In response to a paper published in The Lancet titled Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: results of repeated behavioural surveillance in 2013–17, ACON CEO Nicolas Parkhill stated:
“The Lancet article refers to data more than one year old (collected in February 2017). In 2017 consistent condom use among gay and bisexual men in NSW declined from 46 per cent in 2013 to 31 per cent in 2017.
However, while consistent condom use with casual partners has declined, the overall use of HIV prevention methods, including condoms and PrEP, among gay and bisexual men remains at close to 70per cent.
Annual 2017 NSW HIV data report shows the lowest number of new diagnoses among gay and bisexual men on record. This decline has continued in the first quarter of 2018.
There has been a rapid uptake of PrEP in NSW since March 2016 through EPIC NSW, a study aiming to assess the impact of the rapid expansion in access to PrEP amongst those at highest risk of acquiring HIV, in particular, if it will lead to a drop in new HIV infections.
At the end of April 2018, when the study was finalised, the number of study participants reached 9,478 people enrolled. It is too early to tell the long-term effect of increasing PrEP use (and decreasing condom use) on new HIV diagnoses in NSW.
Data from NSW Health and the Kirby Institute has shown there to be little change in the incidence of STIs in people on PrEP enrolled in EPIC-NSW in the first 12 months of the trial, apart from a slight increase in chlamydia.
Before the introduction of PrEP, HIV transmissions in NSW were relatively stable but there have been increases in gonorrhoea, infectious syphilis and chlamydia notifications. Since the introduction of PrEP we have seen an encouraging decrease in HIV notifications.
The increases in STI notifications are likely to be due to a combination of a real increase in infections as well as improved testing rates. Services like ACON’s community-based a[TEST] clinics that make HIV and STI testing fast, free, convenient, and culturally appropriate have been the key to achieving high testing rates in NSW.
Improved testing helps identify people with undiagnosed STIs who may otherwise go untreated, and potentially transmit their infection. Testing and diagnosis can lead to an increase in people with STIs who are notified and treated, and in turn notify, their sexual partners to interrupt the spread of STIs.
ACON continues to work closely with the community as well as GPs and sexual health clinics to ensure that regular and comprehensive STI screening is a routine part of sexual health care and that gay men are educated about STI transmissions, testing and treatment.
ACON’s sexual health campaigns have a strong commitment to sustaining the central role that condoms play in the prevention of HIV and STIs. Campaign messaging continues to promote condoms as an effective means by which to prevent HIV and STIs. Our campaign evaluations show that sexual health literacy of gay men in NSW continues to be very high.
To not utilise PrEP as a new prevention tool for fear of triggering an increase in STIs would be bad public health policy. Studies have consistently shown that PrEP is extremely effective at preventing HIV transmission, and trials such as EPIC-NSW have continued to demonstrate excellent public health outcomes.
ACON supports and applauds gay men for their continued use of condoms more than 30 years into the HIV epidemic – at rates that exceed that of the general population. New technology like PrEP to prevent HIV means that sexual health practices will need to evolve – and we are very confident that condoms will remain a significant part of gay men’s safe sex practice in NSW.
We reject that gay men, as has been reported by some media outlets, are complacent, when it comes to managing their, and their sexual partners, sexual health. Just like in the general population, not every gay man will use a condom every time.
What is important is that gay men continue to use a HIV prevention strategy every time. In a contemporary response, this includes the use of PrEP. HIV is incurable and life long – driving down HIV transmissions is a key public health priority.”
In response to the article, AFAO CEO, Darry O’Donnell has also said:
“PrEP, in combination with other prevention strategies such as condoms and having an undetectable viral load, gives us the tools to finally deliver significant reductions in HIV transmissions.
This is why we congratulate the Australian Government for making PrEP available at a subsidised rate on the Pharmaceutical Benefits Scheme, as well as the NSW Government for its bold vision and commitment to ending HIV.
We strongly encourage other countries, particularly those in the Asia Pacific region with increasing HIV infection rates in men who have sex with men, to fast track PrEP implementation programs.”