The worrying effect of sex drug
AUSSIE men say they have seen condom use drop because of a massively popular drug which is used to prevent the spread of HIV.
It comes as a major study has been directly linked to a drop in consistent condom use between male same-sex partners in Melbourne and Sydney along with the rapid rise of pre-exposure prophylaxis, or PrEP, pills.
The study published in The Lancet, which involved 17,000 gay and bisexual men in Victoria and New South Wales, shows that, between 2013 and 2017, the numbers of HIV-negative men taking the pills to protect themselves rose from 2 per cent to 24 per cent.
During that period, the proportion of HIV-negative men on PrEP having casual anal sex went up from 1 per cent to 16 per cent, despite a drop in consistent condom use from 46 per cent to 31 per cent.
Dom* from Sydney said the pills can be prescribed from a GP after a couple of questions about any other medication the prospective PrEP user might be on and a quick blood test.
Three months worth of pills are then handed over with a warning from the doctor about the importance of still using condoms.
"The pills affect you liver, so you're expected to go back in three months and have a check-up before they give you it (PrEP) again and there's a blood test to make sure your still free of HIV," he said.
"For me, it just seemed like a really sensible thing to do, especially if you're not in a long-term relationship. It's like, if there's an option to protect yourself, then you should take it."
He said, from what he has seen, heard from others and his own experiences, there has been a drop in the use of condoms among gay men in Sydney.
"The last two guys I've been with have been on PrEP and we've just not used condoms," he said. "It's because now you feel like there's protection and most people feel like they don't need condoms now they're taking pills."
Dom said other STIs can easily be treated with a quick visit to a clinic and a jab, so the concern around them is nowhere near as great as it was around HIV.
"People just ask whether someone's on PrEP or they've remembered to take your pill when you meet someone now," he said.
At a gay "sex-on-premises" party in Sydney over the weekend he said there were numerous people opting to have sex without condoms.
"There is still an element of worry there," Dom said. "But it's nothing like what it was before."
Another single PrEP user from Sydney, Dave*, agreed the drug, which he has taken for two years, has "changed the playing field" when it comes to sex for gay men. However, he argued that condoms were still very much in use in the Sydney scene.
He uses a three-pronged approach to steer clear of HIV: by using PrEP, condoms and only having sex with "undetectables" - who are HIV positive but can't transmit the virus to their partners because of immediate and prolonged treatment.
"I have had a super positive experience with PrEP and had no side effects," he said. "It's a far cry from the 1980s when gay men were scared to have sex. I'm in my mid-forties, so I remember when it was scary.
"It's taken the fear out of sex and it's true that some guys have stopped using condoms but condoms are definitely still in the mix."
ACON - a NSW-based health promotion organisation specialising in HIV prevention - issued a strong response to the Lancet study, pointing to more recent data which shows the lowest number of new HIV diagnoses in NSW among gay and bisexual men on record.
"ACON supports and applauds gay men for their continued use of condoms more than 30 years into the HIV epidemic - at rates that exceed that of the general population," ACON said in a statement.
"New technology like PrEP to prevent HIV means that sexual health practices will need to evolve - and we are very confident that condoms will remain a significant part of gay men's safe sex practice.
"We reject that gay men are complacent, when it comes to managing their, and their sexual partners', sexual health. Just like in the general population, not every gay man will use a condom every time."
ACON said condom use was still relatively high among gay and bisexual men in NSW at 70 per cent.
However, Professor Martin Holt at the University of New South Wales who led the research told The Guardian, the rise PrEP's popularity had "disrupted" condom use.
"Our findings suggest that the rapid uptake of PrEP disrupted condom use at a community level," he said.
"However, it's too early to tell the long-term effects of increasing PrEP use … declining condom use may impede its long-term population-level effectiveness."
PrEP in Australia has grown rapidly over the past few years. This is because state governments have run local trials of the medication.
In April, the Federal Government also agreed to subsidise the anti-HIV drug to make it more affordable and accessible.
CEO of the national federation for the HIV community response AFAO, Darry O'Donnell, reacted to the study by praising the work of the government in making the drug accessible.
"PrEP, in combination with other prevention strategies such as condoms and having an undetectable viral load, gives us the tools to finally deliver significant reductions in HIV transmissions," he said.
HIV cases in Australia, particularly in NSW, have been on the decline in the past few years.
New diagnoses of HIV among gay and bisexual men in NSW have nearly halved over the past five years.
NSW Health says the number of new cases in Australian-born men dropped by 48 per cent in the first three months of 2018 compared to the average for the same period in the previous five years.
However, there has been a spike among some populations, including Aboriginal and Torres Strait Islander people in Northern Australia.
Other STIs, such as gonorrhoea have been making a comeback, as more strains which are resistant to antibiotics spread rapidly in Australia.
A "super-superbug" variety of gonorrhoea landed in Australia for the first time in April, when a Queensland Health spokesman confirmed two cases of the strain which is resistant to multiple antibiotics were detected.
Experts say gonorrhoea is spreading more rapidly through heterosexual sex.
* The names of the men in the piece have been changed at their request