Let’s talk about sex … in the age of PrEP

15 Feb 2017

gay couple

The proportion of HIV-positive gay men on antiretroviral treatment (ART) has reached a historic high, and the use of pre-exposure prophylaxis (PrEP) is soaring as awareness and availability of PrEP rapidly increase.

These prevention strategies are providing new ways to safely avoid HIV.

However, Associate Professor Martin Holt, from the Centre for Social Research in Health (CSRH) at the University of New South Wales (UNSW), says they are also posing challenges to the ways communities understand, and potentially practise, ‘safe sex’.

Holt will explore these challenges in a free public lecture, ‘Antiretroviral sex: the transformation of safe sex?’, at Sydney’s Eternity Playhouse on 22 February.

PrEP is a fantastic opportunity to protect more people from HIV, but it unsettles some of the assumptions that have been built up over decades about what gay men should do when they have sex.

Holt, project leader of the Australian Gay Community Periodic Surveys at the CSRH, says the new possibilities offered by ‘antiretroviral sex’ have transformed ideas about ‘safe sex’ and have had unforeseen impacts on sexual and social relations, identities and HIV-related stigma.

“HIV treatment prevents HIV-positive people from passing on the virus but this is hard for people to get their head around. And while there has been a lot of community interest in and support for PrEP, it has meant that gay men are having to develop new skills about negotiating sex,” he says.

Pre-exposure prophylaxis (PrEP) is HIV medication taken by HIV-negative men before sex to prevent HIV infection. If taken consistently, PrEP is effective at stopping the HIV-negative person from acquiring HIV. In a similar vein, HIV-positive men who consistently take ART dramatically reduce their chance of passing on the infection.

In the Annual Report of Trends in Behaviour 2016, record numbers of gay men (41%) reported having unprotected anal sex with casual partners, up eight percentage points from 10 years earlier. This increase was most pronounced among men aged 25 years or younger. This secular trend away from consistent condom use is one of the reasons there is such current interest in PrEP.

Holt says this can be challenging for older generations of gay men who have relied on condom-based HIV-prevention strategies. Men who continue to practise consistent condom use may be less willing to have sex with someone using PrEP. The result can be tension and confusion when negotiating sexual and social relations, he says. 

“PrEP is a fantastic opportunity to protect more people from HIV, but it unsettles some of the assumptions that have been built up over decades about what gay men should do when they have sex. Now is the time to get people to talk to each other about supportive ways to negotiate sex in the new era, and minimise the potential for discord and division.” 

The public lecture, part of the 2017 Sydney Gay and Lesbian Mardi Gras Festival and supported by Darlinghurst Theatre Company, will be introduced by the Hon Michael Kirby AC and will be followed by a discussion moderated by Australian Federation of AIDS Organisations president Dr Bridget Haire.

What: Free public lecture, Antiretroviral sex: the transformation of safe sex?

When: 22 February, 23pm

Where: Eternity Playhouse, 39 Burton St, Darlinghurst

Details: Lecture is free, register here