SirBillybob

As I would emphasize with my hospital patients in my day, one’s personal experience may be limited for interpreting another’s medical phenomena or needs, and vice versa. Of course, however, it is tempting and common to draw on personal reference points. If procedure-experienced as a patient, all the better position with which to follow up with the provider after the fact. Common possible general vulnerability history, in this case including organ donorship (obviously commendable) further supporting alertness to disease risks, empathic attunement to possibly mutual general medical challenges, etc. Again, IMHO better to be the one, as having been the one up close and personal already, than passing on to the next guy an unsubstantiated conjecture to assess before or during a possible future liaison. The trend would be that prospective new clients would avoid a booking in order to avoid something understandably anticipated to be uncomfortable. Other types of red flags are comparably incontrovertible and the information favour passed on is of a different nature.

Major abdominal surgical scar and an array of small wounds, some evidently more healed than others. He has not attempted to obscure these in various photos posted. I would surmise laparoscopic incisions. If so, these are not called sores, and that kind of term may get anchored in the minds of readers. Better to ask the source than post innuendo. As acknowledged, one can open the convo with a provider by asking what is important to know about the noticeable in terms of guarding him from wound infection or exacerbation of some condition. Then adjust according to his response. Or inquire afterwards if mode of contact is sustained. There’s usually a way of avoiding putting someone on the spot.

Such a straightforward analogue is digitally performed from a pro state.

You may be mixing up prostate with everything working OK prostrate.

Quietly and discreetly return the missing ‘hood fire hydrant to its rightful place and no charges will be laid.

Or penile or urethral or testicular, unless perhaps related to routine blood tests.

What could go wrong? Only the chance of living up to their collective name … or their Latin name pronounced ‘sit, a cuss’ which seems to track.

Every inch per song counts.

Many strip clubs in my earlier days only had table dances for several years, the strippers grinding away even to the point of nudity though I preferred their panties on in the open. A little more backroom meets burlesque. It would be considered rude to not partake. Yet I had zero desire for exhibitionism. Apart from joking above I have zero interest in gawking at other clients even it were possible. Frankly, I rarely do much more behind the coverage of opaque curtains or other visual barriers.

And?😉

I know him from São Paulo last year. I assume the ad is him. As one could easily deduce from the photos he weighs less than 95 kgs.

So never quite the Cream Pi but getting close.

I have his TwitterX and TikTok (no DM please) that match ad pics but don’t know him other than that his media depicts Dominican Rep flag and he depicted a regular profession unrelated to escorting yet no genuine name. So photos may be stolen and one should vet with video call, 3-finger selfie, or front page newspaper etc. Also has inactivated OnlyFans or broken link, so can’t rule out ad authenticity.

Missed breakie, time for brunch, or as the mods say, pizza.

Tangent alert. Any more obnoxious attempts to throw me off my game and I’m going to have to siphon off power from the EV charger.

No bot is capable of programming handling the convoluted reasoning evident throughout these threads.

What advertising? Gilead’s Oct2023 Truvada package insert reflects exclusively two PrEP placebo control randomized clinical trials (RCTs), 42% and 75% efficacy respectively. And the research has been plowing along for well over a decade.

You cannot compute infection risk by subtracting efficacy from 100. Why don’t you just look up efficacy as described in the public domain? If the arithmetic I think you employed is not how you arrived at it, how did you come up with 20%? You seem to be extending the roulette analogy in a way that undermines your points. The 20% risk factor does not assume anything because it doesn’t exist in the context of PrEP effectiveness. But yes, your emphasis on realistic appraisal of PrEP effectiveness is bang on and I have supported that notion throughout. You lost me at risk math.

Popular misconception. 80% efficacy does not translate to 20% risk. The roulette analogy is misguided. Risk with zero drug prophylaxis, as has been previously discussed, is entirely based on HIV status of partner, transmission probability estimate (1.4%) per episode of receptive anal intercourse, if poz partner has detectable viral load. 20% risk would be based on number of such episodes based on the 98.6% probability of non-infection to the power exponent of number of risk episodes. These consecutive episode numbers and infection probability percentages are unrelated to efficacy metrics. That said, the estimated risk metric is on a downward sliding scale according to degree of any uptake of PrEP, however adherent, as PrEP protection is scaled to adherence. There would, of course, be some threshold of nonadherence that does not at all mitigate the 1.4% risk in spite of some degree of PrEP consumption. That trend is evident among young men.

No, not wrong. It is useful to know and calculate ideal condition efficacy to understand poorer real world non-experimental outcomes, in fact, to determine whether differences are due to chance. Paradoxically, overestimating true efficacy risks obscuring breakthrough infection rates owing to treatment failure versus suboptimal adherence. If true efficacy is claimed to be close to 100% then treatment failure would point exclusively to uptake deficiency (eg, lapse) and that is specious. Practice wisdom conjecture and inevitable contradictions regarding infection breakthrough arise as many variables are complex to measure. Hence the disparity between the Aidsmap and NBC news articles. Some research employs adherence in binary categorical terms (full versus not depending on an arbitrary cut-off) and other research on a continuum based on standardized scales, some based on pill count possibly even ‘smart lids’ and others based on self-report. What is universally known is that for any intervention involving medication adherence is far from ideal. The majority of folks living with HIV demonstrate nonadherence levels that their providers are continually attempting to mitigate. If treatment as prevention (TASP) is fraught with inconsistent uptake why wouldn’t prophylaxis as prevention? PrEP failure is worse because viremia is high upon infection. In contrast, the volume of viral load categorized as undetectable / untransmissable has been determined to be much higher than previously thought for a satisfactory TASP standard. ‘Negative on PrEP’ is at most a rough estimate.

$300? I hope that’s an opening bid, Goldie. 😏

Private Benjamin? [I’ll let myself out.]

What fun for a nerd. Andy Carstens, who by the way did not source his breakthrough infection case reports, would have been well advised to do his homework, reading in fact research reported a substantial period of time prior to his article date. It is likely his estimate was derived from a search of individual case reports that clinicians here and there bothered to submit, probably not structured cohort surveillance. One cannot know because the information is missing. It smacks of confirmation bias. Expected real world infection breakthrough extrapolated from prospective study model surveillance is estimated as 1,500 per million consumers for Apretude over a year, 150-fold the erroneous waaaaay off the mark Aidsmap summation (non-adjusted by time and non-specific uptake mode, as they are episodic cases), and then translating to 1 in 133 over 5 years, and then yet a further 3-fold degree for Truvada. It is more accurate because it follows the same cohort given PrEP. See appended media piece. As I wrote above, retrospective case control research, wherein rates of historical oral PrEP uptake, with appropriate data-censoring following discontinuation, are compared between those later seroconverting and those counterparts that remained HIV negative, matched across key demographic characteristics, yielded poor effectiveness results. In contrast to the aforementioned randomized trial depicting 15 breakthrough cases per 10,000 person years, case control results about 22 cases per 10,000 person years, about 29% of infections PrEP users. Of course PrEP is superior to not being on it. That is the relation between intervention and nothing. It will reduce infection risk, no argument. Questioning and appraising the apparent hyperbole associated with effectiveness simply represents appreciative inquiry however much it spurs hyperventilation response. That part is the relation between an intervention and within-group case incidence. No need to go to the mat. The thread topic pertains to the downstream reality of delineating PrEP status. Breakthrough HIV reported in injectable PrEP trial; experts say drug still very effective WWW.NBCNEWS.COM Experts say breakthrough HIV should still remain rare in those receiving ViiV Healthcare’s...

It’s very poor real world effectiveness -wise in nested case-control study for behaviourally high-risk men (ie, STI occurrence corroborating condom practices) younger than 30 that report categorical use of oral PrEP … about 25% effective, not differentiating insertive from receptive anal. In fact the low end of the metric confidence interval for that age group drops below nil efficacy. HIV incidence is much much lower than overall STI incidence but oral PrEP certainly has its limits. For men over 40, real world effectiveness is much better, approaching that of randomized placebo-control research. Given typical punter-scort age differential the prevention key is client PrEP uptake. That said, synergistic assumptions such as enhanced protection conferred by mutual categorical PrEP use should be made with a grain of salt, condom use making up the efficacy gap according to risk tolerance. At some future point, fingers crossed, the long-lasting depot injection PrEP model may prove to be a real world game-changer.

😊Likely a mix of values, resolve, the good fortune of non-chronicity, and constitutional hypersensitivity. First time pot, barf. That was it. First time moderately inebriated drinking far less than peers, barf. Never again. First time Fentanyl-inclusive monitored anaesthesia for hernia repair, barf barf barf 10 seconds after coming to in wheelchair; team rushed in with IM injection. Fortunately surgeon was steps away on lunch break rather than mid-procedure the next patient. A health care colleague is a renowned pain management psychologist and I would likely seek a referral for non-pharmacological intervention if it came to it, though expensive and non-insured. Or get into a study. I am sure stoicism has its limits and blending that approach with meds a possible eventuality. But, right, Dopesick is certainly heartbreaking.