A survey of users of Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP) at a San Francisco hospital found that 45 percent reported using condoms less frequently since starting PrEP, the San Francisco Business Times reports. Clinicians at the Kaiser Permanente Medical Center in San Francisco surveyed 90 of the approximately 500 people who have started PrEP at the hospital. C. Bradley Hare, MD, the director of HIV care and prevention services at the hospital, presented findings from the survey at a World AIDS Day community forum in San Francisco.

Forty-five percent of the surveyed PrEP users reported using condoms less frequently since starting Truvada, while 5 percent reported using them more, and 50 percent reported no change. No one reported an increase in sexual partners. There have been no new cases of HIV among all 500 PrEP users at the hospital.

Speaking with POZ, Hare characterizes the survey’s findings as “extremely preliminary. I think it’s too preliminary to draw any widespread conclusions.”

Hare stresses that these findings did not come from an actual research study. Because Kaiser did not develop a comparison, or control, group, it is impossible to deduce whether any decrease in condom use might have occurred without the addition of PrEP.

Additionally, Hare underlines the fact that the survey was not designed to determine the degree to which PrEP users are using condoms less frequently.

“We don’t know this guy is going from 100 percent condom use to zero, or if people are going from 50 percent to 40 percent,” he says. “And we don’t know which partners they’re not using condoms with. That level of detail we don’t have information on yet, although we hope to in the future.”

Michael Weinstein, the president of the AIDS Healthcare Foundation, who has campaigned energetically against PrEP, was quick to jump on the survey figures.

“There is no question that self-reporting is unreliable because it underestimates risky behavior,” Weinstein said in an emailed statement to POZ/AIDSmeds. “Therefore, it is most likely that many more than the 45 percent of the men cited are not using condoms.  The important point is that the indiscriminate promotion of PrEP by the [Centers for Disease Control and Prevention] and others is encouraging unprotected sex for people taking Truvada and is an overall attack on the condom culture that is responsible for preventing millions of infections—both of HIV and other [sexually transmitted infections]—worldwide.”

Two individuals among the 500 taking PrEP at the hospital, both of them men who have sex with men (MSM), have contracted hepatitis C virus (HCV). According to Hare, it it is reasonable to assume the men did so sexually, because neither reported any other risk factors, such as sharing injection drug needles or works.

There is an emerging epidemic of sexually transmitted hep C among HIV-positive MSM in the United States and elsewhere, but only spotty anecdotal evidence to suggest that HIV-negative men are also acquiring the virus through sex.

Most of the people taking PrEP at Kaiser San Francisco are MSM. There are some women, transgender women and injection drug users also taking Truvada.

In 2013, only 40 people at the hospital were taking PrEP. That number rose to 250 by summer 2014, only to double to 500 at the present time. By comparison, Gilead Sciences’ recent report on PrEP use nationwide as of March 2014 identified 3,253 people as having started PrEP since its approval in 2012. Many news outlets and experts in the HIV field look to that figure to draw conclusions about how widespread the use of PrEP really is. But the Gilead information has many limitations: It was culled from only 55 percent of U.S. pharmacies, and does not account for prescriptions received through Medicaid, or for people who are on PrEP as part of a clinical trial or demonstration project. If a single hospital in San Francisco has 500 people taking PrEP at this time, it stands to reason that the Gilead figures provide a highly unreliable portrait of the actual uptake of PrEP around the country.

To read the Business Times story, click here.

To read a POZ feature article about PrEP, click here.