’Donnell.

“We strongly encourage other countries, particularly those in the Asia Pacific region with increasing HIV infection rates in men who have sex with men, to fast track PrEP implementation programs.”

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