Condoms are inadeguate (CONDOMS VERSUS PrEP FOR HIV PREVENTION, 2010)

Question

Condoms are inadeguate and after decades of experience we should know that very well. They aren't the perfect tool of protection. They occasionally slip, broke and even if not important for a purely medical and preventive point of view they steel the total feeling of intimacy between 2 individuals and that the basic reason why the majority of people don't use them. More successful approaches are needed soon. There's an increasing number of researchers and doctors convinced now that PrEP combined with an undetectable viral load of the infected person provide the same protection of effective condom use and people would be more willing to follow this sort of prevention than condom use. Condoms may have slow the rate of new infections but their use is still lacking considerably. Make sex with a condom is like eating tasteless food. I understand that you prefer holding a more conservative approach in prevention since you continue to ignore the swiss statement and the last PrEP approaches but this HAART as prevention is the future HIV prevention. Several studies are leading in this direction. What is your actual point of view of this approaches? Do you still consider condoms the best way to halt the new infections?

Answer

Hi,

Condoms are "inadeguate"? Inadeguate???

You are correct that condoms are not "the perfect tool of protection." However, they are still the very best tool we have to prevent STDs, including HIV. HIV cannot permeate intact latex. No way. No how. However, as you mention, condoms are not always used properly. This decreases their effectiveness in the real world.

Your comments that PrEP combined with an undetectable viral load in the poz partner provides the same level of protection as proper condom use is not accurate. HIV plasma viral loads can change suddenly due to blips, vaccines, intercurrent common infections (colds, flus, sinus infections, etc.), medication non-adherence and the development of drug resistance. Also, the viral load in the ejaculate or rectal fluids may not be the same as that measured in the blood. In addition, PrEP does not protect against all the other STDs. I understand you and many others don't like using condoms. However, I can assure you you'll dislike having HIV/AIDS much, much more. I've recently written a blog that addresses common condom conundrums. It will be posted on the blog page of this site soon. It addresses your concern about decreased sensitivity and intimacy.

My opinions on HIV prevention are far from conservative and I have not ignored the Swiss Study. Rather, my statements are supported by sound scientific facts. You have misinterpreted the results of the Swiss Study. Do I still consider condoms the best way to halt new STDs, including HIV? Absofrickenlutely!

Be safe. Be well.

Dr. Bob