Using PrEP, losing condoms? PrEP promotion may undermine safe sex

ABSTRACTPrEP is a crucial new tool for the prevention of HIV. However, careful attention must be paid as to whether its widespread adoption could reduce condom usage, which may in turn increase STIs in the long-run. In this article we re-assess whether PrEP uptake may influence condom usage, and we call for vigilance by public health advocates to ensure that PrEP promotion does not lead to a drop-off in safe sex practices. Most of the evidence that PrEP does not change condom usage comes from double-blind clinical trials which are focused on the biological effect of PrEP on HIV incidence. However, subjects in these trials may not change their behavior because they do not actually know if they are taking PrEP. A number of focus group studies on individuals considering taking PrEP show that many see the drug as an opportunity for increasing unprotected sex. National survey data from the CDC show that condom rates are decreasing among MSM, which are a major target group for PrEP. Furthermore, data from public health records show that STIs are increasing among MSM in some areas with relatively high PrEP uptake. There is enough evidence that PrEP is contributing to rising STI infections to warrant concern. Public health advocates must ensure that PrEP uptake does not inadvertently threaten the publicʼs health and that thirty years of condom promotion are not wasted.