There has been a long-term decline in condom use by American gay men, researchers from the Centers for Disease Control and Prevention (CDC) report in AIDS. Similar declines have been seen in men whose sexual partners were of the same HIV status and in men who did not know their sexual partners’ HIV status – showing that the fall in condom use cannot be explained by serosorting or other seroadaptive behaviours.

Researchers involved with the study didn’t want to only assess the trend of condom usage, they also wanted to see if the decline in condom use had anything to do with any or all of three possible factors. Serosorting is the practice some people use to distinguish sexual encounters by the other person’s HIV status. Seropositioning is when gay men try to decrease their chances of getting HIV by strategically choosing sexual positions. Pre-Exposure Prophylaxis (PrEP) use has also been considered because its prescription rate has increased. However, the data suggest that condom usage began to fall in 2005, which is long before PrEP became available. 

Between 1,100 and 1,600 men who have sex with men (MSM) took part in the survey during each year that data were collected (2005, 2008, 2011 and 2014 in 21 different American cities). The research team tried to collect data from people with different socioeconomic backgrounds, and by recruiting men at bars, clubs, businesses and various social organizations.

The data show an increasing trend of the decline of condom usage. The greatest increase in sex without condoms was seen in young men, aged 18 to 24. In 2005, 28.7% of HIV-negative men reported sex without a condom, rising to 32.8% in 2008, 34.7% in 2011 and 40.5% in 2014. Condomless sex with a partner who was believed to be HIV-negative rose from 21.2% to 27.4%.

PrEP use was only reported by 0.5% of men enrolled in the study in 2011, and by 3.5% of men in 2014, which makes PrEP the unlikely factor to have contributed to the decrease in condom use.

According to the researchers, the data suggest that condom use has decreased among men and that the trend cannot be explained by serosorting, seropositioning or because of an increased use in PrEP treatment. The report offers no indication as to why condom usage has been on the decline, but that the findings corroborate previous reports of increases in condomless sex among MSM in the United States.

This increase in condomless sex among MSM was highest among the youngest age group, which also has the greatest increase in the number of new HIV infections. The study suggests that men may perceive themselves and their partners to be HIV-negative, but many men who are HIV-positive are not aware of their infection.

The study also notes that similar increases in condomless sex have been reported from other developed countries. Mathematical modeling from the United Kingdom and the Netherlands suggests that reductions in new HIV cases due to ART and earlier HIV diagnosis have been offset by increases in condomless sex.

"Our data suggests that condom use has decreased among MSM and that the trends are not explained by serosorting, seropositioning, PrEP use or HIV treatment,” the researchers conclude.

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