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PREP and the new sexual Olympians

Discussion in 'LGBT Later in Life' started by TBD, Mar 13, 2017.

  1. TBD

    TBD
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    First, a disclaimer: this may not be the best place for this post, but this forum seemed slightly better than the health advice section.

    Second, another disclaimer: I am not having sex with men, and I don't have any immediate plans or prospects. My situation, however, could change, and if it does, I don't know what I would do. It's terrifying.

    I know that porn is fantasy, but it also reflects some people's desires and fetishes. All I can say is, Wow! Men are doing things I never would have thought of doing. It's as if two men together is gay, but three or more quickly escalates into a sexual contest seeing how many penises can be simultaneously inserted into one man's body. They really should have an Olympic event. (These guys make the luge sledders look like pussies.)

    I saw HBO's Looking, and in one episode, they were teasing one of the men because he wanted to use a condom and everyone else was using PREP.

    I lived in San Francisco during the AIDS epidemic, and I spent a lot of time in hospices watching handsome young men wither away. :^|

    (Needless to say, I don't understand men who are seeking to be infected.)

    I also have an HIV+ friend who says his numbers are such that HIV is undetectable.

    Does anyone have any experience with PREP? How is it supposed to work? What are it's prevention stats? How long does it do it's magic?

    Thanks!
     
  2. Chip

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    PrEP was never designed, is not marketed, and is not effective, as a replacement for condom use. When used correctly, it is remarkably effective, but its developer intended it to be used in combination with condoms.

    Some self-centered people that can't be bothered to use a condom do, in fact, use it instead of condoms, but this is dangerous. First, there are HIV strains developing some resistance to PrEP already. Second, there are a handful of cases on file where people were taking PrEP and nonetheless got HIV anyway. (It is possible these individuals were not consistent in taking their medication.) And there are many other STIs in addition to HIV that are not protected by PrEP.

    There are some pretty significant drawbacks: One, it must absolutely be taken completely consistently. If use is inconsistent, not only does it not provide protection, but according to what I read, there are reports where it has actually had a boomerang effect and increased risks in certain cases.

    Additionally, as a drug intended to be taken all the time, you are putting something into your body that puts additional strain on the liver and kidneys, and doing so for a long time, solely for the convenience of not using condoms (or, if you are using condoms, for the additional peace of mind.) This is a decision that must be made for each person individually.

    For someone like me, the trade-off of potential long-term health impact from drug side effects is not worth it. For someone who is sexually active and has numerous partners, especially if those partners are of unknown serostatus, or are HIV+, then the trade-off makes more sense.

    Finally, there's the cost, either to you directly, or to your insurance company. This drug costs somebody (you or your insurance) about $1500 a month, last I looked. I don't personally like the idea of enriching some shady drug company to the tune of $18,000 a year simply to avoid being cautious in the number of sexual partners I have, and the careful use of condoms and safer sex practices. That money is ultimately reflected in the premiums that each of us pay for health insurance.

    I do believe that for the sexually active person who is fairly promiscuous, that PrEP is a wise idea, though I would always use it in combination with condoms, rather than alone.
     
  3. TBD

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    Thanks for bringing me up to speed. I can see how it could be a license to be more wreckless.
     
  4. OnTheHighway

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    In the U.K., new HIV infections are down around 30 percent. In Sweden, they have seen even greater success and have almost eliminated new HIV infections. The reduction in new infections is a result of increased testing and utilisation of PrEP.

    Let's not be so judgemental in PrEP. It is working! The gay community has enough issues of shame where it does not need an additional one on for a product that is a useful tool fighting new HIV infections and has the prospects of helping to eliminate HIV all together.

    Also, while it may be perceived as a license to be more reckless, the reality is this: a small subsection of gay men are highly promiscuous. This is the section whom would benefit most from PrEP are in the most at risk category. Whether PrEP was available or not, those same gay men would most likely be having bareback sex.

    As for side effects, a very small number of people have side effects. As with all drugs, there are side effects. Each person needs to speak to their doctor and talk about those side effects.

    Chip is correct that PrEP should not replace condoms, it is an additional tool to be used for added protection. That said, there have been three known cases reported in the media. One individual was having more than 50 unprotected encounters in a month (he was taking a record of each episode) - not even PrEP was designed to be able to protect from such extensive sexual activity. The second event occurred by an individual whom did not take his medication consistently (again as Chip mentions this is a no no). And the third individual got a rare strain of HIV. These are still amazingly small numbers of people compared to the overall numbers having sex and those taking PrEP.

    Finally, I would point out that porn is fantasy. It is not real sex. Actors in porn take massive precautions when they bareback. They also get tested more than regularly. Let's not view porn as a representation of what sex is like in the broader gay community.

    If you fit a high at risk category, then PrEP may very well be a good idea for the added protection.
     
  5. smurf

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    ^ All of that.

    Prep works and it has been shown time and time again that people who are in Prep don't change their safer sex practices.

    For porn, the industry has done an impeccable job and keeping HIV transmissions at bay. The industry has really tight regulations that allow a safer environment for people to do riskier things. A lot of porn performers will also only go bareback in porn and not in their personal lives for that reason.

    Correct. Someone who is undetectable means that its harder for them to pass the virus to someone else. The problem is that you are unable to prove whether or not someone is undetectable, as this is an every changing status that is completely dependent on how discipline they are with their meds and health.

    Of course, always talk to your doctor since none of us are qualified.

    That being said, Prep is a concept "similar" to birth control pill. Its something that you have to take every day at the same time in order to keep a stable amount of the drug in your system. The effectiveness of the drug goes down each time you miss a day by a significant amount.

    People taking prep also have to check in with doctors every 3 months. This is to check the health of their liver and to do an HIV test to make sure everything is going well.

    If you are consistent and you take your pill every day, then Prep has a 90% chance of preventing HIV transmission. This is comparable to condom use.

    This is such a loaded paragraph.

    A lot of people us Prep to simply deal with the anxiety that they have about getting HIV. I know a guy who is on prep, but has anal sex maybe once or twice a year. He simply has kids and he is terrified of getting HIV. Does it make sense? Maybe not for some people. Does him being on prep mean that he is paying 18k just to not have to worry about condoms and be a whore? Nope.

    It is also ridiculous to claim that simply taking truvada will have a significant impact on premiums that we pay for health insurance. Its such a minimal part of the cost of health insurance that the idea is laughable.

    As for the cost, the true cost to each person is 100 - 300 a month from what friends have told me. I have heard of people getting it completely covered with a combination of things.


    I'm personally not on Prep, but I am glad that we have yet another tool for people to use at their disposal
     
  6. Weston

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    https://www.facebook.com/groups/PrEPFacts/

    ---------- Post added 14th Mar 2017 at 10:13 AM ----------

    Can you cite a source? On the face of it, this assertion seems highly dubious to me. PrEP either works or it doesn't work. The way it works, according to my layman's understanding, is by preventing replication of the virus in one's bloodstream. The number of partners one has should have no effect on PrEP's efficacy.

    ---------- Post added 14th Mar 2017 at 10:20 AM ----------

    Gilead Science, Inc., the maker of Truvada, has a program that covers insurance copays for up to $100 month.
     
  7. OnTheHighway

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  8. Chip

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    The very fact that one has to get checks every 3 months to ensure their liver function is not impacted is, to me, a deep concern. American society has gotten to a place (largely due to incessant drug advertising that is banned in most other countries) where people believe that it's perfectly fine and reasonable to be on one or more medications daily for this-or-that lifestyle choice (hair loss, eyelash lengthening (i'm not kidding), lack of interest in condom use, or "viagra for women", for example). That's a choice for each person to make, but these drugs *all* have side effects, *all* are toxic at some level to the liver, and we don't know what the long-term effect is on the body.


    Taking Truvada alone probably won't increase insurance premiums across the board. The problem is the mindset: Truvada's manufacturer ideally wants every gay man on Truvada, and not because they genuinely care about the health of the public... it's a profit center. The idea of having a large segment of the population on a medication that is unnecessary (except, perhaps, for a small segment that is promiscuous and refuses to wear condoms) is bad from multiple perspectives. It's costing the healthcare system money that goes to a highly profitable pharma company for no good reason, and is symptomatic of a bigger problem.

    I'm not talking about the cost the end-user pays; I'm looking at the bigger picture of big pharma collecting big bucks from insurance companies for "lifestyle" drugs being paid for and, in combination, running up the costs of healthcare, which is one of many reasons why our healthcare system in the US is so completely broken.

    I completely agree with this, and I also agree with earlier sentiments that it is an important and necessary drug. For the irresponsible people who can't be bothered to use condoms, Truvada may prevent them from becoming HIV+, which is yet another expensive healthcare cost that for the most part wouldn't be a problem if people behaved responsibly and took their own health and safety seriously.

    That said, I fully and completely understand that there are self-esteem issues, poor momentary decisions that lead to a permanent, life-altering change in health status, and other factors where someone can make one dumb decision that affects them in the long term. I would, however, like to see this $18,000 a year spent on, for example, education, therapy, and life skills that reduce the behavioral attitudes and choices that lead to the risky behaviors. For example, the people who have anxiety about getting HIV could benefit from counseling to address the underlying issues behind the anxiety, and education and encouragement to make wise choices rather than an $18K a year drug. And this counseling would have other benefits in lowered healthcare costs and higher quality-of-life overall... but that doesn't fit into the agenda of Big Pharma's profits.

    I know I'm looking at this from a macro-societal level, but increasingly, I think many of the problems we have arise from a societal discomfort at looking at the bigger picture.

    I do completely agree that in the short term, Truvada is necessary for some people, that some folks will never use condoms (for a variety of reasons, many of which stem from worthiness issues), and that these folks should not be shamed for their decision to use Truvada.
     
  9. I'm gay

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    Thanks OP for bringing up this topic, and I appreciate the information being provided. As the only commenter here so far who is actually on PrEP, or Truvada, I would like to add to this discussion.

    I began taking Truvada a couple of months ago. I have not experienced any side effects. That doesn't mean, of course, that others don't experience them, but for me it hasn't been an issue.

    I'm fortunate that my insurance company pays all but the co-pay for it, leaving me with a $25 per month cost. Last month I obtained a discount card from Gildead (the makers of Truvada) and now it doesn't cost me anything.

    I still use condoms, and will continue to use condoms. But I also have sex with men regularly, and many times I don't really know them well enough to trust their "status" just because they say they are HIV-.

    For Chip - I think debating the industry-wide issues with health care and premium costs is a bullshit answer here. We are here to answer OPs question, not engage in a health care debate. This part of your answer, though, I am in total agreement:
    To OP: Do some research, talk to your doctor, and make your own informed choice. I am using it because I know that I want to engage in sex regularly, and I'm not in a committed relationship, so I want the best possible chance I can at preventing HIV. So, I take my pill daily (never skip!!) and I always use condoms.

    I'm happy to answer any other questions, so if you have more, please ask.

    Take care. :stuck_out_tongue_closed_eyes:ride:
     
  10. Weston

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    I have been taking Truvada as PrEP for almost three years, starting soon after the CDC recommended it for all sexually active gay men. Like you, I experience no noticeable side-effects and like most men taking it, my liver functions are normal.

    Again, for anyone who has questions about PrEP, I highly recommend the following Facebook page:
    https://www.facebook.com/groups/PrEPFacts/
     
  11. Weston

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    Thank you for the citation. I was not aware of that article. Having been on PrEP for as long as I have, it has become somewhat routine for me and I don't always follow the latest developments; nowadays, I worry more about other STIs. (In that regard, there was a very interesting article, I believe also in POZ, a few months ago about the possibility of taking antibiotics on a daily basis as another sort of PrEP against chlamydia and gonorrhea.) I found a long and detailed discussion of your article on the PrEPFacts page; many of the contributors to that page are professional people working in the areas of HIV prevention and treatment.
     
  12. TBD

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    I have no judgments about the drug

    I believe I said porn is fantasy. But does life immitate art, or art immitate life? I have an active friend who spoke of something he saw on porn, and was wanting to try, so unless he was lying, there's one example of someone who was inspired by porn to seek out a new adventure.

    ---------- Post added 15th Mar 2017 at 12:51 AM ----------

    I'm also no condemning anyone for using, or condemning others for their sexual explorations.
     
  13. OnTheHighway

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    Wouldn't taking an antibiotic daily as a preventative measure simply lead to the body developing an immunity against the antibiotics? I am not a doctor, but that would seem even riskier than just taking an antibiotic when an STI is contracted. As far as other STI's, when compared to HIV, while uncomfortable, at least they are curable with antibiotics.
     
  14. Chip

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    Yes. I'm not a doctor either, but this is a terrible idea. One of the reasons that we have fewer and fewer effective antibiotics against various bacterial infections is that people have, for decades, been overmedicated on antibiotics, and the result is bacteria that evolve and become resistant to the commonly-used antibiotics, requiring stronger and stronger ones.

    Although PrEP operates in a different way, it's my understanding that there is the same concern (though to a far lesser extent) with PrEP: there are some early reports of resistant strains of the HIV virus evolving.

    With regard to the "fantasy" aspect of porn... there's an extremely high correlation between the rise of gay bareback porn (which started around 2004, after a period between 1995 and 2004 in which nearly every studio was producing only condom porn) and a pretty dramatic increase in HIV infections, and a drop in condom use, among teens and young adults. Now... correlation isn't causation, but at least according to what I've read, there's no other sensible explanation other than the wide dissemination of bareback porn. This is further backed by anecdotal data collected from many young teenagers, who watch bareback porn and get the impression that this is how it is done.

    This gets into a different area (described as a "bullshit answer" by poster "I'm Gay" above) that isn't directly relevant to the OP's question, but I think when we look at the decision to use or not use PrEP, we should, if we give a crap about humankind, also consider related issues. We are absolutely influenced by media, advertising, and various subtle and not-so-subtle messages, and I believe the decision to use or not use PrEP is in part influenced by all of these factors, which are worthy of consideration.
     
  15. OnTheHighway

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    https://www.facebook.com/groups/PrEPFac

    Weston, thanks for this link. I just signed up and spent time reading through it. Very informative. Also, i found some of the discussions really interesting. I was actually surprised to read how many people view PrEP as a total stand alone solution eliminating the need for condoms. And there was quite a bit of debate regarding perceived PrEP "judgement" and shaming of those using PrEP.

    For my own part, I went on PrEP under the guidance of my therapist and physician as a way to eliminate my anxiousness from my own perceived risks of contracting HIV during a promiscuous stage while on my journey of self acceptance. Although I consciously and routinely practiced safe sex during this period of time, I did have an unintended situation that lead me to go on a treatment of PEP (and even that situation was debatable whether I really needed the course of PEP or not). Rather being safe than sorry, the situation that caused me to go on PEP was the catalyst for me to decide to go on PrEP thereafter. Through this period, PrEP was used as a way for me to eliminate the anxiousness that was complicating my overall personal development and progress, not to use it as an excuse to have condom-less sex.

    I found the elimination of the anxiousness to be a massive weight off my shoulders. And being on PrEP helped me prioritize my attention on working through the more important elements of dealing with feelings of shame, internalized homophobia, diminished self esteem and diminished confidence which lead to be in the closet to begin with. See one of my other threads of my perceived success in getting through this period of "Gay Purgatory".

    For me, PrEP was a fundamental tool utilized as part of my journey.
     
    #15 OnTheHighway, Mar 15, 2017
    Last edited: Mar 15, 2017
  16. Chip

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    I agree with OnTheHighway that, when used as an adjunct to existing safer sex practices, PrEP can be a valuable means of protecting oneself. As a public health issue, anything that helps ensure that people do not seroconvert to HIV+ status is helpful, and in this case, given the anxiety and the risk factors of coming out and dating for the first time with same-sex partners, it seems clear that the value of the drug far outweighs the risks associated with taking it.

    When one is working through the other anxiety-provoking issues associated with coming out later in life, doing anything reasonable to reduce that anxiety is a sensible alternative. Pretty much every decision we make is negotiating different forms of risk and choosing the one that makes the most sense to us.

    My three-fold concern with PrEP (mass prescription and its impact on the healthcare system; potential long-term effects; use as "carte blanche" to engage in reckless behaviors) are all real issues. At the same time, I agree with OnTheHighway that PrEP remains one of the tools that should be considered for those in the circumstances where it makes sense to use it.
     
  17. Weston

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    I'm not a doctor either, but I think the risk of an individual developing an immunity to a given antibiotic is low, so long as he or she takes the antibiotic as directed (duration and dose). The development of antibiotic-resistant strains of bacteria is more a case of indiscriminate dosing of whole populations of people (and worse, farm animals) with antibiotics. Long-term, prophylactic use of antibiotics is already a thing in certain circumstances; for example, my own son broke his arm last year and developed a serious infection during surgery. After two months of continuous IV therapy (infusion), he was given a prescription for an oral antibiotic to be taken for at least one year.

    ---------- Post added 15th Mar 2017 at 09:34 AM ----------

    This was precisely the argument Washington State used a couple of years ago in setting up a program that pays for PrEP for individuals without insurance; it was not so much the individuals themselves that were to benefit as the public as a whole.
     
  18. mnguy

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    I'm disappointed how much porn doesn't show condom use. Besides HIV, aren't other STI's on the rise among gay men? Seems like using a condom would just be cleaner for anal sex and how much does it really reduce the enjoyment of sex? I saw/read an example of putting a condom on your finger and see how much you can still feel through it and since the penis is much more touch sensitive than your finger, a condom wouldn't block the feeling that much. Is that just a bunch of nonsense? How much does getting the right size condom impact the enjoyment? Thought I read something about men who got the right size didn't notice the difference as much. I dunno, guess I thought using a condom was standard practice for anal sex and not such a burden. I am often naive :eusa_doh:
     
  19. I'm gay

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    My apologies for making the assumption that I was the only commenter on PrEP. Perhaps this topic triggers me in a way that I didn't realize - and I feel the judgment of others with regard to this medication in my real life, so I reacted with perhaps more hostility than it deserved.

    With that said, I agree with the issues being discussed here and I think it's important that good information be provided without judgment. Thank you Chip for your measured response. Please also include in your thinking, however, that I pay well over $6,000 in insurance premiums each year for what little I use. The fact that drug manufacturing has such a high initial cost is the real problem. My daily blue pill costs next to nothing to make (I know it's the development of the drug where the real costs lie), and I hope this country figures out a better way to do this, but until then, keeping us safe from HIV is more important to me.

    Two months ago I came extremely close to barebacking. I never would have thought that I could do that, and in my rational mind I would never do it. But I really understand now so much better how the "heat of the moment" can definitely result in a lapse of judgment. Thankfully I came to my senses and didn't penetrate without a condom, but I oh so wanted to and almost did.

    We can't lose sight of that. Even people who know better, who don't consider themselves to be especially risky, and tell themselves they will ALWAYS use condoms, can have a lapse in judgment caused by the "moment." If it can happen to me, it can happen to anyone. This issue is especially critical here on EC, because newly out people are the most at risk. For those who are partnered, it's easy to lose sight of those of us exploring ourselves after coming out. It's especially relevant to me right now.

    For those who are considering going on PrEP, I urge you to carefully consider all of these issues, do your research, talk with your doctor, and do what's right for YOU.

    Thanks for listening. :stuck_out_tongue_closed_eyes:ride: