Research reveals motivations behind condom use among PrEP users

A new study has examined the reasons that users of the HIV prevention pill PrEP do or do not choose to use condoms.

The Amsterdam-based research, presented online at this week’s annual HIV Research for Prevention conference, examined data from 352 gay and bisexual men about almost 50,000 anal sex acts, as well as interviews with 43 about their PrEP and condom use.

Condom use among users of PrEP, which reliably prevents HIV but does not protect against other sexually transmitted infections (STIs), is considered an important public health goal, the researchers said.

The men in the study were more likely to use condoms with casual partners than with steady partners.

Their reasons for using condoms included hygiene, protection from infections other than HIV, partners asking for condom use, and being unsure whether they had taken PrEP correctly.

“In Amsterdam where I live now, the STIs are flying around, I am fed up with it,” said one study participant who had returned to using condoms as well as PrEP.

Those who chose not to use condoms gave reasons including STIs being curable and treatable, trust in partners’ undetectable viral load, and concern with sexual pleasure.

“[PrEP is] only about HIV… I am not afraid of STIs, they can be treated,” said one interviewee who did not use condoms.

Among those who used neither condoms nor PrEP, some said that they relied on undetectable viral load, avoided anal sex, or forgot about precautions in the moment.

“I already have this group of undetectable friends, and it is completely unnecessary to take it,” said one participant.

“To me, undetectable means no condoms, no PrEP.”

The research team, led by Hanne Zimmerman of the Public Health Service Amsterdam, recommended that healthcare staff talking to PrEP users should include discussion of their motivations for using or not using condoms.

In Australia, along with the vast majority of people with HIV now having an undetectable viral load and thus being unable to pass on the virus, PrEP has been credited with substantial drops in new cases of HIV.

The medication is available at a subsidised cost through the Pharmaceutical Benefits Scheme.