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A public health ethics analysis of Doxy-PEP: arguments for and against - the 'yes' case

Sam Templeman, Bridget Haire

Abstract

In September 2023, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) recommended doxycycline prophylaxis (Doxy-PEP) to prevent sexually transmitted infections (STIs) in gay, bisexual and other men who have sex with men (GBMSM). However, expanding antibiotic use carries the risk of propagating antimicrobial resistance (AMR) amongst target STIs and non-target pathogens, prompting some experts to advocate withholding Doxy-PEP until further research is done. Thus, the use of Doxy-PEP is a question of whether the risks of AMR to health both in the immediate future and to future generations is justified by the health benefits to GBMSM. Here, we outline the public health ethics cases for and against this strategy.

SH24013  Accepted 02 July 2025

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