Like it or not, some people can’t or won’t use condoms.
“Tell him if it’s not on, it’s not on!” You might be familiar with this campaign message from years gone by, but does this approach still hold currency in a brave new world of biomedical HIV prevention?
Our doctors and sexual health experts do an outstanding job of providing recommendations to help us understand how to protect ourselves. So it’s no wonder they recommend using condoms to maximise our protection against HIV and STIs, even in conjunction with other HIV prevention options.
Condoms are cheap, readily available and have done a pretty good job of preventing HIV and other STIs for over 30 years. But the truth is not everyone uses them every time.
Condoms in history
There’s evidence of condom-like devices being used for birth control as far back as the 15th century. But it wasn’t until the early ’80s that we figured out they prevent the spread of HIV — which is right about when gay guys first started using them.
“…it’s undeniable condoms play an important role in keeping HIV and most other STIs at bay.”
Love ’em or hate ’em, it’s undeniable condoms play an important role in keeping HIV and most other STIs at bay. What they haven’t done is stopped HIV transmissions altogether. So what are some of the reasons they don’t get used?
- Maintaining an erection while wearing a condom isn’t doable
- Being in a monogamous relationship
- For people with allergies, latex-free condoms exist but aren’t always as readily available
- Having a penis size or shape that causes challenges with condom usage or comfort
- Using alcohol or other drugs could impair the ability or decision to use a condom
- The bottom (receptive partner) must rely on the top (insertive partner) to put a condom on and keep it on
- Believing that offering sex without a condom will appear more desirable to others
- Reliance on PrEP as another highly effective HIV prevention strategy
- Negotiated safety based on mutual trust agreements between consenting partners
- Living with HIV and preventing onward transmission of the virus with an undetectable viral load
A complex relationship
Gay and bi guys have a strong history advocating for availability and adoption of HIV prevention strategies. As one community most affected by the HIV epidemic, encouraging use of condoms played a major part in HIV prevention through the ‘80s and ‘90s. Worn out of ensuring survival in a crisis with no other options, it’s possible to see why some attitudes might consider condomless sex a taboo today.
Yet even today, scolding someone for not using a condom doesn’t help protect them and is unlikely to support them to behave differently. Nobody deserves to get HIV regardless of the circumstances.
“…scolding someone for not using a condom doesn’t help protect them and is unlikely to support them to behave differently.”
Not using a condom when we thought we would doesn’t mean any of us has failed. It means we’re human. Human desire for intimacy and connection goes as far back as we can record. Guys into other guys have been using condoms for less than 40 years — a mere blink of an eye relative to the history of sex in our species.
Advertising from the height of the HIV/AIDS crisis spread messages of fear and death, so it stands to reasons we might sometimes have a complex relationship with sex and condoms. If you’ve ever experienced that intense kind of passion in moments of intimacy, perhaps you know how easy it can be to let rational decisions slip by the wayside.
Whether that’s you or someone close to you, there are now even more effective HIV prevention options to choose — and they’re fully compatible with condoms.
If you’re HIV negative, PrEP could be right for you.
PrEP stands for Pre-Exposure Prophylaxis. It’s a highly effective HIV prevention strategy that combines using medication with regular sexual health testing. Using daily PrEP can help you take control of your health and it works around the clock regardless of the choices you make.
Even if you feel that using medication daily isn’t for you, on-demand PrEP could be a suitable and convenient alternative to maximise your protection against HIV just when you decide.
Undetectable Viral Load (UVL)
For people living with HIV, there are big benefits to using treatment.
Modern HIV treatments are safe, effective and help keep people living with HIV healthy. Further to this, using treatment can help someone sustain an undetectable viral load. This means the amount of virus in their body is kept so low it eliminates the possibility of sexually transmitting the virus — even when condoms aren’t used.
Knowing about PEP and how to get it can help you or a mate stay HIV negative in an emergency.
PEP stands for Post-Exposure Prophylaxis. PEP is a one-month course of anti-HIV medication that helps prevent someone from getting HIV after a possible exposure. For PEP to stand a good chance of working it’s best started within 72 hours after exposure and ideally, as soon as possible.