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.
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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.”
Donston
I don’t really see how this assist in stopping the shame though. It pretty much suggest that guys who feel the need to go on Prep are less likely to be condom users in the first place and perhaps have a higher rate of promiscuity, whether they’re on the drug or not. That’s not any new insight or some revelation.
Cam
That’s what I got from it, that the people getting STDs would have gotten them anyway. Unless I misread.
Den
That is pretty much what the article says. Though it does note that increases in STDs among PReP users were not statistically significant, so that perhaps “slut shaming” them is unwarranted.
It is worth noting though that HIV prevention produces a greater saving to public heath budgets and society as a whole than reduction in other STIs.
WindChime
I truly believe that in order to change those promiscuous gays’ repulsive behaviors, you have to keep shaming them to wake up their conscience. They live in an altered universe and those of us who are sane have an obligation to call them out.
ShiningSex
THE “SLUT SHAMING” DEFENSE IS RIDICULOUS. BEING A SLUT IS NOT SOMETHING TO BE PROUD OF, BUT IF YOU ARE THEN OWN IT.
WindChime
Gay men who hook up with strangers and live in a promiscuous lifestyle will keep getting nasty STDs, some of which are resistant to all anti-biotic treatments. They need to alter their reckless behaviors all together and focus more on spiritual growth instead.
Den
Straight men and women get a pass on that “promiscuous lifestyle”? How very Christian of you.
It always amuses me to see the dullards who think sex is somehow a more suspect activity than other human interaction.
Keep your stupid concepts of sin and punishment to yourself, as well as your assumptions about others’ behavior.
Perhaps you should look at your own spiritual growth which seems pretty low level; right there with your intellectual growth.
BoylesqueBubble
@Den
The account is a troll account, also known as CastleSF. They’ve been banned repeatedly and always come back. Their moralizing is so hilarious because it’s so obviously artificial and only comments to try and shame other gay people. Apparently they’re “Asian” from an old picture and a few years ago seemed to be ok with “yellow face” by a very innocuous comment they once made. Don’t feed the troll. They’re just miserable and want to take it out on others. Every website has a resident troll.
ShiningSex
F*CK SPIRITUAL GROWTH.
YES MORE PEOPLE NEED TO PRACTICE SAFER SEX, BUT IGNORANCE RUNS IN EVERY COMMUNITY.
Invader7
Wow. Aren’t the above judjemental ??? For those of us on Prep, a VERY large percentage DO play safe ! Do wear condoms. Do get tested EVERY THREE months. Do take responsibilty for OUR sexual health. Maybe @ Donston,@ Cam,@ WindChime are jealous cause y’all ain’t getting NO dick !! And are burnt up about it. And MOST importantly we responsible NON judgemental men do NOT want to get HIV !!!
Cam
I was just pointing out what the article said. I never got the push against Prep that seemed to come out on the LGBTQ blogs for a while.
Donston
Stop being so damn sensitive. No body is judging you (or at least I’m not). The article claims that this “study” is supposed to help halt “shame”. But all the study concludes is that is that many of its subjects contracted STI’s when they were both on and off Prep. Those results don’t assist in stopping shame. Also, I’m a strict top.
Honestly, folks need to stop looking for validation from these type of nonsense “studies”, because that one was a waste of time and money.
ShiningSex
ACTUALLY THE MAJORITY DON’T USE CONDOMS. SADLY.
tjack47
All of the aforementioned STIs plus herpes can be contracted with condom usage. All of them, oh and HPV too.
1898
the risk is substantially reduced with correct condom usage
@dusyk
You’re all big boys, nothing new here. If you don’t play safe, you know the outcome
1898
“The authors say more research needs to be done into why STI rates are increasing…”
oh good grief, we don’t need more research and more studies. we know why it’s happening. people aren’t using condoms. but sure, let’s wring our hands and spend millions on more studies to tell us what we already know
RandomGuy
Condoms Rose Condoms!!!
mhunter
The reason of increase in STIs is clear. It’s our ridiculous, hypocritical stance on sex. If sex was treated as healthy and normal, with no shame then people would get regular checkups, etc. and we wouldn’t have STDs. Instead we live in a society that discourages birth control yet is shocked about abortions. (Spoiler alert, if you have effective birth control methods, you won’t have abortions), Clutches their pearls about gay sex and the sanctity of marriage and then has TV shows such as “The Bachelor”. It would be comical if it weren’t so tragic.
Openminded
But what would the preacher have to preach about on Sunday?
(mhunter, you are spot on with your comment)
hairydadnyc
This article says nothing at all. The only really way to stop STI’s in the Gay/straight/trans/Bi population is there easy non shaming testing and treatment. Changing behavior doesn’t work, nor should people have to change their behavior to meet a social norm. The action needed; stopping the spread. The best way to do that? Quick/inexpensive testing and treatment.
Josiah Freshmount
Practice safe sex and you substantially reduce the chance of contracting an STI. Behavior is always the root cause of these outbreak. The message that you cannot be sex positive while practicing safe sex has been largely counterproductive.