Will PrEP take away people’s motivation to maintain safer sex practices?

One question is whether people who use condoms regularly will stop using them when taking PrEP. In studies of PrEP so far, this hasn’t occurred. In fact, in at least two large studies people’s risk behavior declined over time and stayed that way throughout the study. Participants in these studies received regular risk-reduction counseling and HIV testing. They were also counseled that Truvada had no known protective effect, and that they might actually be receiving a placebo (dummy pill), which has no protective effect.

We don’t know if PrEP will increase or decrease sexual risks outside of a formal study. In studies so far people didn’t know whether they were taking an active drug or a placebo and they also didn’t know whether PrEP really worked. In the “real world” people will know they are taking a pill that provides protection from infection. This could affect how they think about the risks they take.

A number of studies examining how best to use PrEP in community settings (called demonstration projects) are either planned or underway to explore risk taking and a number of other factors related to PrEP. These studies may help us understand if people using PrEP take greater sexual risks. We recommend strongly that providers who prescribe PrEP outside of a study offer HIV risk-reduction counseling and condoms to their patients and that people taking PrEP discuss their sexual behavior and their condom use with their providers on a regular basis to determine whether PrEP is leading them to take greater risks.

People working on PrEP and other prevention tools don’t see this promising new tool as a replacement for other effective interventions, such as consistent condom use. However, for individuals who simply can’t or won’t use condoms, correct use of PrEP is better than nothing at all. There is much to be learned, and the demonstration projects will help teach us what we need to know in order to address this important consideration and others.

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