Although there’s been a big fall in consistent condom use by Australian gay and bisexual men in recent years, their overall use of HIV prevention is up, researchers say. More of the men’s sex is safer than it was before, mostly because so many more men are now taking PrEP.
Australia has been a world leader in the rapid roll-out of the HIV prevention medication PrEP among gay and bisexual men. HIV treatment is available free of charge for most people and the benefits of HIV treatment for prevention have been promoted.
Professor Martin Holt of the University of New South Wales looked at over 30,000 responses to surveys between 2014 and 2019. Men completed these surveys at gay events, gay bars and online.
He looked at what men said about casual sex in the previous six months. One of the biggest changes was a decline in the number of men who said they always used a condom for anal sex with casual partners (45% in 2014, falling to 23% in 2019). But this was compensated for by HIV-negative men taking PrEP (less than 1% in 2014, rising to 31% in 2019).
The numbers of HIV-negative men who weren’t taking PrEP and had sex without a condom fell, from 30% to 25%.
Another form of safer sex is when an HIV-positive man is taking HIV treatment and has an undetectable viral load (not enough HIV to pass it on). This also increased (from 4.8% to 5.8%) while the numbers of HIV-positive men who were not undetectable and had sex without a condom fell by the same amount (from 1.6% to 0.6%).
There were also men who hadn’t had anal sex with their casual partners in the previous six months (18% in 2014 and 15% in 2019).
Putting together all the men who had practices that we can call ‘safer sex’ – condom use, PrEP, an undetectable viral load or no anal sex – the total rose from 68% to 75% over the five-year period.
And that doesn’t take into account men’s partners. For example, an HIV-negative man who is not on PrEP and has sex without a condom would in fact be having safer sex if his HIV-positive partner had an undetectable viral load.
Professor Holt says these changes are likely to have contributed to recent declines in HIV infections in Australia.
Get more information about PrEP and an undetectable viral load.