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Short abstract:

This paper examines a new strategy by HIV-negative gay/bisexual men not on PrEP, engaging in condomless sex with partners with undetectable viral loads or on PrEP as an indirect protection measure aimed at balancing pleasure and risk - i.e., prevention by proxy.

Long abstract:

The increasing availability of antiretroviral drugs in certain regions of the world for HIV treatment and prevention has led many gay, bisexual, and other men who have sex with men (GBM) to “make transformations” in their sexual practices. A new phenomenon is taking place whereby some HIV-negative GBM not on pre-exposure prophylaxis (PrEP) engage in condomless sexual activities with partners with undetectable viral loads or partners using PrEP. This indirect protection measure is a strategy to balance pleasure and risk reduction in the context of HIV prevention during sex. In other words, these GBM are using antiretrovirals for HIV prevention without directly consuming antiretrovirals themselves, which represents a form of “prevention by proxy.”

This presentation explores this emerging sexual trend, highlighting how GBM are incorporating knowledge of scientific advancements into their sexual practices, despite diverging from conventional public health recommendations. The presentation will discuss how this innovative approach to HIV prevention challenges long-standing public health messages that have historically emphasized “direct self-protection” for HIV-negative GBM by advocating for consistent condom use and, more recently, the adoption of PrEP.

Moreover, the presentation will discuss the global health implications of this new trend. The uneven global access to antiretroviral drugs for both treatment and PrEP highlights a significant justice issue. The “prevention by proxy” phenomenon is continuation of this justice issue by showing that not everyone has the same opportunity to adopt this strategy due to varying antiretroviral access across different regions.