Even as condom use plunges in Australian men who have sex with men, the rapid roll-out and affectionate embrace of the HIV prevention medication PrEP means that the actual “net protection coverage” has increased, according to a study by Professor Martin Holt of the University of New South Wales.

I mean, how good is PrEP?

Admittedly, I may technically have revirginised at this point since it’s been at least the length of a pandemic since I had a bit of meaningful mattress mambo (that’s a lie, it’s been considerably longer) but I rest comfortably knowing that whenever I am ready to jump back in, so to speak, that a quick trip to the sexual health clinic to grab a script for the magic blue pill is all it will take to once again be protected from HIV.

And as I understand it, things have gotten even easier since I last had PrEP because these days, there’s all sorts of different dosing techniques to make your life easier! 

You no longer have to remember to take a daily dose if that’s not your strong suit! 

 

Condom use plunges as options for PrEP usage increase

You can now dose on demand, which might give those of us worried about having to swallow a pill every day on the off chance you MIGHT get lucky, another option!

The study is a new analysis of community surveys over five years and the data for the study comes from 32,048 responses to the Australian Gay Community Periodic Surveys, conducted between 2014 and 2019.

Participants were recruited at gay venues, gay events and online and this analysis only included men who reported casual sex.

Half the participants were aged between 27 and 45 years. Most identified as gay (90%) or bisexual (7%) and were born in Australia (70%). 

Their self-reported HIV status was negative (82%), positive (10%) and untested/unknown (9%). One third lived in New South Wales, one third in Victoria, one fifth in Queensland, and the rest elsewhere in Australia.

The nitty gritty

The repeated surveys over the five-year period allow comparisons over time. Asked about sex with casual male partners in the past six months:

  • Not having anal sex with casual partners was reportedly 18% in 2014 and 15% in 2019.
  • Consistent condom use fell from 45% in 2014  to 23% in 2019.
  • PrEP use by men who had condomless sex went up from 0.7% in 2014 to 31% in 2019.
  • Taking HIV treatment and having an undetectable viral load, and also having condomless sex, was reported by 4.8% in 2014 and 5.8% in 2019.
  • Condomless sex, reported by a man who was HIV negative or untested and not on PrEP, was reported by 30% in 2014, falling to 25% in 2019.
  • Condomless sex, reported by an HIV-positive man who was not undetectable, was reported by 1.6% in 2014, falling to 0.6% in 2019.

As summarised by aidsmap.com, “Whereas the last two groups have a risk of being involved in HIV transmission, the first four are covered by HIV prevention. Summing the numbers in the first four groups, net prevention coverage increased from 68% to 75% over the five-year period.”

The researchers note that they took a conservative approach when it came to their estimation of prevention coverage, noting for example that “if a HIV-negative man who is not on PrEP and has condomless sex is put into a risky group even if he did so because he knew his HIV-positive partner was undetectable.”

“In fact, looking at the HIV-negative men who were not on PrEP and had condomless sex, by 2019, 34% of this group said they often had casual sex with men who were on PrEP and 15% said they often did so with men who had an undetectable viral load.”

We’re definitely on the right track

This is all positive news for the goal to end new transmissions of HIV in Australia and the push for education about and uptake of PrEP; campaigns like U=U which got the message out to the general public that undetectable HIV is untransmissible HIV; and the inclusion of PrEP on the Pharmaceutical Benefits Scheme from 1st April 2018 means that we’re well on our way to achieving this lofty goal!

“There has been a rapid, historic shift in HIV prevention among gay and bisexual men (GBM) in Australia. Net prevention coverage has increased among GBM and ‘at risk’ GBM have become less at risk of HIV, facilitating reductions in HIV transmission.”

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