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Poster campaign claims bareback sex with PrEP ‘better than a condom’

Emma Powys Maurice August 5, 2019
PrEP

The 'potentially harmful' PrEP advertisement is being displayed in several areas throughout Melbourne, Australia (Image supplied)

A new advertisement for HIV medication PrEP describing it as ‘better than a condom’ has raised concerns that it could be discouraging condom use in men who have sex with men.

The posters are being displayed in areas frequented by gay men in Melbourne, Australia. They were issued by the PrEP direct action group ‘See It Clearly 2020,’ which is known for its controversial advertising.

PrEP, or Pre-exposure Prophylaxis, is a medication to prevent someone from contracting HIV. The posters declare that PrEP offers more than 99 percent HIV risk reduction, compared to 72-91 percent with condoms.

PrEP is highly effective in preventing HIV, and if taken correctly, users do not need to worry about a partner’s HIV status at all. However, it does not protect against other sexually transmitted infections, such as gonorrhoea and syphilis.

‘See It Clearly’ poster displayed in Melbourne (Image supplied)

In smaller text at the bottom, the poster indicates that 100mg of doxycycline can be taken daily as a preventative against STIs.

Doxycycline is prophylactic antibiotic which reduces the transmission of some STIs, but is not 100 percent effective. It only prevents against bacterial infections and regular use can result in antibiotic resistance.

The San Francisco AIDS Foundation does not recommend the sole use of doxycycline as a STI preventative for people who frequently have condomless sex.

“A potentially harmful message”

See It Clearly said: “People making their own choice of protection is good, but it is only an informed choice if they have that critical piece of information. Presenting four choices of HIV prevention [PrEP, condoms, PEP and U=U] as somehow all equal and all good is a disservice.”

But Dr Anthony James, Health Advisor for PinkNews, said the ad’s slogan ‘better than a condom’ is problematic.

“Condoms remain the most effective way to prevent against STIs,” he explained.

“Antibiotic prophylaxis, as recommended in this ad, have the potential to contribute to the rise of drug resistance, a real concern with multi-drug resistant gonorrhoea now causing problems in many parts of the world.

“This ad sends a potentially harmful message by implying condoms are not necessary. Condoms remain an important part of having a healthy and happy sex life alongside other interventions including PrEP and regular testing.”

Antiretroviral pills Truvada sit on a tray at Jack's Pharmacy on November 23, 2010 in San Anselmo, California.
Antiretroviral pills Truvada, or PrEP. (Justin Sullivan/Getty)

He added that, alongside increased testing and Treatment as Prevention (TasP), PrEP is “extremely effective and should be made more accessible to everyone.”

However, the UK has seen year on year increases in the number of other STIs, particularly chlamydia and gonorrhoea, “in part driven by increased testing, but also by increased rates of condomless sex.”

Those taking the poster at face value and without doing further research could easily (and wrongly) assume that a combination of PrEP and doxycycline is a reliable preventative against all STIs.

STI prevention is built into the PrEP protocol

Rodney Ellis, a founding member of PrEPaccessNOW (PAN), defended the poster’s message.

“What I always say to people is that STIs are curable, HIV is not, and I’ve lost two decades of friends to HIV but not a single one to an STI — so perspective on that is good,” he said.

“That condoms ‘prevent STIs’ was a convenient myth at the time. It reinforced condom use for HIV, but before HIV, condoms were never considered for STI prevention for gay men. Condoms only reduce some risk for some STIs and with some sexual acts.

“Testing every three months is the more effective STI prevention and that is built into the PrEP protocol. The early adopters of Doxy-PrEP are also reporting good things and I’ve been on it since 2015 and not had an STI since.”

Ellis pointed to a recent study which suggests that increased use of PrEP among men who have sex with men could lead to a decline in the rates of gonorrhoea and chlamydia, even if they use condoms less frequently.

While encouraging, it should be noted that this result was achieved through mathematical modelling and has not yet been conclusively proved.

If you are interested in taking PrEP, or finding out more about it, visit I Want PrEP Now and Prepster. You can also watch how the HIV self-testing kit works and how you can get one through the Terrence Higgins Trust.

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