US Human Immunodeficiency Virus (HIV) practitioners' recommendations regarding condomless sex in the era of HIV pre-exposure prophylaxis and treatment as prevention

Background. We sought to characterize human immunodeficiency virus (HIV) practitioners' recommendations to patients regarding treatment as prevention, pre-exposure prophylaxis (PrEP) and condom use among persons with HIV (PWH) with viral suppression and individuals receiving PrEP. Methods. A brief survey about counseling practices was distributed electronically to previous attendees of an International Antiviral Society-USA continuing medical education activity. Descriptive analyses were performed for all questions. Pearson χ² tests were used to identify potential differences in counseling practices based on sex, degree/license, years in practice, number of PWH cared for in the past year, and practice location. Results. Of the 3238 persons surveyed, 478 (15%) responded. 65% were female, 47% were physicians, 78% had been in practice ≥6 years, and 52% had cared for >100 PWH in the last year. Of the respondents, 51% (95% confidence interval, 46.8%-56.0%) agreed that the evidence "supports, strongly supports or proves" that condomless sex with a PWH with viral suppression does not lead to HIV transmission, and 76% (72.2%-80.0%) commonly or always recommend condoms for such patients. Although 42% (95% confidence interval, 37.0%-46.0%) of respondents said the evidence "supports, strongly supports or proves" that condomless sex involving a person at risk for HIV infection receiving PrEP does not lead to HIV transmission, 81% (77.3%-84.5%) commonly or always recommend condom use for such patients. Responses differed significantly by practitioner experience, region, sex and degree. Conclusions. Although many practitioners caring for individuals with and at risk for HIV infection acknowledge that successful treatment or PrEP prevents transmission, the majority of practitioners commonly or always recommend condom use.