How relevant are serosorting and condoms in the age of TasP and PrEP?

So we have all heard the phrase ‘HIV is different now’, but what does this actually mean? Different now? Different how? We are now living in a world where HIV is a chronic manageable condition and where people with an AIDS defining illness can quickly return to a healthy state with timely medical care. This is been made possible through the continuous improvements to anti-retroviral therapies (ARTs) since the mid 1990’s. These improvements have also lead to the now commonly held idea of Treatment as Prevention (TasP), as well as the preventative provision of ART such as Pre Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP). Biomedical interventions such as TasP and PrEP have had a huge impact on the prevention, treatment and management of HIV around the world. style=”float:left; margin:5px 10px 5px 0″ after the

Previous to these biomedical interventions, the only strategy we had to prevent HIV was through condoms. Due to the nature and gravity of the AIDS epidemic in the 1980’s and the loss and sadness that followed, a culture of condom use became ingrained into the gay community. It quickly became the norm and became common practice for many years. Thirty years later, we have a generation that has grown up without the Grim Reaper campaign and the loss of their friends and family to HIV. The virus doesn’t hold the same gravity in this new generation as it has for those who lived, loved and lost through the 1980’s and 1990’s. The positive in this is a new understanding of HIV with less fear and stigma. The negative is that some people are becoming complacent with HIV prevention because ‘it’s not going to kill me’ and ‘you just have to take one pill per day, right?’  These attitudes (which by all means aren’t held by everyone) can be one of the many reasons why condom use has slacked off within the gay community. There is a need for new HIV prevention methods to accommodate for the time we live in and the new generations ahead; that’s where biomedical interventions such as PrEP and TasP come in.

Biomedical interventions like TasP and PrEP are changing the face of HIV prevention. Both TasP and PrEP and incredibly empowering to both the HIV positive and the HIV negative community. TasP means that people living with HIV can have a suppressed viral load which vastly improves their health and quality of life because the virus isn’t damaging their body. The suppressed viral load, when ‘undetectable’, offers a person living with HIV a 96% reduction in HIV transmission to another person. PrEP is empowering to the HIV negative community as they can take control of their HIV status without having to rely on their partners HIV status or sexual history. The best statistic we have for HIV prevention from PrEP is about 92% (with condoms being 92-98%). With the effectiveness of HIV transmission prevention of TasP and PrEP almost being on par with condoms, it is easy to see how condom use might decline. As PrEP becomes more popular and the concept of TasP becoming more widely known, hopefully serosorting may become a thing of the past as everyone will be HIV equal.

So, in today’s world where TasP and PrEP exist, are behavioural interventions like condoms and serosorting still relevant?

I would say yes… let me explain.

PrEP and TasP are both biomedical interventions that individuals can choose to implement after an informed decision making process with their prescribing doctor. Ultimately it is a choice and individuals can choose not to take medication to reduce their viral load or to prevent HIV. Until the majority of HIV negative individuals who are at risk of contracting HIV are on PrEP and the majority of people living with HIV have an undetectable viral load (i.e. the UN 90-90-90 goals), there will always be serosorting to some extent and condoms. It is also important to note that PrEP and TasP are only preventative against HIV and that sexual health is much bigger than that. PrEP and TasP offer no protection against other STI’s whereas condoms do (and nobody wants antibiotic resistant gonorrhoea). This is why condoms and serosorting still hold an importance and are still very relevant in the sexual health and HIV prevention toolbox.

PrEP and TasP are bringing HIV prevention into the 21st Century. They are fantastic new additions to the HIV prevention tool belt, but it’s important to remember that they aren’t the ‘be all or end all’ solution. It won’t be until we can fully protect our sexual health from every STI, in a way that doesn’t involve abstinence or scroguards, that we will be able to finally say goodbye to serosorting and condoms.

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