Do Gay and Bisexual Men on PrEP Take More Sexual Risks?

Pre-exposure prophylaxis (also known as PrEP for short) is an increasingly popular method of HIV prevention among persons at the highest risk of infection. It involves taking one pill per day that combines two different drugs (tenofovir and emtricitabine). These are actually the same drugs used to treat people who already have HIV; however, when someone who is uninfected takes them, it makes it very difficult for HIV to establish an infection in the body should that person be exposed to the virus through sexual activity or injection drug use.

PrEP was originally approved by the FDA five years ago and it’s estimated that 136,000 people are now taking it—a figure that continues to climb significantly year over year. The vast majority of the people taking PrEP in the United States are gay and bisexual men, given that they’re the group that’s most at risk for contracting HIV here. However, as more men who have sex with men have begun taking PrEP, concerns have been raised over whether this drug might be changing their sexual behaviors. Specifically, do people who start using PrEP tend to ditch condoms because they no longer fear HIV? This is an important question to address because PrEP is only designed to protect against HIV—condoms are still needed to protect against other STIs.

In my latest article over at TONIC, I explore what the research on this subject has revealed. The short version is that early clinical trials showed no evidence of risk compensation, meaning that it didn’t seem to be the case that PrEP users tended to stop using condoms. However, several newer studies have found that, on average, there tends to be a decrease in condom use among gay and bisexual men who start on PrEP.

Check out the full article to learn more about why newer studies seem to be reaching different conclusions than older studies and what all of this means for public health.

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