Safe Sex in an Age of Biomedical Prevention

A recent “Dear Colleague” letter from Dr. Demetre Daskalakis at New York City’s Department of Health and Mental Hygiene noted they are investigating a case of HIV infection in a New York City resident who was reported to have been adherent to HIV PrEP.  Initial reporting of this case was made by Dr. Howard Grossman at he HIV Research for Prevention conference in Chicago.  According to the letter “The medication approved for PrEP, Truvada, is highly effective at prevention HIV infection, but rare episodes of HIV infection are still possible and expected.  Vigilance for breakthrough infections is necessary.”  Does this change what the community says about safe sex and condoms in the age of biomedical HIV prevention?

It’s time to talk about it;

I invite you to join the discussion at this year’s National HIV PrEP Summit or to start a dialogue in your local community.  Is there a community position about safe sex and condoms in the age of biomedical HIV prevention?  While it’s difficult to get consensus on anything, this is one of many questions and challenges our movement needs to address in order to fully and effectively implement biomedical HIV prevention.  When we ask the new administration to build a plan to end the epidemic, are we approaching (or getting close to) a community consensus on how best to use PrEP, TasP, and PEP alongside condoms and other prevention tools to build pathways to ending the epidemic.

You may have thought the new HIV prevention paradigm meant no more talk about sex, just meds.  Nothing could be further from the truth. Now more than ever, we need honest open discussions about sex, personal responsibility, and how to be healthy and sexual. If we want to get rid of the stigma surrounding HIV, then we need to get rid of the stigma surrounding sex, particularly gay sex.  To shine a light on gay sex because there is nothing shameful about what we do.  Hell, to talk about sex in general, because there is nothing shameful about sex between consenting adults.

While I think it’s time to rethink what safe sex means in 2016, does this latest case of HIV infection while adherent to PrEP change our message?  At the same time, I also know that my colleague and the new executive director of the National Coalition of STD Directors, David Harvey, wants us to focus on more than HIV.  Recently there was a significant increase in sexually transmitted infections (STIs), particularly among gay men.  We don’t believe this increase is tied to PrEP, but what does it say about the future?

Unlike HIV, many (but not all) STIs can be cured.  At the same time, drug-resistant STIs are becoming more prevalent as are concerns about the overuse of antibiotics.  Still, do condoms still matter?  From an intellectual perspective, the answer seems clear.  Of course condoms matter.  Yet if you look at the consistent, but a flat number of annual new HIV infections, you have to wonder if attitudes about condoms are already baked into the HIV prevention equation?  Have we reached the limits on who will use condoms?  That is why biomedical HIV prevention is so important.  It’s not here to replace condoms, but it can add to our HIV prevention arsenal, particularly for those sexually active Americans who may not use condoms every time they have sex.  NMAC believes our movement is about empowering the disempowered.  To get highly sexually active people linked to the care, services, and the medical monitoring that goes along with PrEP, rather than to shame people about not using condoms and turn off the exact communities we are trying to reach.  Once in care, we can monitor for STIs, but without the link to healthcare, it is difficult to stay connected.

Some may think I’m being irresponsible. This is why it’s important to have these discussions. Before we can present a plan to the new administration, we need to try and build community consensus about PrEP, TasP and PEP implementation and building pathways to end the epidemic. For NMAC, a central question to these final phases is how to achieve health equity for communities of color so their HIV statics match those of the White community. To fight for racial justice so the color of your skin is not a factor in determining your health outcomes.  I invite anyone with a different perspective to write to NMAC and maybe we will publish your comments in a future e-newsletter.  It’s time to talk, that is why the National HIV PrEP Summit is so important. The National Coalition of STD Directors with facilitate a session on safe sex in the age of biomedical HIV prevention at this year’s Summit. Join us for this and many other important discussions.  If we are going to create pathways to end the epidemic, then we need to hear your voice.  NMAC wants to thank lead donor Gilead and Levi Strauss Foundation, and ViiV for their support of the 2016 Summit.

It’s our job to educate our communities about safe sex in the age of biomedical HIV prevention.  What is our message? 

Yours in the struggle,

Paul A. Kawata
Executive Director 


Our mailing address is:

1000 Vermont Avenue, NW, Suite 200, Washington, DC 20005


NMAC leads with race to urgently fight for health equity and racial justice to end the HIV epidemic in America. 

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