PLAYING WITH FIRE
High-risk sexual behaviour is on the increase as men on preventive HIV medication ditch condoms while having sex with multiple male partners
Paul Williams* has been on PrEP for about a year, and believes the “magic pill” has protected him from HIV infection.
The 24-year-old from Malmesbury, Western Cape, is not ashamed to say he rarely uses condoms with his partner and other men. He has casual sex whenever an opportunity presents itself.
“I prefer bareback and taking PrEP has put me at ease about the risk of getting infected with HIV,” he says.
“I take PrEP every day at the same time without fail and my partner takes it too. So, I know we are protected.
“PrEP reduces the risk of HIV infection by more than 90% for those who adhere to it. I am the living proof that it works because last year I had unprotected sex with two different guys on more than one occasion.
“I met one at a night club and another through a mutual friend. Despite having had unprotected sex with them, I am still HIV-negative,” he says.
Williams admits that though he knows that PrEP offers him more than 90% HIV protection, he does worry that his reckless behaviour may land him in trouble at some stage.
“I am aware that there is a small chance that I could become infected or be exposed to other STIs such as gonorrhoea. I guess I have to find a way to discipline myself and use a condom religiously,” he says.
“I lost my uncle to Aids 11 years ago. I saw the pain in his family when he was bedridden and eventually died. I don’t want my family to go through the same pain.”
*Not his real name
Health experts are worried about reckless sexual behaviour among gay teens and men who are increasingly ditching their condoms, believing their preventive HIV medication will protect them. Doctors now suspect this behaviour may be driven by the growing use of HIV pre-exposure prophylaxis (PrEP) among this group.
Oscar Radebe, doctor and senior clinical advisor at Anova Health Institute, told City Press this week that doctors are seeing high rates of sexually transmitted infections (STIs) among gay teens and young men who have sex and who are on PrEP, indicating that their condom use is low or inconsistent.
He said what was more concerning was that “in most cases, these adolescents and young men [18 to 25 years old] have multiple sexual partners and prefer barebacking [sex without a condom] because they are on PrEP”.
Radebe said the reason behind this trend might be the rising popularity of hook-up websites such as Grinder that seem to be promoting high-risk sexual behaviour among gay men, and men who have sex with men, as long as they are on PrEP.
PrEP is a prevention strategy that involves giving HIVnegative people the antiretroviral medicine Truvada to reduce their chance of HIV infection. When taken daily, Nat Morajane* says taking PrEP for HIV is more of an insurance policy than a licence for him to have unprotected sex.
“I want to be able to have sex without a condom without worrying about HIV, if I choose to,” he says.
Morajane (34) has been taking PrEP for two years. He and his partner don’t use condoms, but when he has sex with other men, condoms are a must. He explains that PrEP protects people against HIV infection when they do not use condoms.
“It is useful as a public health intervention precisely because some people do not consistently use condoms and do not want to acquire HIV. For protection against HIV, it is not at all the case that PrEP has to be complemented with condom use,” he says.
“When people do not use condoms, however, they risk exposure to other STIs, which are by and large manageable, or curable. People should decide what combination of prevention tools they want to use, based on the kind of sex they want to have, and based on how they want to manage the risk of being infected with STIs, including HIV.” Morajane advises those taking PrEP to adhere to the drug. “If people do not use condoms, I would recommend that they speak to their partners about other STIs and go for regular screenings. Some STIs such as chlamydia are asymptomatic, sometimes, so it is useful to get laboratory tests done if possible,” he said.
*Not his real name prevention methods.
“If they decide not to use a condom, it should be an informed decision and they must be aware that they could get STIs,” he said.
Anecdotal evidence from Anova is in line with findings by the French Ipergay trial presented at the Conference on Retroviruses and Opportunistic Infections last year. The study found that more than half of the participants who religiously took PrEP rarely used condoms.
Hugo said low condom use was a problem throughout South Africa, and studies show that even heterosexual men rarely use condoms, and when they do, they are inconsistent.
Radebe attested to this, saying: “In all conventional prevention studies that have been done on condom use – be it in gay or straight people – findings show that condom use remains inconsistent and low.
“We need to have a comprehensive approach to prevention that addresses all groups of people with different sexual behaviours.
“People must understand how each method or intervention can help to protect them from HIV infection or STIs,” he said.
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