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

CityPress - - Front Page - ZINHLE MAPUMULO zinhle.mapumulo@city­press.co.za

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.

TALK TO US Are you aware of the grow­ing use of HIV pre-ex­po­sure pro­phy­laxis (PrEP)?

SMS us on 35697 us­ing the key­word PREP and tell us what you think. Please in­clude your name and prov­ince. SMSes cost R1.50

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