SirBillybob

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 NICE rejects cabotegravir for PrEP in draft guidance - The Pharmaceutical Journal PHARMACEUTICAL-JOURNAL.COM The National Institute for Health and Care Excellence (NICE) does not recommend the injectable HIV...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.

Roulette is simply a hazards analogy. Playing it is not a death sentence. If accurate information were to accompany the decision as to how to use PrEP there wouldn’t be an inclination to downgrade effectiveness hyperbole with narratives that appear to attempt to cancel out the merits of Truvada when a balanced view of effectiveness and risk is paramount.

It’s only obsolete to the extent that one is rigid about applying probability notions to any number of situations ranging from dire to comparatively innocuous. If marriage was the roulette example there might be some contrarian objection to the analogy except for those trapped in it likening it to a death sentence metaphorically, depending on the outcome. The probability of failure is as high as one roulette pass. The HIV analogy works for some better than others. Nobody is stuffing a rubberless idea into you.

It’s not an analogy I would necessarily use. Everybody knows the current implications of HIV infection. That is the reason I framed it in temporal terms. In fact, firearm roulette odds differ according to whether the bullet is left in the chamber or is removed and replaced in the chamber that is then spun for subsequent risk event. What is missing in the education that should accompany prescribing and dispensing Truvada (and its generics) is that in the most recent randomized trial comparing it to Apretude, the rate of infection was such that the chance of HIV infection over a sexual activity lifetime of 82 years was calculated as 100%. The time to inevitable infection in spite of Truvada uptake is even less, when applying the incidence metrics, for younger men and for men leaning towards a greater proportion of receptive anal intercourse. In fact, the real world efficacy studied retrospectively for young men is very low. Look up “PrEP Jourdain (author)” if interested. Since the intent of Truvada uptake by consumers is to avoid treatable infection, you can leave it to Truvada recipients to do the math regarding their own arbitrarily chosen chunks of time going foreword or you can employ a analogy that pertains to particular hazard odds in order to crystallize infection probability in a way that is more relatable than a span of 8 decades. All this is to say that if hyperbole about efficacy, when in fact Gilead and generic producers will commit in the product monograph to evidence of 42% and 75% efficacy in two studies respectively, is used to encourage uptake but not accompanied by all the breakthrough infection risk facts, decisions about condom supplementation occur in an information vacuum. As posted upthread, about 1 in 82 acquired HIV infection over a median duration of 9 months. If anyone here took Truvada over the past 6 years with a sexual activity profile consistent with the trial participants your chances of infection would be 10%, even higher if predominantly receptive over insertive because the probability of the former is 12-fold greater. This is a probability calculation that may play a role in future condom usage for some, not an efficacy calculation that is distorted according to whim.

I thought the rentmen dot eu platform was being phased out. Could be it cuz messages are functioning in rent dot men on my phone.

“Drop off only, back bay” Just saying.

Et voilà, summoned.

He is the person in the photos, as posted earlier this year by another board member, and his OF which is linked within rent dot men but seemingly not linked in rentmen dot eu. From near Campinas, lives in Asia where some Caucasians try to make their mark in modelling and where a group of them can share accommodations at very low cost. He has occasional presence in Europe but I doubt has stepped foot much in USA but he did post a visit of a few days in LA June ‘23. In contrast, he posts huge volumes of Asia and Europe travel, as well as the usual Dubai.

“Fancy a …”? Who are you?

Ejaculating or not could cum down to the same thing in terms of the potential for sufficient arousal within the sexual response cycle. Unlike in unpaid hookups or personal relationships, he more likely stratifies the costs and benefits in such a way as to hold all the cards regarding progress to orgasm or inhibiting orgasm. Whether he actually blows ‘accidentally’ or with true subjective pleasure intention, a possible lapse in physical control finesse or in the contract, or a pre-existing or emergent urge, there is nothing but advantage for him to subtly or overtly impute to you that you were hot enough to govern it. In a transactional context orgasm may be monetized within the session or in terms of repeat booking advantages. In contrast, non-ejaculation may be monetized going forward to a subsequent booking in which situational orgasmic conservation will have had a role that day, or with a partner in which such occupational conservation may be subsequently relevant for intimacy. The point is that absence of orgasm with you may represent no less inevitability for orgasm than if he hadn’t somehow truncated his arousal in order to regulate ejaculation, to the extent of his having mastered ejaculatory control. Labeling his ejaculation as a unique pleasurable outcome for him is overly simplistic because the transactional context uniquely dictates that outcum. While in you he may have been no more no less into you according to whether his orgasm occurs. He holds the superpower majority, so let go of attempts at interpretation regarding your capability for being a turn-on and for considerations of its influence on exchange in kind. His ejaculation can only be an upsell because the broader client constituency both assumes it’s the penultimate aim of sexual satisfaction and is willing to pay for an illusory ego boost. 😏

How Orwellian. What better way to suggest somebody implies some are more equal than others and criticize that perspective than to counter it with the notion that some are more equal than others? Does this mean we have to retrospectively review and correct all posts using the term ‘MSM’ and regressively replace with gay/bisexual? Can I age down a few decades too?

Perhaps there’s a middle ground between false amplification of HIV PrEP effectiveness level and the use of hyperbole to represent the risk of breakthrough infection without condom supplementation. In the Apretude non-inferiority research, MSM and TGW (transwomen), the incidence of HIV infection within the Truvada arm by person-years denominator was very high, considering the chances of infection per single receptive anal intercourse exposure to semen with non-suppressed viral load is merely 1 in 72. One in 82 subjects taking Truvada seroconverted prior to the ethical decision to offer unblinding and access to the more protective Apretude (itself not at all failsafe). Given sexual behaviour patterning consistent with the overall study cohort, sustaining such risk predicts a guarantee of infection within 95 years of such activity. Obviously none of us thinks in such terms of longitude, but theoretically one within a group of 10 of us all taking tenofovir / emtricitabine, equally representative of the research cohort’s sexual interaction, would likely seroconvert with HIV over the upcoming decade. Again, this is extrapolated from systematic research findings, not real world (eg, retrospective case-control) data. Both Truvada (and it’s generic equivalents) and Apretude product monographs urge condom use to augment prophylaxis. They are not downplaying infection risk. Treatment as prevention (TasP) is floundering; the general population incidence of untreated HIV infection is unfairly stacked against the risk reduction conferred by pre-emptive antiretroviral exposure. Bear in mind that a majority of those using PrEP are taking Truvada or Descovy but neither of these would receive ethics approval for a comparison with placebo, because some benefit is inarguable, yet more importantly with a drug (Apretude) now deemed to offer a satisfactory metric of relatively greater protection. Simply put, Truvada PrEP will no longer be studied using gold standard methodology, not because it’s deemed sufficiently effective, but because it’s technically inadequate compared to other fairly inaccessible pharmacological options . How does this fit the standard roulette analogy? 1 bullet in one of 6 receptacles, 5 empty chamber receptacles? You would have to work out your risk tolerance. Apart from other STI acquisition risk, and assuming sexual behaviour volume consistent with that of trial participants, would I tolerate HIV infection risk equivalency of 1 pulled trigger every 15 to 20 years? Not me, not in terms of my standards of expectations when committing to a medicine. It’s but the icing on the condom. Like has been said before, it is futile to go exclusively by risk reduction while neglecting baseline incidence risk magnitude, taking the actual regimen, in decision-making.

At the studio level two ideologies intersect in the context of preponderance of non condom choreography: responsibility and autonomy. It is easy to curate in practical terms so as to accommodate safety within collective occupational hazard while implicitly modelling individual preference unencumbered by condom application and visibility. There is no accompanying message “do as we say, not as we do”, whereas the former is based on a relatively invisible yet complex and detailed set of behind the scenes protective measures and the latter conveys a mode of intimacy for maximum erotic charge that itself reinforces the preference of freedom to optimize arousal irrespective of the reality that non use for some is simply because condoms impede pleasure and that pharmacologically augmenting risk reduction for others (or both) may be no easier to perfect than overcoming condom use complexity. Without modern prophylaxis and STI surveillance developments we would be more likely seeing the same condom presence as when such was expedient. The two ideological components are easily integrated in entertainment erotica because the scenes often seem to be more realistic than they are. In the real MSM world we seem to see a division in condom use position that is ideologically split, where embracing use is more likely to be erroneously conflated with responsibility for self and others, and non use tends to be more falsely conflated with individual autonomy, labelled reckless even, for optimal pleasure. Condom use ranges from easily facile to fraught with complexities. I identify with the former, but I view it more as random good fortune to the extent that condom use has true health promotion value, rather than a unique skill that places me above others in sexual health self-efficacy terms. At a time when condom use was imperative I tripped into discovering that a kick-start wrapper tear for a few on hand eliminated the frustration of lubed fingers slipperiness and made it simple to extract when needed, not just a single accessible in this manner because often one applies multiples in sequence with slippery hands; that solo practice made perfect in terms of brand, size, fit; that solo practice enabled finesse in the more difficult task of condom application on flaccid tool, in fact eventually either non-erect or erect application accomplished in seconds; that mutual ambiguity about HIV status and disease implications more serious than exist currently supported immediate understanding of condom presence and preference; and that health security and attendant emancipation from disease risk could be fused with psychosexual arousal. All this could easily promote a superiority complex because health is a penultimate value. It could easily be packaged as representing a greater level of responsibility for others, of collectivism. However, my interpersonal sexual practice also just happens to align with personal autonomy; my pleasure is inadvertently tied into it and altering the measures would downgrade my enjoyment. The historical habituation also facilitates condom use accompanying HIV PrEP. Therefore, it would be disingenuous to position myself as a cut above in awareness and consideration for universal well-being. I believe that most of those well adapted to consistent condom use have just enough pleasure to justify it, whereas those that more likely endured condom usage but now implement it less than previously did not suddenly shift in terms of whatever responsibility / self-serving split may come into play in related discourse. The distinction is artificial. Now then, what should I expect from others more on the opposite end of the spectrum with respect to comfort, ease, and preference regarding condom use? The ideological embrace of autonomy is equally a logical fallacy, particularly if it insinuates I’m unnecessarily stuck in the aforementioned transient piece of the fossilized past in which condom use was inarguable but is now less expedient. I’ve already established that condom use can enhance the end game of sexual pleasure; in fact, I failed to mention that the degree of enjoyment is subjectively no less compared to a reference period of non condom use predating HIV emergence. If you truly have understandable struggles with condom use for a variety of legitimate reasons and have lacked opportunity for mitigating such difficulties, the merit of fronting such a reality with assertions of some type of more advanced modernity, of greater capacity for optimal sexual pleasure, of a superior grasp of the risk-benefit equation, is simply lost on me. Apart from the misapplication of ideological positions, which overall subgroup group do you think can be said to more greatly experience and express a range of regret? Those that acquire disease due to condom non-usage or those that use condoms and maintain sexual health albeit some trading off some degree of pleasure?