www.hivandhepatitis.com

American Gay Men's Use of Condoms Has Been Falling for a Decade

There has been a long-term decline in condom use by American gay men, researchers from the Centers for Disease Control and Prevention (CDC) reported in the May 5 online edition of AIDS. Similar declines have been seen among men whose sexual partners were of the same HIV status and among men who did not know their sexual partners’ status -- showing that the fall in condom use cannot be explained by sero-sorting or other sero-adaptive behaviors. Moreover, condom use began to fall long before pre-exposure prophylaxis (PrEP) became available.

[Produced in collaboration with Aidsmap.com]

The survey data were collected in 2005, 2008, 2011, and 2014 in 21 American cities as part of the National HIV Behavioral Surveillance (NHBS). Between 1100 and 1600 men who have sex with men took part in each round. Men were recruited at bars and clubs, social organizations, gay businesses, bathhouses, parks, etc. The researchers asked whether a condom was used with the respondent’s last anal sex partner.

HIV-Negative Men

In 2005, 28.7% of HIV-negative men reported sex without a condom, rising to 32.8% in 2008, 34.7% in 2011, and 40.5% in 2014.

Condomless sex with a partner who was believed to also be HIV-negative rose (from 21.2% to 27.4%), as did condomless sex with a partner of unknown or HIV-positive status (from 7.6% to 13.1%). 

With PrEP use reported by only 0.5% of men in 2011 and 3.5% of men in 2014, PrEP is unlikely to have contributed to the fall in condom use. A sensitivity analysis which excluded PrEP users showed that the trends remained unchanged.

The greatest increase in sex without condoms was seen among young men, aged 18 to 24.

HIV-Positive Men

The overall trend was similar for HIV-positive men: in 2005, 34.2% reported sex without a condom, rising to 37.3% in 2008, 39.8% in 2011, and 44.5% in 2014.

Again, condomless sex rose both with partners of the same HIV status (from 19.0% to 25.4%) and with partners of unknown or different HIV status (from 15.0% to 19.0%). The only hint of a sero-adaptive behavior is that condomless receptive anal sex with partners of unknown or different HIV status rose, while condomless insertive sex with those partners did not. (There is less risk of HIV transmission if the HIV-positive partner takes the receptive or bottom role.)

The rising trend of sex without a condom was seen both among men taking antiretroviral treatment for HIV (which reduces the risk of onward transmission, regardless of condom use) and among men not taking HIV treatment. 

"Our data suggests that condom use has decreased among [men who have sex with men] and that the trends are not explained by sero-sorting, sero-positioning, PrEP use, or HIV treatment," the researchers conclude.

6/9/16

Reference

G Paz-Bailey, M Mendoza, T Finlayson, et al. Trends in condom use among men who have sex with men in the united states: the role of antiretroviral therapy and sero-adaptive strategies. AIDS. May 5, 2016 (online ahead of print).