How Well Do Condoms and PrEP Prevent HIV Among Gay and Bi Men?

Benjamin Ryan
Original Article:

Since the early years of the AIDS epidemic, gay and bisexual men seeking to lower their risk of contracting HIV during intercourse have relied on condoms for protection. So it may come as a surprise that scientists only recently conducted a truly rigorous analysis to estimate how well condoms work among men who have sex with men (MSM) in the United States. And it may come as a further surprise, given how the ultimate estimate of condoms’ success rate has since been accepted as a solid or near-solid fact by numerous press reports and among the chattering classes, that this figure is still clouded by statistical uncertainty—and probably will always remain something of an enigma.

At the 2013 Conference on Retroviruses and Opportunistic Infections (CROI), Dawn K. Smith, MD, MPH, an epidemiologist at the Centers for Disease Control and Prevention, presented results of research she and CDC colleagues conducted about the effectiveness of condoms among MSM. (“Effectiveness” is synonymous with condoms’ success rate, or how well they reduce HIV risk.) Those MSM who always use condoms, she reported, have a 70 percent lower risk of HIV than those who always bareback.

To condom devotees, this figure may seem alarmingly low, even farfetched. If nothing else, 70 percent is quite a drop in effectiveness when compared with studies showing that latex is a nearly impermeable barrier to HIV, and that condoms’ HIV protection rate is in the high 90 percent range—in an ideal laboratory setting, that is. Real-life safer sex is considerably more complex.

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