Health & Fitness

A pill that protects people from HIV may also lead to more sex without condoms

 HIV pills
A man holds some HIV pills. FILE PHOTO | NMG 

A pill that protects people from contracting HIV may lead to reckless behaviour such as non-use of condoms during sexual intercourse, a study has shown.

The study published in the Lancet HIV Journal showed that the introduction of Pre-exposure prophylaxis (PrEP) had coincided with increases in sexually transmitted infections (STIs) like chlamydia and syphilis, a sign that condom use had dropped.

"When seat belt laws went into effect, some studies suggested drivers became more likely to speed or drive recklessly a phenomenon called "risk compensation." Is the same thing happening among people at risk of HIV, now that they can take antiretroviral drugs to protect themselves from the virus, they are not using a condom," revealed findings from the study.

The study surveyed 17,000 men who have sex with men in Sydney and Melbourne between 2013 and 2017.

The new study analysed the uptake and effect of PrEP, particularly on condom use by gay and bisexual men.


Recruitment occurred at gay venues or events and online. Eligible participants were 18 years identified as male (including transgender participants who identified as male), and having had sex with a man in the past five years.

Using multivariate approach, researchers assessed trends in condom use, unprotected anal intercourse with casual partners and PrEP use by gay and bisexual men, controlling for sample variation over time.

"Use of pre-exposure prophylaxis or PrEP daily antiretroviral pills taken by uninfected people during the study years jumped from 2 per cent of the HIV-negative participants to 24 per cent," revealed the study

The findings also revealed that in the same time frame, consistent condom use dropped from 46 per cent to 31 per cent in men who reported having anal sex with casual partners.

A rapid increase in PrEP use by gay and bisexual men in Melbourne and Sydney was accompanied by an equally rapid decrease inconsistent condom use.

Last year in May, amid much funfair, Kenya launched a pre-exposure prophylaxis drug dubbed PrEP, in a bid to reduce new HIV infections by 75 per cent, by 2019.

A year later after the launch of PrEP as an HIV-prevention measure, the experts warn that the uptake is still lower than expected.

The HIV-prevention pill Truvada, taken by people who are HIV-negative before exposure to the risk of HIV infection, contains the same antiretrovirals as some of the pills taken by people who are HIV-positive to control the virus in their bodies. Its effects last for eight hours.

When taken as prescribed, PrEP can reduce the risk of catching HIV by up to 90 per cent.

"It is taken once daily for the period of potential risk. PrEP is prescribed for one month, must be taken for at least seven days for its effectiveness to kick in, then continued. Studies have shown that, with good adherence, PrEP works miracles," said Dr Christine Ogolla, a programme director at the Elizabeth Glaser Aids Foundation.

"PrEP is not for everyone and it’s not to be taken for life. Individuals who perceive themselves to be at risk should visit a healthcare facility for a HIV test and have a discussion with the healthcare provider," said Dr Nelly Mugo, the principal research scientist at the Kenya Medical Research Institute and the principal researcher on the PrEP efficacy trials conducted in Kenya.

Currently, the drug is only available for use upon prescription. "If a non-infected person takes PrEP, then the virus is killed if it enters their body. This means it doesn’t have a chance to hide in reservoirs, and so it is harder for that person to become infected," explained Dr Mugo.

However, PrEP is only meant for specific populations at high risk of infection like young women, serodiscordant couples and sex workers and youth.

Experts, however, warn that PrEP is not a magic bullet, and must be taken in combination with safe sex practices like use of condoms. Moreover, after a month on PrEP one requires further screening to check levels of the drug in their blood and to check if they contracted HIV while on the drug.

"The same study can apply to Kenyans, using the drug does not mean that you forget about other safety measures, they must go together," Dr Mugo said.

Aids Healthcare Foundation (AHF) Advocacy Manager Mary Nyaguthii says that promoting the use of a condom in the country has been a challenge particularly to people in steady relationships and also married partners.

According to Kenya Modes of Transmission study done in 2015 in condom use promotion and distribution among men and women between 15-24 years shows a 43 per cent consistent condom use among men with their female partners of unknown HIV status in the past 12 months

With 11 per cent consistent condom use among women with their female partners of unknown HIV status in the last 12 months while 89 per cent of women aged between 15-24 years reporting non-use of condom with partners of unknown status

The study’s lead author, a social scientist Martin Holt of the University of New South Wales in Sydney, says this likely occurred because the first public campaigns that advocated PrEP use targeted gay and bisexual men who reported inconsistent condom use with partners they did not know.

"One theory is we’ve removed this massive group of guys who otherwise would be at high risk of HIV. The initial results are promising, but I’m slightly concerned," Holt says. about the long-term effects." Prof Holt said.

He says if condom use norms change and it "is not the default strategy used by gay men," then HIV transmission rates could spike.