What Would PrEP Mean For Safer Sex?

PrEP stands for Pre-Exposure Prophylaxis, the taking of a medication in advance of a possible exposure to a disease. Commonly used for decades in travelers to exotic locales, multiple PrEP trials are currently underway to examine to effectiveness of taking an HIV medication prior to exposure. Putting aside the worrisome aspect of long-term side effects, the prospect of a daily pill to ward off HIV is thrilling, to say the least, but even at a very high rate of effectiveness, the risk of contracting HIV and the necessity of maintaining consistent safer sex practices would remain.

But according to a troubling new survey of gay men in New York City, a high percentage of those most at risk indicate that they would abandon safer sex practices were HIV PrEP to become available.

A substantial proportion of gay men say they would reduce their condom use if pre-exposure prophylaxis (PrEP) proves to be effective, US investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. The investigators found that the availability of 80% effective PrEP could reduce inhibitions about unprotected sex. Their results also showed that it could lead men to view unprotected sex as having an acceptable level of risk. “A better understanding of the emergent issues inherent in the provision of PrEP will allow for the development of both individual-level interventions supporting PrEP users and community-level interventions designed to increases awareness and acceptability of PrEP”, comment the investigators. [snip]

Little research has been undertaken into the potential impact of PrEP on sexual behaviour. Therefore investigators in New York designed a study involving 180 substance-using HIV-negative gay men who had had at least one recent episode of unprotected anal sex. They completed a questionnaire about their use of club drugs (cocaine, ketamine, ecstasy, methamphetamine, GHB or poppers), sexual risk behaviour, and attitudes towards PrEP. The men also answered questions to assess behavioural disinhibition and risk compensation. Researchers measured risk perception on a five-point scale using seven questions to assess the extent to which condom use was dependent on the participant's perception of risk in each individual sexual encounter. The men had a mean age of 29 and were racially diverse. Only a minority of men (42%) had been to college, and 40% had an annual income below $20,000. The men reported a median of three high-risk sex acts in the previous 30 days, a median of two occurred when using club drugs.

How effective would HIV PrEP have to be before you'd consider raw sex to be an acceptable risk? I think you know what the answer should be, but be as honest with yourself as you can.