Men use condoms less even as syphilis and other STDs rise

Men use condoms less even as syphilis and other STDs rise


The basket of free ultra-thin, studded condoms remained full to the brim — a recurring reality that no longer surprised DC health workers this month offering an HIV test in a downtown plaza.

Public health authorities are facing a rise in sexually transmitted infections in a world where condom use has steadily declined – and, with it, one of the most effective ways to curb the spread of the disease.

They’ll laugh about it, or sometimes they’ll get it and throw it away,” said Kevins Anglade, a community outreach worker for Whitman-Walker Health, a DC-based LGBT healthcare organization that opened in the 1970s. under the name Gay Men’s. Venereal disease clinic. “It’s a new normal, which is very sad.”

The United States recorded nearly 2.5 million cases of chlamydia, gonorrhea and syphilis in 2021, more than doubled over the past two decades, according to preliminary data of centers for disease control and prevention.

About half of new infections last year were among young people between the ages of 15 and 24. Men who have sex with men acquire infections at higher rates than heterosexuals because they are more likely to have multiple recent partners and it is easier for sexually transmitted diseases (STDs) to circulate in networks fewer people.

Condoms, once central to STD eradication campaigns at the height of the AIDS crisis, have become harder to sell due to medical advances such as long-acting contraception and drugs that dramatically reduce transmission of HIV.

Federal family planning surveys show that condoms have gone from being the main contraceptive tool for 75% of men in 2011 to 42% of men in 2021. annual report.

Several studies found an increase in unprotected sex among men who have sex with men. The percentage of high school students who said they used a condom the last time they had sex rose from 63% in 2003 to 54% in 2019, according to an annual government survey.

“Historically, young people who have used condoms have been largely scared off by the threat of HIV or unwanted pregnancy,” said David Harvey, executive director of the National Coalition of STD Directors. “They now have more options to prevent these things.”

Scientists recently discovered that people with HIV cannot spread the virus if they adhere to treatment that lowers their viral load, prompting a campaign known as ‘undetectable = untransmittable’ to focus on treatment as form of prevention.

The advent of daily pills and injectable drugs taken as pre-exposure prophylaxis, known as PrEP, to prevent HIV infection has also allowed people to have sex without a condom at considerably greater risk. weak from contracting HIV, while leaving them vulnerable to other diseases that are spread through fluids and skin-to-skin contact.

Health officials grapple with the perception that syphilis, chlamydia, and gonorrhea are treatable nuisances, even though those infected risk lasting complications, including infertility and organ damage.

John Guggenmos, a longtime owner of DC’s gay bars, said condoms have gone from a staple item in his establishments to largely out of sight because patrons prefer PrEP to prevent HIV.

“It was a staple in the ’90s: you had vodka behind the bar and condoms outside the front door,” Guggenmos said. “Now they’re just not used, they get knocked over, so we just stopped. There are some behind the bar, but who’s going to ask a bartender for them?

If PrEP causes an increase in other sexually transmitted infections is a controversial issue among researchers. Studies show that PrEP users are less likely to use condoms, but also undergo mandatory regular STI testing to receive the medicine.

” In obtaining diagnosed and treated soon after getting the infection, they become less likely to pass it on to others,” said Zandt Bryan, who leads STI prevention for the Washington State Department of Health.

Some experts say racial and income disparities in PrEP use also accentuate the need to promote condoms as a solution, especially among high school and college students who still have their sexual habits.

“There are a lot of people who decide they don’t want to take pills and who distrust the medical community,” said Brian Mustanski, director of the Institute for Sexual Minority Health and Wellbeing and at Northwestern University, which designed an online education program that one study found was effective in increasing condom use among young men of color. “We must not give up on reminding people of the value of condoms and teach people how to use them correctly.

Officials at Whitman-Walker, DC’s LGBT health center, say interest in condoms tends to be higher in majority-black neighborhoods where HIV rates are higher and PrEP use is higher. is weaker. Several older African Americans were among the few who took condoms at the group’s recent outreach event.

But LGBT health providers often rely on government grants for their disease prevention work and say they lack funding for strong condom distribution campaigns because public health agencies prioritize other forms. prevention such as PrEP.

“A lot of the focus is on treatment,” said Rama Keita, director of community health at Whitman-Walker. “It’s a difficult place we find ourselves in right now.”

Davin Wedel, president of Global Protection Corp., which supplies condoms to governments and nonprofits, said public health agencies have been placing fewer orders since the advent of PrEP. But he said sales have started to rebound in recent months as authorities sound the alarm over rising sexually transmitted infections, a demonstration that public health has not given up on condoms even though they are no longer a focus .

“I can’t imagine a situation where condoms won’t be helpful, but at the same time we need to continue to work on developing more effective tools to prevent these infections,” said Leandro Mena, who leads the Centers for Disease Control and Prevention. STD prevention service.

Scientists and health officials are now focusing on vaccine development, affordable home testing and post-sex drugs as the next generation of weapons in the fight against sexually transmitted infections.

The most promising of the options is an oral antibiotic taken as soon as possible after sex to prevent bacterial STDs, a strategy known as post-exposure prophylaxis.

Preliminary data from a study funded by the National Institutes of Health showed that the method was effective against gonorrhea, chlamydia and syphilis. CDC is developing clinical guidelines for using the antibiotic for STD prevention in gay and bisexual men and transgender women who have HIV or are taking drugs to prevent HIV – groups represented at NIH study.

Although more and more home STD test kits are coming on the market, they are neither affordable nor widely distributed. Experts hope they can eventually be as accessible as rapid coronavirus tests.

There are no vaccines for syphilis, gonorrhea or chlamydia on the horizon, but officials hope they may eventually join the arsenal alongside vaccines to prevent hepatitis B and HPV.

“All of these efforts have been made globally to create tools that aren’t condoms, because we’re finally getting there: humans don’t like condoms,” said Jim Pickett, an HIV activist from longtime consultant for public health agencies. “And no matter what we do, we’re not going to get the kind of use out of them that would be needed to really make a dent.”

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