Condom use has been trending downward among younger gay and bisexual men over the last decade, even when they aren’t taking pre-exposure prophylaxis (PrEP).
This is according to a study – “Behavior Change Among HIV-Negative Men Who Have Sex with Men Not Using PrEP in the United States” by Steven M. Goodreau, Michael P. Barry, Deven T. Hamilton, et al – that was published in AIDS and Behavior.
This study – which measured changes in sex without condoms among HIV-negative gay and bisexual men who are not taking PrEP – used data from the 2014-19 cycles of the American Men’s Internet Survey, a web-based survey of cisgender men ages 15 and older who have sex with men (MSM).
The researchers found that roughly half of HIV-negative men reported using condoms at least sometimes in the last year. That was higher than the 15% of respondents who reported using PrEP.
But HIV-negative MSM men who are not using PrEP seem to be not using condoms increasingly often. The study specifically found that the proportion of these men who had condomless sex increased 2.2% in the average year.
Rates of people who weren’t using condoms was higher among younger and Latinos, 7.2% per year for young MSM ages 15 to 24, and 18.7% among young Latino gay and bisexual men.
Properly used condoms can prevent the spread of disease, including HIV; taking PrEP also reduces the likelihood of HIV transmission. The increase in condomless sex for men not on PrEP suggests potential new HIV transmission pathways, researchers said, and the concentration among young Latino men could expand existing health disparities.
According to Goodreau, lead author and UW professor of anthropology, health equity and the importance of continued education about the benefits of using condoms during sex should be stressed.
“Some people really don’t like condoms and aren’t going to use them, so PrEP provides another option for them. But like most pharmaceutical interventions, it means people need to know about it and be continuously tied to the healthcare system,” Goodreau said.
For Goodreau, PrEP has limitations. “There are all sorts of things happening in people’s lives — from unstable housing to dealing with mental health and substance use — that make taking a pill every day not the easiest thing to do. So, PrEP has positives but also challenges.”
With condoms, “they’re far cheaper and much easier to access. For some people the lack of daily regimen is a plus. They prevent a much wider range of sexually transmitted infections, not just HIV. But they also take their own form of planning and negotiation. In the end, I see both as key to lowering HIV transmission rates.”
Noting that “a growing set of young gay and bisexual men, and especially young gay and bisexual men, seem to be missing out on both interventions”, Goodreau said this “raises questions of equity”.
“We must remember that every generation is starting anew with their knowledge about sexual health. If we have a generation that is coming of age when conversations about condoms that were common in the past haven’t been as present, then they aren’t starting with that broad familiarity. And if LGBTQ+ inclusive sex-ed, which covers HIV prevention for gay and bisexual men, isn’t evenly distributed in the population, then we indeed have equity concerns.”
The researchers recommended:
- focusing on a shift in that thinking. “Some folks in public health think that gay and bisexual men just don’t want to hear about condoms anymore. That’s certainly true for some, but I don’t think it’s as broadly true as we assume.”
- LGBTQIA+ inclusive sex education is “extremely important”. Only about half of high schools have this, and “that’s a key first place for young, gay and bisexual men to learn about the different prevention methods and what would work for them given where they are in life. This is a time when the barriers to PrEP are especially high for many people, so making sure that condoms are seen as a valuable and viable option is especially important”.
- Put condom use as an option (along with PrEP) in dating apps that men use to find partners to ” “That seems like a huge missed opportunity, both to actually share information condom use and to “send the message that condoms are on par with other sexual health tools”
- Make condoms available in every bar and club catering to gay men. “They’re still there some of the time, but not as consistently, and there’s rarely any material explaining and promoting them.”
“In the end, it’s key to remember that things like condom use are highly subject to social norms — many people use what they see and hear from their peers and beyond as a guide for their own decisions. Even just a little bit more attention to the topic may help to get many of those conversations started again,” Goodreau ended.
