The introduction of PrEP in two large cities led to a rapid fall in condom use, almost negating the benefits of the treatment, researchers warned last night.
The Australian research, published in The Lancet HIV, raises questions about PrEP, which is currently under investigation by NHS England.
Researchers reported the impact of introducing PrEP – pre-exposure prophylaxis – in Melbourne and Sydney over a five-year period.
The study found that gay men reporting condomless sex with casual partners increases from 1% to 16% between 2013 and 2017. And consistent use of condoms declined from 46% to 31%.
There was a sharp increase in unsafe sex among HIV-negative men not protected by PrEP. The proportion increased from 30% to 39%.
The researchers reported that rates of HIV testing, treatment and viral suppression all increased during the period, suggesting a wide range of benefits from the PrEP programme.
During the five years, the proportion of HIV-negative men receiving PrEP increased from 2% to 24%.
Researcher Professor Martin Holt, of the University of New South Wales, Sydney, said: “PrEP has been heralded as a game-changer for HIV, but declining condom use may impede its long-term population-level effectiveness.
“We need better monitoring and evaluation to assess the effect of PrEP on sexual practices at the community level in both PrEP and non-PrEP users.”
He added: “If individuals not taking PrEP feel safer, they might use condoms less often because they perceive that sex without a condom has become less risky as PrEP use by others increases.
“The long-term consequences of this shift in community behaviour are unclear. It’s possible for HIV transmission to rebound in HIV-negative and untested men not using PrEP.”
Professor Martin Holt et al. Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: results of repeated behavioural surveillance in 2013–17. The Lancet HIV 6 June 2018
http://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(18)30072-9/fulltext
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