April 11, 2019

Newly released research published by Traeger, Cornelisse, Asselin, et al in JAMA showed that “among gay and bisexual men using PrEP, STIs were highly concentrated among a subset, and receipt of PrEP after study enrollment was associated with an increased incidence of STIs compared with pre-enrollment.” They concluded that “these findings highlight the importance of frequent STI testing among gay and bisexual men using PrEP.” These rising STI acquisition rates certainly signal an urgent need to promote and provide easy access to STI education, prevention and treatment.

However, in the same JAMA issue, an editorial by Gandhi, Spinelli and Mayer, points out the linkage between the above findings and the data verifying that HIV can’t be transmitted by someone living with an undetectable HIV viral load. In other, more familiar terminology, Undetectable = Untransmittable.

The Traeger study confirms that PrEP delivers protection in the other direction, enabling HIV negative people to block their acquisition of HIV. The fact that a subset of participants in the trial experienced increased acquisition of other STIs during the study confirms that they were having condom-less sex with partners who may or may not have been living with HIV. Their consistent use of PrEP protected them from HIV per se but left them vulnerable to other STIs.

This is both clinically and politically significant. This evidence demonstrates that antiretrovirals can block transmission in BOTH directions. Therefore, the burden of protection can no longer rest wholly on the shoulders of the partner living with HIV, a fact that strengthens the argument against HIV criminalization. Current laws put all the responsibility for controlling HIV transmission on the person living with HIV. Now we know that HIV-negative people who choose to have sex with someone of unknown HIV status are capable of protecting themselves from possible HIV exposure by using PrEP.

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