Reintroducing condoms: filling the gaps in HIV prevention

In recent years, HIV prevention efforts in the United States have shifted predominantly toward biomedical interventions such as PrEP (pre-exposure prophylaxis), U=U (undetectable equals untransmittable), and doxyPEP. While these methods are highly effective in reducing HIV transmission, they have led to a significant decline in public health campaigns promoting condom use among men who have sex with men (MSM) and trans women. Despite this shift, condoms remain an essential tool in HIV and sexually transmitted infection (STI) prevention, particularly for individuals who have not adopted newer biomedical strategies.

Recent nationwide surveys show that approximately 50% of HIV-negative MSM reported using condoms at least occasionally, a figure surpassing the 15% of MSM who use PrEP. Among younger MSM aged 15-24 who are not using PrEP, condomless anal sex has increased significantly, particularly within the Latinx population. This increase indicates that while HIV transmission rates may have declined among high-risk groups utilizing PrEP, there remains a vulnerable subset of MSM at heightened risk due to inconsistent prevention practices.

Public health advocates have largely shifted focus away from promoting condoms, citing factors such as the lower perceived threat of other STIs and a belief that MSM prefer PrEP. However, the continued rise in STI rates suggests that relying solely on biomedical interventions is insufficient. Reinvigorating condom promotion is necessary, particularly for those unable or unwilling to access PrEP. Comprehensive sexual education, greater accessibility to condoms, and the integration of condom promotion in both online and offline sexual health messaging are essential to achieving more equitable HIV and STI prevention strategies.