Do HIV-Negative Gay Men Need Condoms if They're on PrEP? Here's What I Tell My Patients

Published: November 15, 2014

The Body
Howard Grossman, M.D.
Original Article:

Those of you who have read my blog know that I am on pre-exposure prophylaxis (PrEP) to reduce my risk for HIV infection. And more and more of my patients are also beginning to take Truvada (a pill combining the antiretroviral drugs tenofovir and emtricitabine) as PrEP to prevent HIV infection. And all of my patients are asking me what my recommendations are for condom use in light of the data on PrEP.

If you ask most clinicians, researchers and public health officials, the usual answer is: "Well, you should continue to use condoms because, of course, Truvada does not protect against STIs (sexually transmitted infections)."


Let’s face the fact that everyone hates condoms! We hear a lot about gay men not using condoms these days, but how many heterosexual men are using them if their female partners are on birth control? Are doctors counseling that all of their straight patients need to use a condom every time in every situation, now and forever? You know they’re not. But that’s the only message we’ve had for gay men for a long time. It’s a message that was vital in the days when we had no other tools, had unreliable testing and did not understand transmission well. It’s a message that saved countless lives. But now it’s a message that pathologizes gay sex and fails to recognize that people are making reasonable and rational choices about risk. Now we have PrEP and treatment as prevention (TasP).

People want to know if using PrEP could actually allow them to go without condoms. They are looking to their doctors for guidance. If we sidestep the question by talking about STIs, then we leave people fumbling around to find their own way. PrEP opens the door to talking about situations where the risk of HIV infection will be so low that perhaps going without condoms is a reasonable choice. I will share with you the guidance I give my patients.

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