A Fading Weapon in the HIV Fight: Condoms

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Gay and bisexual men are using condoms less than ever, and the decline has been particularly steep among those who are young or Hispanic, according to a new study. The worrisome trend points to an urgent need for better prevention strategies as the nation struggles to beat the H.I.V. epidemic, researchers said.

Over the past decade, prevention medication known as PrEP has helped fuel a moderate drop in H.I.V. rates. And yet, despite persistent public health campaigns promoting the drugs, they have not been adopted in substantial numbers by Black and Hispanic men who are gay or bisexual.

The use of condoms, which prevent H.I.V. as well as other sexually transmitted infections, has been declining across the board in recent years, not just among gay men, contributing to a rise in sexually transmitted infections.

Researchers said that, with so much focus on PrEP, public health officials have overlooked condoms, contributing to the drop-off in their use.

“The goal of promoting PrEP is a valuable one, but it has overshadowed other prevention strategies like condoms,” said Steven Goodreau, an H.I.V. expert at the University of Washington. He led the new study and co-wrote a related editorial.

A spokesman for the Centers for Disease Control and Prevention acknowledged declining condom use, but he said the agency continues to promote them. Local health departments that receive federal money for H.I.V. prevention must include condom distribution in their strategies, for example.

H.I.V. rates have fallen in recent years thanks in part to PrEP. But the decline in the United States — 12 percent from 2017 to 2021, according to government estimates — has trailed many other wealthy Western nations and even some hard-hit African countries.

Gay and bisexual men are disproportionately affected: They make up just 2 percent of U.S. adults and 70 percent of new H.I.V. cases. And infection rates are much higher in Black and Hispanic gay men than in white gay men.

In 2012, pre-exposure prophylaxis, or PrEP, debuted amid landmark research showing that, when taken daily, antiretroviral drugs nearly eliminate the risk of contracting H.I.V.

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