Reconciling risk, pleasure and pills; multicultural perspectives on combination prevention

A very interesting talk today by Assoc Prof Adam Bourne today addressing many of the benefits and obstacles to reducing harm in sexual practices.

I thought the most fascinating part of the talk centered around the use of Pre-Exposure Prophylaxis (PrEP). Recently I heard there were almost as many people on PrEP in Sydney as there are on ARV's. 

The talk was largely a positive spin on PrEP, highlighting how it has improved sexual experiences, and undoubtedly the mental well being of the MSM community as well as PLHIV. However many of the issues associated with its use stem from peoples reluctance to use PrEP due to the stigma associated with taking HIV medication. I felt however the issues of condoms no longer being used by many using PrEP in casual relationships was understated. PrEP no doubt has a crucial role in prevention of transmission of HIV in serodiscordant couples, however if our message is its safe to have sex with multiple casual partners if we have an undetectable viral load or PrEP in the absence of other safe sex practices (such as condoms), the rates of other STIs will skyrocket. I know many of these STI's are treatable, though with resistance patterns seen in gonorrhea and the latency often seen in syphilis we could have serious problems on our hands. Not to mention the fact there is resistant HIV virus in the community, to which the PrEP may be ineffective. The message we should put out is yes PrEP can protect you from HIV (in most instances), however it doesn't mean that if you shouldn't use a condom if you're going to have sex with multiple casual partners. 

PrEP is still a long way off in East Timor (my current place of work), though as health resources improve could be a great aid to reduce HIV transmission.