Almost half of American gay men recruited to a survey via advertising on a major mobile phone dating app say that at least one potential sexual partner has said that he was taking PrEP (pre-exposure prophylaxis), and even more have interacted with someone who said that he was HIV positive but had an undetectable viral load. Many of these potential partners were looking for sex without a condom, according to the survey results, reported in an article published online ahead of print in the Journal of Acquired Immune Deficiency Syndromes.
Banner and pop-out advertising recruited survey participants between November 2014 and February 2015. Questions about PrEP were answered by 668 men and those on undetectable viral load by 727 men. Average age was 38, three-quarters of respondents were white and 14% had been diagnosed with HIV.
Asked, “When you’ve been on mobile dating apps looking for sex partners, has anyone ever told you that they are on PrEP?”, 43% of HIV-negative men and 62% of HIV-positive men said yes.
Asked a similar question about having an undetectable viral load, 68% of HIV-negative men and 90% of HIV-positive men said yes.
Of these men, most said that at least one of the sexual partners (who had disclosed PrEP or undetectable viral load) had asked to have sex without a condom. Further, at least one partner had refused to have sex unless condoms were not used.
However, one weakness of this cross-sectional survey is that it didn’t ask how often sex without a condom was proposed by other potential partners – those who didn’t talk about using PrEP or having an undetectable viral load. The survey can’t show whether sex without a condom is more common when these prevention methods are used.
Nonetheless, respondents who had had sex without a condom with someone using PrEP, or with someone who had an undetectable viral load, were asked why they didn’t use condoms. Respondents explained why in their own words and these answers do suggest that many men took the use of biomedical prevention methods into account.
Fifty-five per cent of the HIV-negative men who had condomless sex with someone using PrEP specifically said that the risk of HIV transmission is lower when PrEP is used. There were similar responses in relation to condomless sex with a man with an undetectable viral load.
The survey found that men with diagnosed HIV were more likely to interact with someone who talked about his PrEP or undetectable viral load, and were also more likely to meet up and have sex without a condom with him.
The researchers noticed a novel seroadaptive behaviour that they call ‘biomed-matching’ – typically an HIV-negative PrEP user having sex without a condom with an HIV-positive man who has an undetectable viral load. They suggest that the pairing of two effective prevention methods is likely to be highly effective. Condomless sex between two HIV-negative PrEP users would also be ‘biomed-matching’.
The results suggest that discussion of PrEP use and of having an undetectable viral load is becoming more mainstream among American gay men, specifically in the context of dating apps. Discussing these facts in face-to-face environments may be more challenging.
Newcomb ME et al. Partner Disclosure of PrEP Use and Undetectable Viral Load on Geosocial Networking Apps: Frequency of Disclosure and Decisions about Condomless Sex. Journal of Acquired Immune Deficiency Syndromes online edition, doi: 10.1097/QAI.0000000000000819, 2015.