Words by Matthew Hodson - @Matthew_Hodson


Condom use has gone down.

The latest data suggests 60% of gay men in London have had sex without condoms at least once in the last three months (and it may not be the case that the other 40% always used condoms, it’s possible that they didn’t have any sex). This fall isn’t really news. Condom use has been steadily falling since the introduction of effective HIV treatment in 1996.

Much has been made of the impact of PrEP on  condom use and rising rates of STIs but it’s  challenging to isolate evidence that tells you what STI rates would be if there wasn’t PrEP. We’ve seen STI increases among heterosexuals too, whose PrEP use is currently insignificant.

I struggle to understand gay men who oppose PrEP. I have no problem at all with gay men who choose not to use PrEP. I appreciate the added security that condoms provide against other STIs. I sympathise with the desire to reduce as much as you can the amount of medicines you take. I applaud people whose sex life means that any HIV acquisition risk is negligible. There are lots of good reasons not to choose PrEP as your HIV prevention strategy, but these don’t add up to a good reason to oppose it.

In an era of PrEP, when people with diagnosed HIV on treatment no longer pose any risk of HIV transmission, the avoidance of STIs is one good reason to maintain condom use. For some, the prospect of sex with someone, especially a new partner, without condoms and with the risk of STIs, is anathema. For others though, STIs are just a price that they are willing to pay for having the condom-free sex that they desire. You may disagree with that cost/benefit analysis, your own choices may be different, but that doesn’t render that decision invalid.

I believe that some who are concerned about sexual health generally have become accustomed to riding on the fear engendered by HIV. The virus has been used by some as a method of social control, telling people what kinds of sex are acceptable and condemning those who stray from the path of sexual righteousness. Gay men who have grown up inculcated with a dread of HIV may be hard to convince that other STIs are a sufficient cause for concern.

I have heard the complaint from some of those who oppose PrEP, that they face sexual rejection due to their insistence on condom use. I totally understand how frustrating this may be, if condoms are your preferred way of avoiding HIV and other STIs. I’m certain that there are enough men for whom condom use is important for them to hold on to hopes of finding each other. At the same time, I relate to how galling it must be to see your sexual possibilities diminish over time.

Gay men aren’t always good at being kind to each other. You see this exhibited in our bars and clubs, and even more so on dating apps. Sexual rejection on the basis of race, age, body shape, hair colour, HIV status, masculinity (or the lack of it) is commonplace. Most of us have some sexual preferences that we find appealing, and there’s no harm in that. Where the harm arises is when these preferences are expressed callously or cruelly.

Our sexual preferences and the risks that we are willing to take vary from person to person. Nobody deserves to be scorned for their appearance or HIV status. People who choose to use PrEP should be respected, just as people who choose to use condoms. Different ways of preventing HIV have different benefits and drawbacks. Let’s ensure that we discuss effectiveness and support choice. Condoms are great, I support condom use and people who choose to use them, but I do not accept that they are morally superior.  


Matthew Hodson is the Executive Director of NAM/aidsmap. Visit www.aidsmap.com.


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