News Analysis: CDC Drops ‘Unprotected Sex’ in Favor of ‘Sex Without Condoms’

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Unknown: how much of this increase, resulted from newer risk reduction options.  Source MMWR 11/29/13

Unknown: how much of this increase, resulted from newer risk reduction options. Source MMWR 11/29/13

The Centers for Disease Control and Prevention will no longer use the phrase ‘unprotected sex’ in research. Instead it will use the phrase ‘sex without condoms’ to reflect increased HIV prevention options such as Pre-exposure Prophylaxis (PrEP), Post-exposure Prophylaxis (PEP), serosorting, etc.

 

While disagreements exist about their effectiveness, people using these strategies are making conscious decisions to reduce their risk. This language change does not proclaim the end of the condom era, but does recognize the presence of additional options for HIV prevention.

Controversy drove this language change, as it has driven most changes in this epidemic. It began with an article in Morbidity and Mortality Weekly Review (11/29/13). This article emphasized two findings from national studies of HIV risk among gay, bisexual and other men who have sex with men:

1) The percent of HIV negative men that reported some unprotected anal intercourse within the prior 12 months increased from 47 percent in 2005 to 57 percent in 2011.

2) About 33 percent of the HIV negative, or status unknown, men had either never been tested for HIV or had not tested in more than a year. This first point generated the controversy.

Some people argued that reporting an increase in unprotected sex failed to accurately describe the behavior of men using the newer prevention options and that this failure inflated the amount of actual risk behavior that occurred. HIV Prevention Justice Alliance (HIV PJA) organized an open letter campaign to correct this problem. On Jan. 23 in a conference call with HIV PJA and others, the CDC agreed to use the phrase “sex without condoms” rather than “unprotected sex.”

According to Julie Davids of HIV PJA, the article implied that “men were less likely to protect others from infection — since reported rates on condom use had dropped and that was labeled ‘unprotected sex.’” Julie added “we know that people with HIV are using a variety of methods, not just those that are condom-based, to prevent transmission. So, using ‘unprotected’ as a synonym for ‘no condom used’ is inaccurate at best, and stigmatizing at worst.”

HIV PJA and others had more objections to the article, such as the exclusion of transgender women. Julie Davids stated that despite some improvements “transgender people are not explicitly included” in any of the three HIV risk groups: men who have sex with men, drug users and heterosexuals. She also said that the CDC has failed to state in its reports if transgender people were included, excluded or if transgender data was not analyzed.

According to a statement issued by HIV PJA, the CDC also committed to working with HIV PJA on these other issues raised in the open letter such as “descriptions of sexual identity, practices and risk; HIV testing recommendations; transgender inclusion and data clarity.”

The following groups participated in the open letter and the conference call with the CDC: ACT UP Philadelphia, AIDS Foundation of Chicago, GMHC, Housing Works, HIV Prevention Justice Alliance (HIV PJA), International Rectal Microbicides Advocates (IRMA,) Positive Women’s Network of the USA, Sero Project, Transgender Law Center, Treatment Action Group and Visual AIDS.

Stigma and sensationalism have always lurked in the shadows of discussions about HIV transmission. While some question the effectiveness of the new options, they are not “barebacking.” This language change reflects that distinction.

For more information visit:

VICTORY: CDC responds to Open Letter, commits to condom clarity! (http://bit.ly/1iJPV27)

HIV Testing and Risk Behaviors Among Gay, Bisexual, and Other Men Who Have Sex with Men — United States (http://1.usa.gov/1cYMlTE)


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