Health agencies sometimes recommend people taking the HIV prevention medication PrEP to use it alongside condoms – even if we know that an important reason why many people choose PrEP is that they find it difficult to use condoms each and every time.
But what do PrEP users do in practice? To find out, Dutch researchers asked around 350 gay and bisexual men to fill in daily sexual diaries and also interviewed 43 of them to find out the reasons for their choices. They collected data on almost 50,000 anal sex acts.
Most of the time, the men used PrEP only: this was the case for 81% of the sex men had. In interviews, men explained that they trusted PrEP would protect them from HIV and that they found condomless sex more pleasurable. While condoms are recommended in order to protect against sexually transmitted infections (STIs), many interviewees said that most STIs are curable with treatment and that condoms are not being completely effective against STIs anyway.
Using PrEP and condoms at the same time covered about 20% of men’s sex with casual partners they hadn’t met before. Reasons for condom use included concern about more serious STIs such as hepatitis C, specific situations such as sex parties or chemsex and missed PrEP doses. Another reason was to avoid telling a sexual partner that they were using PrEP: men expected to sometimes have a negative reaction.
Some men were using ‘event-based PrEP’, which involves taking it at least two hours before sex and then for two days afterwards. These men occasionally used condoms only (4% of the time), often because they had not taken a PrEP dose by the time sex happened or because they anticipated a negative reaction from a casual partner. The men taking ‘event-based PrEP’ also sometimes had neither form of protection (9% of the time), occasionally in the heat of the moment, but also when they were with a steady partner who they knew had HIV and an undetectable viral load.
Click here to read the full story, including excerpts from the men’s interviews.