S.F. Gay Men Are Ditching Condoms In Favor Of Truvada
The results of a new survey conducted by Kaiser Permanente have become a cause for concern in the healthcare community.
First, the good news heralded by the report: among those who take Truvada to prevent the risk of HIV infection during sex "there has been no increase in the number of their sexual partners and no new HIV infections."
The celebration of that headline has been tempered by one of the preliminary survey's worrisome findings. A 45 percent subset of PrEP users have reported using condoms less during sex since beginning preventative treatment. Truvada may shield more than a 90 percent of a risk of HIV infection during sex, but abandoning condoms leaves users exposed to other sexually transmitted infections.
As the San Francisco Business Times points out, the larger picture is more opaque. "It represents only self-reported condom use by a subset of about 90 PrEP patients in the Kaiser program."
"We can't say how that applies to the entire group of people on PrEP," adds Dr. Brad Hare, director of Kaiser San Francisco's HIV care and prevention program.
Instinct spoke briefly with Dr. Hare Wednesday to clarify more of the preliminary report's results, and he revealed the following:
- This was done for clinical care, and not yet analyzed in a scientifically rigorous manner
- We don't have information on what demographic of patients reduced condom use (e.g, was is primarily among men in serodiscordant, monogamous relationships, or among those with multiple partners), to waht decgree condom use decreaed (100% to 0%, 10% to 0%, 100% to 90%), and in what circumstance condom use decreased (all times, just with primary partner and not with other partners).
- We don't have a 'control' group, so we don't know how condom use may change in the absence of PrEP
- We don't have results over mutliple time points, so we don't if this change will be sustained
Michael Weinstein, AIDS Healthcare Foundation president and an early, controversial critic of Truvada as PrEP, trounced on the report. "Why would men take this medication if they intended to use a condom? It's utterly predictable."
Despite Weinstein's continued criticism, there is much deserved praise surrounding Truvada as a HIV prevention routine.
"The main point that should not get overshadowed: PrEP is prescribed to prevent HIV infections, and it appears to be working in our population," Dr. Hare told Instinct. "Among >500 MSM prescribed PrEP with over 200 person-years on treatment, we have seen no new HIV infections."
"The reasons people are coming in are different," he added. "People are seeking PrEP because their friends are on it and they're sharing stories about it changing their lives. Patients are coming in and saying, 'It must be for me, too.'"
(Updated with Dr. Hare interview and the direct data he provided Wednesday at 1 p.m. est)