Condom fatigue: how to reduce your risk of HIV infection

While there are many effective methods in reducing the risk of HIV transmission during anal intercourse, some are more popular or more widely used than others. Condoms have been promoted as the most popular option for over 25 years, but condom fatigue has long set in. It’s time for public health to offer a more […]

Health Sexual Health Bill Coleman, PhD

Condom fatigue: how to reduce your risk of HIV infectionWhile there are many effective methods in reducing the risk of HIV transmission during anal intercourse, some are more popular or more widely used than others. Condoms have been promoted as the most popular option for over 25 years, but condom fatigue has long set in. It’s time for public health to offer a more meaningful dialogue on other alternatives to reduce HIV transmission.

Current research suggests condoms are only up to 76% effective in preventing HIV infections during anal intercourse, whereas, Truvada as PrEP can reduce an individuals risk by over 99%. It’s also incredibly important for HIV negative people to know that having bareback sex with a partner who is undetectable is over 99% effective.

What you need to know about reducing your risk of HIV infection:

Condoms:

  • Inexpensive and widely accessible.
  • Protect against some STIs, but not all.
  • Most people do not like condoms and report sex is not as good with them.
  • It’s easy to lose and erection.
  • They reduce the feeling of intimacy and skin-on-skin touch.
  • Condoms break, slip off, or aren’t used properly.

Truvada as PrEP:

  • Incredibly effective in stopping HIV transmission when taken daily, as prescribed.
  • The reliability of information on HIV status from a partner is not a concern.
  • You do not have to worry about stealthing.
  • There is no disruption of sexual activity to stop to put on a condom.
  • Any kind of lubricant can be used.
  • Prescriptions can be expensive if not covered under insurance or other assistance plans.
  • Less than 2% of people experience side effects from taking Truvada.
  • It can take some effort to find a doctor informed about Truvada as PrEP an willing to prescribe it.
  • There is still the potential risk of getting other STIs.

Undetectable partners:

  • Most guys in developed nations who test positive are immediately treated with antiretroviral drugs (ARVs) to reduce their viral load count to an undetectable level.
  • A sense that positive undetectable guys are more fun to have sex with and are more open to exploring sexuality.
  • Guys are more open about their undetectable status as the community embraces and understands sexual health risks.
  • It is still possible to contract STIs.
  • You must trust your partner is undetectable and has had a recent viral load test to ensure an undetectable status.
  • You have to openly discuss HIV status with your partner.
  • Not all positive undetectable guys will have condomless sex with HIV negative partners.

You can use these three risk reduction methods separately, or combined. For example, you can take Truvada as PrEP and have an undetectable partner. Or use condoms with undetectable partners. Or use Truvada as PrEP along with condoms.

It is also important to be educated on sexually transmitted infections (STIs). You should know how you can reduce your risk and be easily treated for STIs. Getting tested regularly is key for your sexual health. You should always know your HIV and STI status.

Public health has been slow to provide new information for individuals to make smart, educated, and informed decisions. The conversation needs to move to alternative options to reduce the risk of HIV and to make sex fun again. The message of using condoms is engrained, but with the advances of AVR’s, condoms aren’t the only method of risk reduction like they were during the peak of the HIV/AIDS crisis. Besides, it is still possible to become HIV positive even while using only condoms.

Change can be difficult for some, especially when condoms have been the only message hear for decades. The time is now to talk to your doctor and understand that there are new and alternative ways to reduce your risk of HIV, that doesn’t rely on out-dated practices.

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2 thoughts on “Condom fatigue: how to reduce your risk of HIV infection

  1. Pingback: Truvada, Undetectable. and Condoms; what is best for you? | Dr Bill Coleman

  2. Rick Perera

    What a biased article. I am a fan of PrEP — I take it — but this is written like a promotion for PrEP and a not-so-subtle attempt to dis condoms.

    You use an apples-to-oranges comparison of condoms to PrEP. Your 76% figure for condoms (what’s your source? I’ve never seen that number) is based on “real world” use, accounting for failures and breakages. It’s invalid to compare that to 99+% for PrEP, which assumes perfect conditions, never missing a dose. In reality, when guys adhere consistently to condom use — difficult as that can be — they protect almost as well as perfect PrEP use.

    Your list of “what you need to know” reads more like a litany of cons about condoms, making blanket statements about their negative impact on sex that aren’t backed up with any research. While it’s important to acknowledge the issues many people have with condoms — these have been brushed aside for far too long — they aren’t universal. Many guys function just fine with condoms.

    The general impression I get is that you are slanting the list against condoms by emphasizing the negatives — the way many anti-PrEP writers do by exaggerating side effects or understating effectiveness.

    Regarding STIs other than HIV: they are a big and growing problem in the gay/bi male community. Any tool that can reduce risks — including condoms — should not be dismissed just because it’s not perfect. By way of comparison: condoms prevent about 50% of syphilis cases. Seatbelts and airbags prevent between 45% and 60% of traffic deaths. In both cases, we don’t have perfect protection, but these are important harm reduction tools.

    Acknowledging people’s frustrations about condoms does not have to entail further stoking them. Given the challenges that remain in accessing PrEP in Canada, you are doing your readers a disservice in not-so-subtly discouraging them from continuing to try to adhere to condom use. For now, that is the best strategy for most Canadian guys.

    Thank you for raising awareness about PrEP and TasP, but please do so in an accurate and unbiased fashion in the future.

    Reply