Spotlight Center on HIV Prevention Today


We Aren't the Sex Police: What PrEP Providers Say About Condoms and STIs

January 29, 2016

The potent protection from HIV afforded by Truvada as PrEP allows men to have sex with less worry and fear of HIV. But some worry that the inclusion of PrEP as a public health strategy will lead people to abandon condoms -- which still have a role to play in further reducing risk of HIV and other STIs. In San Francisco -- even before PrEP's availability in 2012 -- rates of STIs among men who have sex with men have been steadily increasing and rates of condom use have gone down.

BETA wanted to know -- what do PrEP providers think? How do these practitioners, who see clients every three months for sexual health screenings and STI testing, talk to their clients about condom use, STIs and navigating the complicated landscape of protected, or safer, sex?

To find out, BETA talked to Stefan Rowniak, MSN, PhD, a PrEP provider and nurse practitioner at San Francisco City Clinic and researcher and assistant professor at University of San Francisco; Pierre-Cédric Crouch, PhD, ANP-BC, the nursing director at the San Francisco AIDS Foundation health and wellness center Strut; Robert Blue, a PrEP program coordinator for San Francisco City Clinic; and Hyman Scott, MD, who leads the Ward 86 PrEP Clinic at San Francisco General Hospital.

Here's what they said.

The rates of gonorrhea, chlamydia and early syphilis infection have been on the rise in recent years in San Francisco. Do you see this as a major problem?

Pierre-Cédric Crouch, Ph.D., A.N.P.-B.C.

Pierre-Cédric Crouch, Ph.D., A.N.P.-B.C.

Pierre-Cédric Crouch, Ph.D., A.N.P.-B.C.

Obviously nobody wants to get gonorrhea, chlamydia, or syphilis, but these are risks that we have from living. The only way to completely avoid them is to not have sex at all and that's not who we are as humans. You can also get the flu from having sex, or strep throat. People die from the flu. People don't die from gonorrhea, but there's more stigma attached to gonorrhea than the flu. The levels of STIs are going up in San Francisco -- and have been since before PrEP was available here -- but they're nowhere close to what they were in the '70s and '80s.

Stefan Rowniak, M.S.N., Ph.D.

Stefan Rowniak, M.S.N., Ph.D.

Stefan Rowniak, M.S.N., Ph.D.

That's a very difficult question -- but one the community is going to have to answer. If people suddenly find themselves saying, "My god, this is the third time I've gotten gonorrhea in three months," they may think, "What can we do about this?" It's going to take people realizing that they don't want to get gonorrhea over and over again every time they have a new sex partner. Health providers will be there to help the discussion along -- but we're not the sex police. We are there to inform and help people make those decisions themselves.

This excerpt was cross-posted with the permission of Read the full article.

Related Stories

No New HIV Infections in San Francisco Community PrEP Clinic
Flow Chart for Accessing PrEP for HIV Prevention

This article was provided by BETA. Visit their website at

Reader Comments:

Comment by: Anonymous Fri., Feb. 5, 2016 at 1:59 pm UTC
I'm curious, if this conversation were had on the other side of the viral divide, would it sound so acceptable? Just yesterday, a major gay website published YET ANOTHER article in which undetectable men are admonished to continue wearing condoms. The argument was typical: "still a chance of transmission", "syph is a pretty big deal", blah blah blah.

I find this it peculiar, though hardly surprising, how comfortably healthcare officials embrace an undeniable double standard. When someone is negative, "we all make mistakes", "STDs don't matter", etc. Test positive and you're beaten over the head from day one with the concept that you are a walking time bomb, despite decades of responding evidence to the contrary.

As an added insult, you people actually wonder why poz men have been loathe to advocate chemoprophylaxis. It'd be hilarious if it weren't disgusting.

Reply to this comment

Add Your Comment:
(Please note: Your name and comment will be public, and may even show up in
Internet search results. Be careful when providing personal information! Before
adding your comment, please read's Comment Policy.)

Your Name:

Your Location:

(ex: San Francisco, CA)

Your Comment:

Characters remaining:


The content on this page is free of advertiser influence and was produced by our editorial team. See our content and advertising policies.