This article by Benjamin Ryan first appeared in POZ magazine here.
In the age of using antiretrovirals to prevent HIV transmission, some gay men have started to believe that condoms don’t matter at all, even for sexually transmitted infections.
Now that science is showing us that antiretrovirals can prevent the transmission of HIV, a new conversation about the place of condoms in gay men’s sex lives is taking place. This is thanks, for example, to a study published in July that estimates that Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP) lowers the risk of acquiring HIV by 100 percent if gay men take it daily as directed. And other research has suggested that having an undetectable viral load makes HIV-positive guys virtually uninfectious. Hearing all this, some gay guys are questioning whether latex is even needed anymore.
Sure, when it comes to the threat of HIV transmission, condoms might not be required to officially have “safer sex”—so long as you’re an HIV-negative guy on daily PrEP, or you’re a positive guy who has an undetectable viral load or who’s having sex with another positive guy. But then there’s the threat of other sexually transmitted infections (STIs), which neither PrEP nor antiretroviral treatment for HIV protects against. (Although research suggests Truvada apparently does lower the risk of herpes by about a third.)
Such an inconvenient truth seems to have spawned a reactionary philosophy among some gay men, which usually goes something like this: “Well, condoms don’t really make any difference when it comes to STIs, because you can get them from oral sex anyway.” In other words, unless you use condoms during blowjobs, then you’re not at a heightened risk of STIs if you ditch the rubbers for anal sex.
This claim is partly built on fact, but at the end of the day is a myth. Indeed, you can get almost all the major STIs in your throat or around your mouth. (The exceptions are LGV and trichomoniasis.) And those infections can then transmit to another man’s urethra, in the case of bacterial infections, or to his genital area or anus in the case of ulcerative STIs that infect the skin. But the bottom line is this: Using latex for anal intercourse lowers the overall risk of transmitting STIs.
Yes, condoms lower your risk of getting or passing on STIs.
Jeffrey Klausner, MD, MPH, a professor of medicine and public health at the University of California, Los Angeles, says that “while people don’t use condoms for oral sex, the idea is harm reduction: We want to meet people where they’re at, and ideally you use condoms where you’re comfortable using condoms.”
Andrew Grulich, PhD, the head of the HIV Epidemiology and Prevention Program at The Kirby Institute in Sydney, who is one of the world’s leading experts on STI transmission among gay men, says, “We do have a clear picture that if you want to reduce your acquisition risk for sexually transmitted infections, you’ll be using condoms when you have new partners. You get very substantial protection by doing so.”
Part of the faulty reasoning that likely goes into the condoms-don’t-make-any-difference argument is an assumption that if someone with an STI has oral sex with his partner, then his partner’s chance of acquiring that STI is as high as it’s going to be. The argument falsely assumes that subsequently adding anal sex to the mix does not then increase the risk of transmission. People’s reasoning on this matter may go askew for a number of reasons. Perhaps they assume that the risk of transmission during oral sex is 100 percent, so therefore it’s not possible to raise the risk any further. But no STI has such a high risk of transmission.
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