HIV Preexposure Prophylaxis and Condomless Sex: Disentangling Personal Values From Public Health Priorities

Abstract

Daily HIV preexposure prophylaxis (PrEP) is an effective form of HIV protection that remains unknown and inaccessible for many people in the United States despite receiving federal approval over five years ago. PrEP is supported by the public health community, but forgoing condoms while taking PrEP has proven controversial; this controversy may be contributing to the lag in PrEP uptake. We argue that limiting PrEP access based on anticipated or actual sexual behavior contradicts the goals of public health research and practice and is not scientifically justified. As evidence for the effectiveness of novel forms of biomedical HIV protection emerges, public health professionals need to accept new definitions of "protected sex" and ensure that their personal values do not override empirical evidence when determining public health priorities.

FIGURE 1—

Number of Cases of Sexually Transmitted Infections (STIs) Among Men Who Have Sex With Men (MSM): King County, WA, 2016 Note. The rising STI rates reported as an extension of previous trends when earlier data are included. A 2016 commentary by Alaei et al. presented STI incidence data from 2013–2016 to implicate preexposure prophylaxis (PrEP) uptake in the rising rates of STIs among MSM in King County, WA. STI rates increased between 2013 and 2016, but rates have been rising since 1997, with a pattern of accelerated growth beginning in 2008, 4 years before the approval of PrEP by the United States Food and Drug Administration. Source. Reproduced from the 2013 King County Sexually Transmitted Diseases Epidemiology Report, with subsequent extrapolated data points obtained from the 2015 and 2016 fourth quarter reports (http://www.kingcounty.gov/depts/health/communicable-diseases/hiv-std/patients/epidemiology.aspx).