Reckless reporting increases HIV risk
Keletso Makofane, MPH MSM technical adviser: The Anova Health Institute Member: World Health Organisation Civil Society Reference Group on HIV I was alarmed to read the article titled Playing with fire (City Press, March 5 2017) on pre-exposure prophylaxis (PrEP) among gay men. It makes the claim that “reckless sexual behaviour among gay teens and men” is being fuelled by the increasing use of PrEP. This claim rests on a conceptual misunderstanding and some factual errors.
The conceptual misunderstanding is to equate sex without a condom among people who are on PrEP with “recklessness”. Accessing PrEP takes planning and resources.
In a context where many doctors are still uninformed about basic sexual health for gay men, never mind PrEP, it takes courage for gay men to bring it up with their doctors and make plans to access it.
Accessing PrEP means one must go for regular HIV testing (you can only be on PrEP if you are HIV-negative). A person who is diligent and courageous in protecting their health is hardly “reckless”.
Further, there has been a bevy of studies that show that PrEP is protective against HIV with or without condoms, and that if someone is HIV-positive and virologically suppressed, they do not transmit HIV. The concept of “recklessness” must change as we learn new ways of preventing HIV transmission.
The claim that there is a spike in sexually transmitted infections (STIs) among young people on PrEP has no basis in data.
In South Africa, there are not enough people on PrEP to draw that conclusion (or at least not enough people whose STI burden we can measure). Further, in settings where STIs among gay men are on the increase, it is not clear that this increase is attributable to expanding PrEP use, or whether STIs are increasing for other reasons.
Large-scale PrEP trials certainly have not found that people who are on PrEP increase their sexual risk. On the contrary, it has been the people who know that they are already at higher risk for HIV who have opted to take PrEP to manage their risk.
Finally, we make a critical omission when we speak about a potential spike in STIs without speaking about the fact that the STIs in question are largely curable, or at least much easier to manage than HIV.
If, as a by-product of protecting people against HIV infection, we end up with more cases of curable STIs, we would still be having a positive effect on people’s lives.
Contracting HIV is no longer a death sentence, but it is a chronic condition that requires strict adherence to the regime of taking daily medication and making regular clinic visits for the rest of one’s life.
In a time when the global HIV epidemic is raging among gay and bisexual men, it is reckless to stigmatise new prevention technologies and the users of these technologies.
It is especially reckless in the South African context to spread misinformation about HIV.
It is not gay men on PrEP who are playing with fire, it is the author of this article and the editors who approved it.