SirBillybob

As long as the enthusiasm is tempered.

Especially where I am currently, Zürich, where ‘sleigh ride’ is schlittenfahrt. 📣📢🧨🕯️🪭

Does farting Waltzing Matilda at Melbourne’s Beans Bar for free drinks count?

The distinction isn’t made because the synthesized estimate is based on a combination of incidence rates according to estimates of background prevalence, essentially receptive partner HIV positive or serostatus unknown, and of incidence rates based on partner HIV positive, obviously viral load data unavailable overall. Since being “top” uncircumcised insertive partner is much higher risk it is odd that the final estimate of .11% did not seem to incorporate that metric. However the authors point out a UIAI risk estimate of .22% in another study, not stratified according to circumcision. Interestingly, a “top” anally is more likely to be infected from a positive partner than a woman’s likelihood of acquiring infection from vaginal intercourse with a positive male partner. It can be as much about circulating virus in mucosal secretions as virus in semen.

Especially a nose ring making you stand out too much from the herd.

Still, sucking himself while shaving, impressive flexibility and time management, if not perfect dexterity.

It’s a good question because obviously a one-week lead-in does not occur. Since there is very little difference in drug concentrations and no difference in estimated protection between an average number of 4 doses vs 7 doses weekly, as well as no difference in breakthrough infection comparing 2-1-1 and daily, it is assumed that the 2-dose on-demand lead-in augmentation of drug concentration is sufficient for equivalent protection. Drug concentrations are in fact specifically organized around the risk event. However, the actual breakthrough infection risk cannot be compared for single events within the two uptake versions because a study can only compare by person-time denominators and number of intercourse risk events is impossible to comparatively tally over time. Similarity in breakthrough infection incidence may be a function of greater protection conferred by daily dosing that is undermined by a greater frequency of risk events. Therefore, the preference is based on convenience and the frequency and capacity to forecast events, or to be able to access some degree of protection for an impromptu encounter. That said, full protection is a misnomer. Protection can only be as good as it gets.

+ / - 💃 🕺(salsa)

One can approximate the relative risk for bottoms as about 12 times that of tops for one episode of intercourse, outside of PrEP considerations. There is no known relative risk factor for intercourse “too soon” following initial PrEP dosing because that time frame is continuous whereas sexual position is binary. The increase in risk is theoretical. However, the top engaging in intercourse “too soon” forfeits some of the aforementioned risk difference relative to the bottom who delays intercourse until optimal drug levels are obtained. Since penile mucosal tissue drug concentrations may be similar to vaginal concentrations in that it is known such vaginal concentrations are much less and take longer to accrue compared to rectal mucosal tissue (either gender), practice wisdom would not lean towards tops shortchanging the duration of time in which intercourse postponement is recommended.

The answer is in two parts as I assume a “top” wonders about the confluence of drug concentrations in his bloodstream and mucosal tissue, while not typically exposed to semen, unless of course residual infected semen in the “bottom’s” rectum from very recent encounters which is rare . Two factors: Insertive anal and time to PrEP protection. The time to protection in terms of drug concentrations in penile mucosal tissue is not as clear as for rectal mucosal tissue but it is reasonable to assume similar or more tentative. The point is that urethral, glans and foreskin tissue is vulnerable to infection from virus contained in rectal mucosal tissue fluids and traces of rectal blood plasma possibly present, but transmission risk is less than for receptive intercourse. However, bacterial STI infection could increase risk as well. If a “top” trades off some degree of wait time to peak drug concentration levels, the point at which the advantage of lower behavioural transmission risk by virtue of insertive position is lost is unknown.

If it’s code it prolly means arrives on the dot, then not splash and dash, but pay much mor$e for punctuality and punctilious treatment.

Nevertheless I only purchase pure virgin wool garments accompanied by a lab test certificate.

Wait until after the competition. Shortlist your favourites and search for their placements and socials. With so many categories, yet only the one 1st in each, chances are your shortlist will be comprised of mainly 2nd place or lower. DM “You were obviously robbed and I’m available if you want to take it out on someone and also walk away with full coverage for supplements on your next cycle, and more. Signed: Antonio The Muscleworshipper”

Based on a worldwide pooled research total of 54 HIV cases assessed for estimates of adherence drawn from post diagnosis lab samples for residual tenofovir levels often obtained long after TDF-FTC discontinuation and seroconversion. No statistical analysis for the groups stratified by estimated adherence, as tiny sample not amenable to sufficient statistical power. More HIV seroconversion cases in the extrapolated more adherent 4-7 weekly doses subgroup compared to the less adherent 2-4 weekly doses subgroup!! Tenofovir drug resistance in which breakthrough infection is attributable to a poor response to the medication was also is a confounder.

It’s a good thing, then, that STI treatment syringes and pill containers are all biodegradable in landfill.

Looks like has been walked back except for those that commenced uptake and you got in under the wire. NICE rejects cabotegravir for PrEP in draft guidance - The Pharmaceutical Journal PHARMACEUTICAL-JOURNAL.COM The National Institute for Health and Care Excellence (NICE) does not recommend the injectable HIV...

NIAID sponsored, with dual collaboration both manufacturers Gilead and ViiV. I have no affiliations. Actually, I personally favour Truvada, a generic equivalent is partially insured where I am, along with condom use for myself. It is unlikely that I will eventually pursue an injectable PrEP format given my low HIV acquisition risk level as well as desire to mitigate bacterial STI risk utilizing condoms to supplement PrEP. Gilead has its own long acting injectable coming out imminently, a capsid inhibitor called Lenacapavir. They won’t be buried as a footnote to Apretude (Cabotegravir; integrase strand transfer inhibitor). The reverse transcriptase inhibitor (Truvada, or TDF/FTC) completes a trifecta of these antiretroviral drug classes. Have to wonder if combinations will eventually emerge. Who do you think is going to foot the bill for progressively sophisticated PrEP? Truvada generic oral format cost is a very small fraction of the retail price for injected Apretude. On a two-to-tangle model what 3rd party payer will commit to coverage of $500-1,000USD weekly when other prophylaxis options exist?

Call me old school, but you both have vocal cords, right? That is, if you are mutually comfortable speaking by phone. I have found that easier and faster especially for first time, particularly if a history of face-to-face interaction. It helps parties to have access to the nuances of boundaries and transaction compensation. Subsequent bookings by text if the playbook had been mutually established and executed.

I am glad. Of those taking Truvada under formal appointment monitoring in the Apretude-Truvada comparison study, 1.67% acquired HIV infection by week 57. Condom use was encouraged and this figure does not distinguish between predominant ‘bottoms’ and ‘tops’, so the former, along with non-condom use participants (neither variable assessed in analysis) would have had higher than 1.7% infection occurrence. If you assume that 80% of breakthrough infection was dispersed within the split-half of the Truvada cohort reflective of higher-risk behaviourally, not a stretch considering that receptive anal intercourse is 10 times riskier, then the infection rate for them increases to 2.67%. If 2.67% is the incidence over one year, the approximate incidence over 5 years is 13%. Again, condom use in the trial may have mitigated HIV breakthrough cases. Truvada merely postpones HIV disease among those engaging in frequent condomless receptive anal intercourse. The assumption that the reason for infection is related more to sub-adherence in taking the medicine than related to behavioural risk overlooks the importance of supplementation, of stacking up prevention modalities, two or more barrier slices of Swiss cheese if you will. It is not considered tone deaf to exhort proper medication consumption. Missed dosing is not loaded with the idea of judgement lapses at point of unprotected sex. Condom use is less popular; we all get it. PrEP has spared the clinical community some of the resentment directed towards condom advocacy. Condom supplementation is now more a footnote because a partially useful substitute prevents some infection incidence among those disinclined to condom use. I am fine with describing the parade and anybody that thinks I am raining on it is free to be bitter. I am faced with the same decisions and have no less prerogative to drill down into the data in such a way as to influence my sexual activity. Take it or leave it. This isn’t my first rodeo with ostrich heads stuck down in the corral sand. There are folks living with a chronic disease in spite of having been capable of doing the things that prevent infection without unduly obstructing sexual pleasure.

Correct, the task of self-appraisal wasn’t the jist of your statement. I wouldn’t have found that idea odd since risk behaviour assessment and tolerability can only occur at the level of each person. It requires accurate, objective, science-based information. All you had written was an ambiguous post asserting that the content here, a gay forum, compared to what exists in the real gay world is as different as night and day. To suggest that a message board that celebrates MSM intimacy is in no way a representative microcosm of the broader community is, well, peculiar. The one central thing that is not lost on me is that your view of the degree of protective benefits aligns with a distorted estimate that you reference when in fact that reference irresponsibly omits the peer-reviewed published facts related to HIV infection incidence among PrEP research participants that are taking conventional dosages of PrEP. The accurate relevant data on infection risk while taking PrEP is incorporated by some, yet not accessible to a substantial proportion of the sexually active that would otherwise tweak the balance of risk behaviour and true probability of breakthrough infection. I don’t think that there are flies on me in terms of the complexities of this topic.

What a strange way to put it. There is obviously considerable overlap between ‘here’ and the broader world of men having sex with men globally. The most meaningful differences occur at the individual level of grasp of bacterial and/or viral STI reality. Aside from that, differences here according to protective measures attitude and practice are mirrored in sexual contexts where the proposed application of condoms is either popular or unpopular. If a difference in preferences didn’t exist in the real world this thread wouldn’t exist as a representative slice of the real world. If you are stratifying according to condom use as standalone or addition to PrEP or TASP, then yes, the real world is divided according to groupings of sexually active gay men enduring different degrees of disease burden downstream. Sex is sex, rubber or not. The difference between living and not living with HIV is far more vast. Because health maintenance is a universal value it should come as no surprise that defensively rationalizing greater risk is associated with reality distortion in which consequences are downplayed and that rationalizing upgraded protection more accurately follows scientific data and clinical recommendations to maximize risk mitigation. Sadly, the clinical community lacks cohesiveness in guidance because it doesn’t know how to reconcile the antipathy that occurs among different attitude / practice groupings of MSM. Therefore, we see a contradiction in which PrEP effectiveness is distorted, by some, to suggest that condom application is relatively superfluous in bridging the PrEP failure risk window when described as more narrow than the clinical data reveal. The clinical community is torn between promoting use by overemphasizing efficacy in order to induct greater numbers into PrEP use when in fact distorted views of efficacy subvert both PrEP adherence and behavioural risk reduction, on the one hand, and on the other hand accurately portraying the limitations of PrEP out of concern that a large proportion of MSM will bypass the use of PrEP and realistic degree of protection conferred when it can offer some degree of risk reduction in its own right. You need to ask yourself: why aren’t the published data on HIV infection probability over time for research cohorts taking Truvada, with altruistic volunteerism and commitment to adherence (taking properly), particularly the enormously higher infection breakthrough rates for predominantly bottoms and sides compared to tops, presented? Not only is an assertion of 99% efficacy for the total group completely out of whack, but efficacy tells a small part of the story because bottoms on PrEP benefit from risk reduction relative to counterpart bottoms not taking PrEP, but the infection rates for bottoms nevertheless occurring in spite of PrEP would send distorted efficacy estimates packing. No big shock that lack of consensus, mirroring substandard knowledge translation by the clinical community, would manifest in a predominantly layperson message board. Factions of the clinical community are out to lunch, misrepresenting and omitting information because they arrogantly think they know what is best for you and cynically believe that accurate behavioural alteration messaging takes a back seat when a medication regimen is able to offset disease incidence. The endgame of some degree of global infection abatement via pharmacological intervention does not assist individuals to realistically appraise risk.

It’s not. The 99% estimate is misleading and is an artefact of a lack of grasp of inferential statistics. The CDC and others have taken the absolute hazards ratio based on assumptions of 100% PrEP adherence, the column furthest to the right in the attached figure. However, only a small percentage of follow-up based on a small overall number of subjects in that category. The confidence interval, that is, the range within which the true metric value exists, does not rule out infection incidence. The confidence interval is 50-100% efficacy in one comparison and 57-100% efficacy in another comparison. Translating this to 99% is simply incorrect because the sample size lacks the requirement of adequate statistical power. This explains why, paradoxically, less adherence yielded a better efficacy result utilizing the essential confidence interval calculation. The devil is in the details.

Yet the phrase heard in common “It isn’t in yet as it’s long overdue.”

Treatment is theoretically uniformly effective if taken as prescribed. However, there may be some trade off of quality of life for length of life. At least 10% don’t acquire sustained suppressed viral load.

It is meant to be dramatic as a foil against the exaggeration of the merits of Truvada. It wouldn’t be necessary if exaggerating the effectiveness of Truvada didn’t actually contribute to uptake nonadherence. It wouldn’t have a place if prescribers were transparent about the notion that breakthrough infection is now considered to be attributable to exposure to semen containing retrovirus that has become resistant to the reverse transcriptase inhibitor class of antiretrovirals. Truvada will still be promoted because it reduces the chance of infection, but that is not all the information there is.