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to Section One | to Arts & Entertainment
posted Friday, June 3, 2016 - Volume 44 Issue 23
Condom use down 10%, new study says
Trend not explained by serosorting or PrEP
Section One
ALL STORIES
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Condom use down 10%, new study says
Trend not explained by serosorting or PrEP

by Mike Andrew - SGN Staff Writer

The number of men having condomless sex in America has increased by more than 10% in the last decade, a new study says.

The National HIV Behavioral Surveillance Survey was conducted in 2005, 2008, 2011, and 2014, and asked more than 1,000 Gay or Bi men in 21 US cities if they used a condom in their last sexual encounter.

Researchers hoped to determine whether changes in the use of condoms reflected increased serosorting, where men only have sex with men of the same HIV status, or increased use of medications like antiretroviral thereapy (ART) and PrEP.

Their report, published this month in the journal AIDS, concluded that condomless sex continues to increase among men who have sex with men, but 'the trends are not explained by serosorting or ART.'

'Our data suggest that condom use has decreased among [men who have sex with men] and that the trends are not explained by serosorting, seropositioning, PrEP use, or HIV treatment,' noted the researchers, who worried that 'the benefits of [antiretrovirals] in reducing transmission of HIV' could be 'undermined' without increased promotion of condoms and access to PrEP.

In the nearly 10 years between the first survey in 2005 and the most recent in 2014, the number of HIV-negative Gay and Bi men who reported having sex without a condom rose from 29% to 41%.

Reduction in condom use was reported across the board, the study shows, whether or not sexual partners were of the same HIV status and regardless of whether survey respondents knew their partners' HIV status.

From these data, researchers concluded that reduced condom use cannot be explained by serosorting.

For HIV-positive men, the trend was similar. Positive Gay and Bi men also reported a higher incidence of condomless sex - 45% in 2014 compared with 37% in 2008. As with negative men, positive respondents reported condomless sex regardless of whether they thought their partners' status was positive, negative, or unknown.

'The only hint of a seroadaptive behavior is that condomless receptive anal sex with partners of unknown or different HIV status rose, while condomless insertive sex with those partners did not,' the Aidsmap website noted.

In other words, tops are more likely to use condoms when having sex with partners of different or unknown HIV status than bottoms are. This finding is disturbing because bottoms are more at risk of HIV infection than tops. In one study, for example, tops were 86% less likely to contract HIV.

Even more disturbing was that even HIV-positive men who are not taking medication to treat their HIV are using condoms less than before. The risk of HIV infection for a negative partner is significantly reduced when the positive partner is on ART and his viral load has been reduced to the point that it is clinically undetectable.

Previous studies indicated that HIV-positive-but-undetectable men are 99% less likely to transmit HIV, regardless of whether they use a condom.

On the PrEP side, the study found that the decline in condom use started long before PrEP use became usual.

For example, PrEP usage was reported by 0.5% of the Gay and Bi men in the 2011 survey. That number rose to 3.5% of men in 2014, still short of the over 10% increase in condomless sex.

As AIDSmap points out, 'Condom use began to fall long before PrEP became available.'

HIV Plus magazine reports that the decline in condom use could actually be greater than the latest survey indicates because of 'self-reporting bias.'

In other words, the survey is not based on observation of the survey participants' behavior by a neutral observer but on what they themselves report to the researchers. Self-reported survey data are often skewed toward what respondents believe is the socially acceptable answer - in this case, using condoms - so the real numbers might tend even more toward an increase in condomless sex.

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