Pre-exposure prophylaxis and the strategy based on the undetectable equals untransmittable concept (I = I) would be the main responsible for said preventive improvement.

Australian gay, bisexual and other men who have sex with men (GBHSH) appear to have effectively implemented major changes in their HIV prevention strategies. Thus, despite the fact that the use of condoms has decreased significantly in this population, the adoption of other strategies such as pre-exposure prophylaxis against HIV (PrEP) and the role of antiretroviral treatment as prevention (which is known as I = I or undetectable equals untransmittable, has resulted in an increase in preventive coverage of new infections, according to a study published in the journal AIDS.

Australia has been one of the leading countries in expanding the use of PrEP among the GBHSH male population. The preventive strategy is free for most people and the benefits of treatment as prevention –through the I = I message– have been widely disseminated among the community.

To shed light on how this paradigm shift has impacted the prevention of new HIV infections, a team of researchers analyzed the results of a series of surveys conducted in the Australian GBHSH community of men between 2014 and 2019, to which were analyzed the responses from 32,049 questionnaires. Participants were contacted online and through events and venues geared towards the GBHSH male population. The analysis only included participants who reported having had sexual relations with sporadic partners.

Half of the participants were between the ages of 27 and 45. Most identified themselves as gay (90%) or bisexual (7%) and were born in Australia (70%). Their HIV status was negative in 82% of the respondents, positive in 10% of the cases, and unknown in 9% of the participants.

  • Regarding sexual relations with male sporadic partners, the participants answered that they had not practiced anal sex with them by 18% in 2014 and by 15% in 2019.
  • In the same type of relationships, the consistent use of condoms was reported by 45% of the participants in 2014 and by 23% in 2019.
  • The use of PrEP among those who reported practicing sex without a condom rose from 0.7% in 2014 to 31% in 2019.
  • Having HIV, having sex without a condom and having an undetectable viral load thanks to antiretroviral treatment was referred by 4.8% of the participants in 2014 and by 5.8% in 2019.
  • Practicing sex without a condom, being HIV negative or with unknown serological status and not taking PrEP was referred by 30% of the participants in 2014 and by 25% of them in 2019.
  • Practicing sex without a condom, being HIV positive with a non-undetectable viral load was referred by 1.6% of the participants in 2014 and by 0.6% of them in 2019.

Although the last two groups referred to are still at risk of participating in HIV transmission, the first four would be covered by prevention strategies other than condoms (PreP and treatment as prevention [I = I]). Adding the numbers of the changes in the first four groups, the net preventive coverage would have increased by 7 points from 2014 to 2019 (from 68% to 75%).

The researchers highlighted that their approach has been conservative and that certain aspects would not have been adequately determined in the survey. In fact, an important aspect that could be detected (although only in 2019) and would go along this line would be that men without HIV who were not on PrEP and practiced sex without a condom manifested in 34% of the cases that they performed these practices routinely with men who were on PrEP and in 15% of cases with men with undetectable viral load.

The results of the present study show how the improvement in prevention can occur even with a reduction in the use of condoms, a fact that indicates the good reception that PrEP and the I = I message have had among GBHSH in order to evolve strategies for prevent the acquisition of HIV.


Source: Aidsmap / Elaboración propia (gTt-VIH).

References: Holt M et al. Increasing preexposure prophylaxis use and ‘net prevention coverage’ in behavioural surveillance of Australian gay and bisexual men. AIDS, 35: 835-840, April 2021. doi: 10.1097/QAD.0000000000002797



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