HIV pre‐exposure prophylaxis and the ‘problems’ of reduced condom use and sexually transmitted infections in Australia: a critical analysis from an evidence‐making intervention perspective

• Published in: Sociology of health & illness Vol. 41; no. 8; pp. 1535 - 1548
• Main Authors: Holt, Martin, Newman, Christy E., Lancaster, Kari, Smith, Anthony K., Hughes, Shana, Truong, Hong‐Ha M.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.11.2019
• Subjects: Adult; Antibiotics; Australia - epidemiology; Clinical skills; Condom use; Condoms; Epidemiology; Female; HIV; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV prevention; HIV pre‐exposure prophylaxis; Human immunodeficiency virus; Humans; Infections; Interest groups; Interviews as Topic; Male; Middle Aged; Observation; Optimism; Personal experiences; Policy analysis; Poststructural policy analysis; Poststructuralism; Pre-Exposure Prophylaxis; Prevention; Prevention programs; Preventive medicine; Problematisation; Qualitative Research; Resistance; Sexual and Gender Minorities; Sexually transmitted diseases; Sexually Transmitted Diseases - epidemiology; Sexually transmitted infections; STD; Australia; Condom use; Poststructural policy analysis; HIV pre-exposure prophylaxis; HIV prevention; Problematisation; Sexually transmitted infections
• ISSN: 0141-9889; 1467-9566
• DOI: 10.1111/1467-9566.12967

HIV pre‐exposure prophylaxis (PrEP) has been embraced in Australia, making PrEP available with public funding to people at risk of HIV. Here, we consider the associated ‘problems’ of reduced condom use and sexually transmissible infections (STIs), as seen by HIV professionals. Twenty‐one interviews were conducted during May‐August 2017. All agreed that PrEP was a valuable addition to HIV prevention, but their views about reduced condom use and STIs were variable. Using poststructural policy analysis, three main stances were identified: (1) Concerned/alarmed. PrEP was seen as causing reduced condom use, STIs and antibiotic resistance, posing threats to the general population; (2) Neutral/normalising. Stakeholders emphasised that condom use was declining and STIs increasing independently of PrEP, and that PrEP was simply a new tool to be accommodated; (3) Optimistic/critical. PrEP was seen as diminishing fear of HIV and engaging users in more frequent testing and treatment that could lead to declining STI rates. What linked all three stances was the selective performance of evidence, deploying a mixture of personal experience, clinical observations, behavioural data and epidemiology. Anticipating possible futures through evidence‐making suggested practical, political and moral consequences for what PrEP could become. We encourage others to consider these consequences with care.