Participants spoke of trust in the effectiveness of biomedical prevention strategies and being able to rely on PrEP as one of the main reasons for no longer using condoms. Using PrEP only was reported by the majority of participants (81% of the time) for sex with any partner type, regardless of PrEP regimen or time since initiation. The median age was 41 while other characteristics were similar to the larger sample. The majority opted for daily PrEP (74%), while the other participants opted to use event-driven PrEP, scheduled around the time of sexual encounters.Ī total of 48,949 anal sex acts were reported over the course of the study: 11,632 with steady partners, 19,547 with known casual partners and 17,770 with unknown casual partners.Īdditionally, 43 participants were interviewed to gain qualitative insights into their PrEP and condom use. The median age at the beginning of the study was 39 most participants identified as White (86%) and were college educated (77%). However, some people do continue to use the term as a synonym for condom use. Modern definitions should also include the use of PrEP and the HIV-positive partner having an undetectable viral load. In the past, ‘safer sex’ primarily referred to the use of condoms during penetrative sex, as well as being sexual in non-penetrative ways.
Describing this as ‘safer’ rather than ‘safe’ sex reflects the fact that some safer sex practices do not completely eliminate transmission risks. Sex in which the risk of HIV and STI transmission is reduced or is minimal. If the participant had had sex, they were asked further details about their partner and use of condoms. Participants were asked two questions daily about taking PrEP and whether or not they had had anal sex. Researchers collected mobile app-based diary data from 352 participants (351 gay and bisexual men and one transgender woman) from 2015-2019.
For example, in AMPrEP, researchers observed decreasing condom use, but did not find a significant rise in STIs over two years of PrEP use. The relationship between the use of PrEP and STIs is complex. Public health guidelines in the Netherlands, as elsewhere, recommend using condoms alongside PrEP. However, there have been public health concerns that its use would lead to ‘risk compensation’ – that, due to PrEP’s effectiveness at preventing HIV, those on PrEP would stop using condoms altogether and that this would lead to an increase in other STIs. PrEP is highly effective at preventing HIV infection. These findings from the Amsterdam PrEP (AMPrEP) demonstration project were published in AIDS by Hanne Zimmermann and colleagues from the Public Health Service of Amsterdam. Those who opted to use condoms did so in situations of perceived vulnerability to HIV and other sexually transmitted infections (STIs) and in instances when they did not want to talk about using PrEP with sexual partners.
While over 80% of anal sex among pre-exposure prophylaxis (PrEP) users in Amsterdam was covered by PrEP alone, condoms and PrEP were used for nearly one in five anal sex acts with casual partners.