Condomless sex and HIV transmission among serodifferent couples: current evidence and recommendations

Abstract

Human immunodeficiency virus (HIV) infection remains a global pandemic. The primary driver of HIV incidence is sexual transmission between serodifferent individuals. Condoms, when used consistently and correctly, are effective at preventing sexually transmitted HIV infections and are considered an integral component of a comprehensive approach to HIV prevention. However, the demonstrated effectiveness of antiretroviral therapy (ART) to prevent HIV transmission, known as treatment as prevention and of pre-exposure prophylaxis, have raised an intriguing dilemma on the necessity and additive preventive benefit of condom use among individuals in serodifferent relationships utilizing these prevention strategies. Recent published evidence, although of limited follow-up duration, has shown no linked HIV transmissions with condomless sex among serodifferent couples where the infected partner was on ART and virologically suppressed. This paper will review the evidence surrounding HIV transmission risk among serodifferent couples with and without the use of condoms and will highlight factors that increase or attenuate this risk. It will also address the important benefits that condomless sex offers couples. This paper aims to provide a template for providers to have personalized discussions with their patients, particularly those with an HIV-positive sexual partner, around their individual risk of HIV transmission and the role of condom use.

Inconsistent condom use between serodifferent sexual partnerships to the human immunodeficiency virus

“…Thus, observing HIV transmission outside the relationship with fixed partnerships increases the importance of counseling nurses assessing types of partnerships and inconsistent condom use ( 13 ) .…”

“…Condoms, when used consistently and correctly, are highly effective at preventing sexual transmission of HIV and other STIs and are considered an important component of a comprehensive approach to HIV prevention ( 13 ) . Reducing condom use increases the risk of exposure to STIs and HIV infectivity and, therefore, their transmissibility ( 14 ) .…”

“…In this sense, inconsistent male condom use has been described as prevalent among PLHIV with different types of sexual partnerships - both regular and casual, with negative HIV status or unknown HIV status, in different regions of the world ( 13 - 19 ) .…”

Psychometric properties of the European Portuguese version of the Perceived Risk of HIV Scale in the general population and HIV-uninfected partners from sero-different couples

“…In fact, in our group of HIV-uninfected partners, almost half of the participants (46.3%) reported never having had sex with a condom with their partner in the previous 3 months. Regardless the viral suppression of the partner living with HIV, it seems relevant to reinforce condom use, specifically, within these couples, since they may also be in a higher risk of acquiring other STDs [49].…”

Knowledge of PEP and PrEP Among People Living with HIV/aids in Brazil

“…In fact, condoms have advantages in terms of low cost, easy access and low adverse effects when they are adopted consistently and correctly. In addition, they are effective in preventing other sexually transmitted infections [4]and considered fundamental to a comprehensive approach to prevention [5].…”