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Are Condoms Over? Cont A QUARTERLY JOURNAL ON HIV PREVENTION, TREATMENT AND POLITICS VOLUME 7, NO. 2 acHIeVe INSIDE HEPATITIS C: A RISK FOR GAY Are MEN 7 Among gay men with HIV, sex appears to be an increasingly Condoms common means of hepatitis C transmission. Personal Perspective: Over? MY SECRET LIFE 12 When I asked for an HIV test, the nurse said this wouldn’t have happened had I “been following God’s will.” LATINO MSM: IDENTIFYING NEEDS, Research and Reality ELIMINATING BARRIERS 14 In the past twenty for Gay Men years, HIV rates among Latino MSM have consistently HIV education, gay men get almost all by Mark Milano increased. their info about safer sex online. It is perhaps due to this that misinformation ““Condoms are over. Everyone knows they Personal Perspective: about HIV transmission is something I don’t work for gay sex. If you use them, UNDOCUMENTED AND UNSURE 17 regularly encounter in the workshops I you’re naïve.” My undocumented friends see HIV as give at ACRIA. For example, at a recent the least of their worries. “Condoms were for all the AIDS guys workshop on HIV prevention, one par- 30 years ago.” ticipant put oral sex without a condom THE UNENDING “The reason there were so many more in the highest risk category, even though PARADOX 19 gay AIDS cases than straight ones in it’s actually a very low-risk activity. Many Why Are HIV the ’80s and ’90s is that both gays and similar statements have convinced me Rates Higher in straights used condoms, but they broke that we need to relaunch in-person or Black MSM? much more for gay men.” online interactive safer sex workshops, especially for gay men. “There’s no point in using condoms But where has the lack of faith in con- A LOST GEM: because they will break 50% of the time. doms come from? Since I began working VICTOR POND 21 They’re more trouble than they’re worth.” as an HIV educator in the late ’80s, I have Victor was senselessly robbed of his life hese are all direct quotes captured always taught that correct and consistent by despicable, selfish, raging idiots. a few months ago by longtime gay condom use was over 98% effective in pre- activist Rebecca Reinhardt at a venting HIV transmission, based on CDC EDITORIAL 23 West Hollywood gathering of gay statements. Had I been wrong all those collegeT alumni in their 20s and 30s. years? Is there really a big difference in the Achieve is a publication of I was disappointed but not shocked effectiveness of condoms for vaginal vs. when she posted these quotes online. anal sex? I decided to look at some of the Since the steep decrease of in-person claims and the data. continued on next page Are Condoms Over? cont. from previous page years ago that I had HIV, would you have kept seeing me if you thought that con- HI V PrEP vs. Condoms doms were only 70% effective?” He said ac e e One of the first things I encountered was there was a strong chance he wouldn’t condom-bashing from PrEP advocates. have. My reassurances that condoms Now, I think PrEP (taking Truvada to would protect him allowed him to be with EDITOR IN ChiEF prevent HIV infection) is an important Benjamin Bashein his first HIV-positive partner. option and should be made available to all So if gay men become convinced that EDITOR who need it. Regardless of how well con- condoms offer only partial protection, Mark Milano doms work, it’s clear that many gay men will those who aren’t taking PrEP become ASSOCIATE EDITOR aren’t using them and that more preven- afraid to have sex with poz guys? And if Joseph Lunievicz tion options are badly needed. condoms fail so often, how has my boy- But do we need to bash condoms in friend remained negative all these years MEDICAL EDITOR order to promote PrEP? One PrEP advo- without PrEP? We use a condom every Jerome A. Ernst, MD cate created a graph showing that PrEP time and haven’t had one break. Are we PUBLICATIONS MANAGER was 99% effective but that, according to really that far outside the norm? Let’s take Mark Milano the CDC, condoms were only 70% effec- a look at the data. tive. Really? The data I’ve seen on PrEP PUBLICATIONS ASSOCiaTE shows proven effectiveness of around Laura Engle The 70% Study 92% (the 99% number is a mathemati- For years, most of the data around condom cal model that needs more research), and effectiveness came from studies of hetero- that was in studies in which people also sexuals. In my workshops, I often cite a used condoms. But since the 99% figure is 1994 study by the European Study Group For information on how to obtain being used everywhere, I can see why a gay on Heterosexual Transmission of HIV. It bulk copies of Achieve, call man might abandon condoms for PrEP – found no HIV transmissions among 124 212-924-3934, ext. 134, email who would take a 30% risk with condoms serodiscordant couples (one partner with [email protected], or write to when a pill could lower it to 1%? HIV, one without) who reported using a Achieve I also wonder what effect this could condom every time. That was powerful evi- 575 Eighth Ave, Suite 502 have on HIV-positive gay men. I recently dence of the effectiveness of condoms, long New York, NY 10018. asked my boyfriend, “When I told you 12 before PrEP was available. Copyright © 2015 AIDS The Robert Mapplethorpe Community Research Initiative of America. Clinical Research Program All rights reserved. Non- commercial reproduction is encour- BMS-663068 Ibalizumab aged provided appropriate credit People with HIV who are 18 and older People with HIV will receive infusions is given. Subscription lists are kept will take BMS-663068 (an experi- of ibalizumab (a monoclonal antibody) confidential. mental HIV attachment inhibitor) or to study its safety and effect on the Photos used in Achieve imply noth- Reyataz for up to 96 weeks. Everyone immune system. will also take Isentress and Viread. ing about the health status, sexual Selzentry orientation, or life history of the Sovaldi People with HIV who are 18 and older models. ACRIA will review the medical charts and who have not taken HIV meds Every “Personal Perspective” in of 100 people with HIV who took will take either Selzentry or Truvada Achieve contains the views and Sovaldi for HCV and 99 people with for 22 months. Everyone will also take opinions of the attributed author HIV who took peg-interferon and Prezista with Norvir. and does not necessarily represent ribavirin, to analyze health resource the views and opinions of ACRIA. utilization in the year before treatment and the year after treatment. For more information on these studies, contact us at 212-924-3934, ext. 100. ISSN 1948-0687 (print) Compensation is available for some ISSN 2165-4883 (online) studies. 2 VOL. 7, NO. 2 acHIeVe But that was heterosexuals in 1994. ineffective condoms were. But those stud- people who report that they never use con- What about gay men today? Do condoms ies included people who were given con- doms, there are 70% fewer HIV infections offer the same level of protection for anal doms and never used them. Smith was among those who report they always used sex as for vaginal sex? To answer that saying that even when people said they a condom. So our best estimate of condom question, Dawn Smith of the CDC did an used condoms every time, they offered effectiveness for anal sex is 70%. analysis of two studies from the late ’90s only 70% protection for anal sex. Since But why do other studies of condom of HIV-negative MSM (men who have sex her study was well done and carried great failure have rates that are so much lower? with men). (The study includes this dis- weight, I arranged an interview to ask her Our study could include cases where the claimer: “The findings and conclusions in to address how the results were being mis- condom slipped or broke and the users were this report are those of the authors and do interpreted. Here are some quotes from not aware of it. Nothing in life is 100%. not necessarily represent the official posi- our talk. It’s not surprising to me that we don’t find tion of the CDC.”) Do we need to bash condoms in order to promote PrEP? One PrEP advocate created a graph showing that PrEP was 99% effective but that, according to the CDC, condoms were only 70% effective. Really? Dr. Smith, your study is being cited 100% protection from this or any other all over the web as “The CDC reports intervention. Smith looked at 4,492 MSM enrolled that using a condom every time for anal I’m just trying to respond to people in an HIV vaccine trial, VAX 004. In that sex is only 70% effective.” Is that what who say your study shows condom fail- study, 48% reported anal sex with an HIV- you meant to say? ure rates of 30%. positive partner during the study, and 7% It is correct that in our analysis, when Then you’re talking to the wrong person. acquired HIV infection. She also looked condoms were reported to be used 100% We never used the number 30%. If some- at 3,233 MSM from Project EXPLORE, of the time for anal sex, they were 70% body out there is using that number, you a behavioral intervention study.
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