Maziarz, Lauren

English

OSU Libraries Digital Journal Publishing (Ohio State University)

1ojph.org Ohio Public Health AssociationLETTER/OP-EDPrEP and condom use: A tale of unintended consequences?Lauren Maziarz11Assistant Professor, Bowling Green State University, OHCorresponding Author: Lauren Maziarz • 120 Health and Human Services Bldg • Bowling Green, OH • (419) 372-7725 • lmaziar@bgsu.edu Last year marked the 4th consecutive record year for new cases of sexually transmitted diseases (STDs) in the United States, with 2.3 million diagnosed cases of chlamydia, gonorrhea, and syphilis.1 Ohio continues to have one of the highest prevalence of STDs, ranking 14th in reported chlamydia cases and 11th in reported gonorrhea cases in 2016.2 Gonorrhea is of particular concern to public health professionals, as the prevalence of antibiotic resistant strains has increased significantly over the last 20 years.3 The mainstays of STD prevention continue to include barrier protection (e.g., latex condoms and dental dams), and yet condom use remains low with only 23.8% of women and 33.7% of men wearing condoms at their last sexual encounter in the past 12 months.4 To be fair, persuading people to use condoms has never been easy but the stakes are getting even higher as our treatment options dwindle. Public health professionals protect the health of the public, which can at times include assessing the inadvertent outcomes of medical progress. One example of an important biomedical breakthrough in the area of human immunodeficiency virus (HIV) prevention is PrEP, short for pre-exposure prophylaxis, which is a daily oral medication used to prevent the acquisition of HIV in high-risk individuals. When taken consistently, PrEP reduces the risk of HIV acquisition by as much as 90%, and is even more effective when used with other prevention methods, such as condoms.5 Among men who have sex with men (MSM), the highest-risk pop-ulation for HIV, reducing the fear of HIV through PrEP has the po-tential to increase risky sexual behavior, such as condomless sex. In a 2018 systematic review of PrEP use and sexual behavior in MSM, researchers found an increase in self-reported condomless sex among PrEP users in some, but not all, of the studies included for review.6 These findings speak to the theory of risk compen-sation, whereby individuals adjust their behaviors in response to perceived level of risk. As other researchers have also noted, as we continue to take perceived risk of HIV out of the equation we may be losing ground on prevention of other STDs. 7,8 Of course we cannot determine why new cases of STDs continue to increase without adequate funding and attention from Con-gress. Funding for STD prevention programs supported by the Centers for Disease Control and Prevention has decreased 50% over the last 15 years.9 We are left dealing with the consequenc-es of an area of public health left underfunded and ignored. The research is not yet clear what effect, if any, PrEP has on condom use and risk compensation, especially for high-risk populations other than MSM, but there is a growing consensus among public health professionals that increased rates of STDs are an unintend-ed consequence of an important medical innovation. 6,7,8 Public health professionals, as well as PrEP users, must now decide if the benefit of PrEP, a lifesaving drug, outweighs the costs of acquiring other less harmful STDs, many of which are routinely screened for and easily treated with well-tolerated antibiotics. The cost-benefit ratio is delicate but having access to adequate STD services is an essential step in preventing further morbidity. Ohio’s public health community should demand support for STD prevention, screening, and treatment from the state legislature, especially as STDs continue to reach record highs. REFERENCES1. Centers for Disease Control and Prevention. New CDC analysis shows steep and sustained increases in STDs in recent years. https://www.cdc.gov/nchhstp/newsroom/2018/press-release-2018-std-prevention-con-ference.html. Accessed October 8, 2018. 2. Centers for Disease Control and Prevention. 2016 Sexually Transmitted Diseases Surveillance. https://www.cdc.gov/std/stats16/tables.htm. Accessed September 12, 2018.3. Centers for Disease Control and Prevention. Antibiotic-Resistant Gon-orrhea. https://www.cdc.gov/std/gonorrhea/arg/default.htm. Accessed October 18, 2018.4. Copen, CE. Condom use during sexual intercourse among women and men aged 15-44 in the United States: 2011-2015 National survey of fami-ly growth. National Health Statistics Reports. 2017; 105:1-17.  5. Centers for Disease Control and Prevention. Pre-Exposure Prophylaxis (PrEP). https://www.cdc.gov/hiv/risk/prep/index.html. Accessed Sep-tember 12, 2018.6. Traeger MW, Schroeder SE, Wright EJ, et al. Effects of pre-exposure prophylaxis for the prevention of human immunodeficiency virus infection on sexual risk behavior in men who have sex with men: A sys-tematic review and meta-analysis. Clin Infect Dis. 2018; 67(5):676-686. Accessed September 12, 2018.7. Kojima, N., Davey, JD, Klauser, JD. Pre-exposure prophylaxis for human immunodeficiency virus and sexually transmitted infection acquisition among men who have sex with men. AIDS. 2016; 10(14):2251-2. 8. Chen, YH, Guigaymona, J, McFarland, W, Snowden, JM, Raymond, HF. Increases in pre-exposure prophylaxis use and decreases in condom use: Behavioral patterns among HIV-negative San-Francisco Men who have sex with men, 2004-2017 [published online ahead of print Octo-ber 10, 2018]. AIDS Behav. doi:10.1007/s10461-018-2299-7.9. National Coalition of STD Directors. Impact of cuts to federal STD prevention funding. Accessed October 18, 2018. http://www.nmac.org/wp-content/uploads/2017/07/Impact-of-Proposed-Budget-Cuts-on-STDS.pdfOhio Journal of Public Health, November 2018, Vol. 1, No. 1 ISSN: 2578-6180© Lauren Maziarz. Originally published in the Ohio Journal of Public Health (https://ohiopha.org/ojph/) November, 2018. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivatives License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work (“first published in the Ohio Journal of Public Health...”) is properly cited with original URL and bibliographic citation information. The complete bibliographic information, a link to the original publication on https://ohiopha.org/ojph/, as well as this copyright and license information must be included.

PrEP and condom use: A tale of unintended consequences?

Bowling Green State University: ScholarWorks@BGSU

Bowling Green State University ScholarWorks@BGSU Public and Allied Health Faculty Publications College of Health and Human Services 11-1-2018 PrEP and condom use: A tale of unintended consequences? Lauren Maziarz Bowling Green State University, lmaziar@bgsu.edu Follow this and additional works at: https://scholarworks.bgsu.edu/publ_allied_health_pub How does access to this work benefit you? Let us know! Repository Citation Maziarz, Lauren, "PrEP and condom use: A tale of unintended consequences?" (2018). Public and Allied Health Faculty Publications. 36. https://scholarworks.bgsu.edu/publ_allied_health_pub/36 This work is licensed under a Creative Commons Attribution 4.0 International License. This Other is brought to you for free and open access by the College of Health and Human Services at ScholarWorks@BGSU. It has been accepted for inclusion in Public and Allied Health Faculty Publications by an authorized administrator of ScholarWorks@BGSU. 1ojph.org Ohio Public Health AssociationLETTER/OP-EDPrEP and condom use: A tale of unintended consequences?Lauren Maziarz11Assistant Professor, Bowling Green State University, OHCorresponding Author: Lauren Maziarz • 120 Health and Human Services Bldg • Bowling Green, OH • (419) 372-7725 • lmaziar@bgsu.edu Last year marked the 4th consecutive record year for new cases of sexually transmitted diseases (STDs) in the United States, with 2.3 million diagnosed cases of chlamydia, gonorrhea, and syphilis.1 Ohio continues to have one of the highest prevalence of STDs, ranking 14th in reported chlamydia cases and 11th in reported gonorrhea cases in 2016.2 Gonorrhea is of particular concern to public health professionals, as the prevalence of antibiotic resistant strains has increased significantly over the last 20 years.3 The mainstays of STD prevention continue to include barrier protection (e.g., latex condoms and dental dams), and yet condom use remains low with only 23.8% of women and 33.7% of men wearing condoms at their last sexual encounter in the past 12 months.4 To be fair, persuading people to use condoms has never been easy but the stakes are getting even higher as our treatment options dwindle. Public health professionals protect the health of the public, which can at times include assessing the inadvertent outcomes of medical progress. One example of an important biomedical breakthrough in the area of human immunodeficiency virus (HIV) prevention is PrEP, short for pre-exposure prophylaxis, which is a daily oral medication used to prevent the acquisition of HIV in high-risk individuals. When taken consistently, PrEP reduces the risk of HIV acquisition by as much as 90%, and is even more effective when used with other prevention methods, such as condoms.5 Among men who have sex with men (MSM), the highest-risk pop-ulation for HIV, reducing the fear of HIV through PrEP has the po-tential to increase risky sexual behavior, such as condomless sex. In a 2018 systematic review of PrEP use and sexual behavior in MSM, researchers found an increase in self-reported condomless sex among PrEP users in some, but not all, of the studies included for review.6 These findings speak to the theory of risk compen-sation, whereby individuals adjust their behaviors in response to perceived level of risk. As other researchers have also noted, as we continue to take perceived risk of HIV out of the equation we may be losing ground on prevention of other STDs. 7,8 Of course we cannot determine why new cases of STDs continue to increase without adequate funding and attention from Con-gress. Funding for STD prevention programs supported by the Centers for Disease Control and Prevention has decreased 50% over the last 15 years.9 We are left dealing with the consequenc-es of an area of public health left underfunded and ignored. The research is not yet clear what effect, if any, PrEP has on condom use and risk compensation, especially for high-risk populations other than MSM, but there is a growing consensus among public health professionals that increased rates of STDs are an unintend-ed consequence of an important medical innovation. 6,7,8 Public health professionals, as well as PrEP users, must now decide if the benefit of PrEP, a lifesaving drug, outweighs the costs of acquiring other less harmful STDs, many of which are routinely screened for and easily treated with well-tolerated antibiotics. The cost-benefit ratio is delicate but having access to adequate STD services is an essential step in preventing further morbidity. Ohio’s public health community should demand support for STD prevention, screening, and treatment from the state legislature, especially as STDs continue to reach record highs. REFERENCES1. Centers for Disease Control and Prevention. New CDC analysis shows steep and sustained increases in STDs in recent years. https://www.cdc.gov/nchhstp/newsroom/2018/press-release-2018-std-prevention-con-ference.html. Accessed October 8, 2018. 2. Centers for Disease Control and Prevention. 2016 Sexually Transmitted Diseases Surveillance. https://www.cdc.gov/std/stats16/tables.htm. Accessed September 12, 2018.3. Centers for Disease Control and Prevention. Antibiotic-Resistant Gon-orrhea. https://www.cdc.gov/std/gonorrhea/arg/default.htm. Accessed October 18, 2018.4. Copen, CE. Condom use during sexual intercourse among women and men aged 15-44 in the United States: 2011-2015 National survey of fami-ly growth. National Health Statistics Reports. 2017; 105:1-17.  5. Centers for Disease Control and Prevention. Pre-Exposure Prophylaxis (PrEP). https://www.cdc.gov/hiv/risk/prep/index.html. Accessed Sep-tember 12, 2018.6. Traeger MW, Schroeder SE, Wright EJ, et al. Effects of pre-exposure prophylaxis for the prevention of human immunodeficiency virus infection on sexual risk behavior in men who have sex with men: A sys-tematic review and meta-analysis. Clin Infect Dis. 2018; 67(5):676-686. Accessed September 12, 2018.7. Kojima, N., Davey, JD, Klauser, JD. Pre-exposure prophylaxis for human immunodeficiency virus and sexually transmitted infection acquisition among men who have sex with men. AIDS. 2016; 10(14):2251-2. 8. Chen, YH, Guigaymona, J, McFarland, W, Snowden, JM, Raymond, HF. Increases in pre-exposure prophylaxis use and decreases in condom use: Behavioral patterns among HIV-negative San-Francisco Men who have sex with men, 2004-2017 [published online ahead of print Octo-ber 10, 2018]. AIDS Behav. doi:10.1007/s10461-018-2299-7.9. National Coalition of STD Directors. Impact of cuts to federal STD prevention funding. Accessed October 18, 2018. http://www.nmac.org/wp-content/uploads/2017/07/Impact-of-Proposed-Budget-Cuts-on-STDS.pdfOhio Journal of Public Health, November 2018, Vol. 1, No. 1 ISSN: 2578-6180© Lauren Maziarz. Originally published in the Ohio Journal of Public Health (https://ohiopha.org/ojph/) November, 2018. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivatives License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work (“first published in the Ohio Journal of Public Health...”) is properly cited with original URL and bibliographic citation information. The complete bibliographic information, a link to the original publication on https://ohiopha.org/ojph/, as well as this copyright and license information must be included.

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PrEP and condom use: A tale of unintended consequences?

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