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PrEP is not the driving force behind rising STI rates, says new study

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Rates of chlamydia, gonorrhea, and syphilis among gay men have shot up in recent years. One of the reasons put forward for this is more men are taking PrEP, having sex without condoms, and therefore putting themselves at greater risk of acquiring other sexually-transmitted infections (STIs).

A new study from the University of New South Wales in Australia suggests this may not be the case, or that such a scenario has been exaggerated.

The study tracked 2,400 men who have sex with other men and collected data from 54 sexual health clinics. The men were tracked for a period before starting PrEP, and then whilst taking PrEP.

It found the 50% of the men tested positive for an STI in the year before commencing PrEP, while 52% of the men tested positive for an STI in the year after taking PrEP. That 2% difference is not statistically significant enough to point to PrEP being the cause of the increase, which could also be explained by underlying trends in STI rates.

The authors of the study point to the fact STI rates have been increasing in countries such as Australia and the US before PrEP became available. Therefore, other factors are at play. For example, potentially the increased use of hookup apps or financial cuts to preventative health programs.

Related: Men taking PrEP show decrease in ‘sexual compulsivity’ and drug use

PrEP, when used correctly, is highly effective in preventing someone from acquiring HIV. In New South Wales, the HIV rate fell by around a third after a rapid roll-out over the course of just 12 months.

“Our findings indicate that men targeted for PrEP were at high and increasing risk of STIs before initiating PrEP,” said the study’s authors. “Although the reasons for this are not well established, they have been correlated with increases in condomless anal intercourse and numbers of sexual partners.”

This isn’t just down to PrEP, though. It’s now established that HIV+ men who are undetectable have zero risk of passing on the virus, and this information has also led to more condomless sex.

This study said it found condom use was hit and miss among this particular high-risk group of men both before and after starting PrEP. They found, “no change in the proportion of MSM [men who have sex with men] reporting condomless sex from baseline to follow-up while taking PrEP.”

Another significant finding was that the men taking PrEP showed a slight increase in the number of times they went to a clinic for a sexual health check-up. This brings public health benefits, as it means some infections will be caught early, before being passed on to anyone else.

The authors say more research needs to be done into why STI rates are increasing, to not blame it all on PrEP, and say their work highlights the need for more efforts to control STIs among gay and bi men.

One expert on PrEP told Queerty he wasn’t surprised by the results.

“The reason it doesn’t surprise me is that early adopters of PrEP have generally been people who were already not using condoms, and so you might already expect STI incidence to be fairly higher in those men,” said Dr. Will Nutland, a co-founder of the PrEPster program in England, which has campaigned for wider PrEP access.

Related: 5 ways to get PrEP delivered to your doorstep

Nutland says decreasing condom use has been happening for several years. He also points to HIV+ people becoming undetectable through treatment (known as ‘Treatment As Prevention’, or ‘Undetectable = Untransmittable’) as a major factor.

“This has already been happening. Treatment As Prevention (TASP) has had an impact on people’s willingness and desire to use condoms, and PrEP may also have an impact, but saying that TASP and PrEP are solely responsible for these increases is a knee-jerk reaction, and we only have to look at some of the other factors playing out.”

Nutland points to cuts to sexual health funding and a drop in targeted campaigns aimed at gay men in England.

“We know that young queer people are leaving school inadequately equipped to know about how to prevent STIs and HIV. We know in some parts of the country it’s really hard to get an STI clinic appointment. So I think it’s all of these things that have come together. It’s not just PrEP.”