SirBillybob

Obviously different regional approaches when knowing a Sachertart is in town and knowing a flaky pastry usually filled with nuts and honey is in town.

For clues …

I know one that actually played varsity football. Strips in a club and advertises as well. Others that work in curated settings but don’t use ad platforms. But these variables transcend ethnicity.

Apples oranges. PrEP uptake among the majority of eligibles would make an enormous difference in case incidence. There is substantial leeway for imperfect PrEP adherence of the nature you are describing regarding cholesterol-related medication, missed doses despite adherence intentionality. If cholesterol pharmacological management drugs are reasonably accessible and have salutary outcomes then a rate of 25% uptake at a binary level for folks that can truly benefit from the intervention surely represents complacency at combined individual and systemic levels. Sure, there are stigma-related obstacles with PrEP. One reason that the men I referenced historically as a chorus of future evaluation would assert amazement and critical appraisal at what would seem to them to be a current wackadoodle reality is that the challenges of widespread consumption of PrEP to progress further towards disease eradication are a far cry from what previous consequences and outcomes of infection were. They might also opine that the way MSM galvanized strategies for MPox control could be replicated, that inexplicable contradictions exist within realms of possibility. This is not to dismiss confounders and comparator limitations that relatively temper disappointment and judgement, but let there be Hamlets sniffing around.

He’s been in Rio all autumn following European travels through the summer. I would interpret his USA presence as limited by visa regs, therefore less inclined to cultivate regularized clientele. Unless he has American status currently and the freedom to roam.

There exists a substantial literature on screen-and-treat proposed methods aimed at reducing HIV incidence, but these are simulated mathematical models that yield varying metrics of impact depending on how key variables are inserted algorithmically. The outputs range from modest to miraculously eliminatory. Naturally both serostatus capture for TasP and serostatus capture for PrEP eligibility contribute to reduction goals while posing logistical complications. If several decades ago when absolute regional new case incidence trended at, say, 6-figures annually, if a crystal ball had correctly predicted that virtually failsafe pharmacological prophylaxis could lower transmission to negligible levels within a circumscribed sexually active population most would exclaim with background Madonna tracks running that something is really fucked and riddled with abject complacency about, say, mid-5-figure incidence in 2025 … even with post-diagnosis virologic control, opportunistic infection elimination, inhibited disease progression similarly soothsaid. Or posit challenging retroviral mutation (that didn’t manifest). Success is measured by what could happen given research advances and knowledge/resource context, not some superficially meaningful fraction of potentiality.

Well aren’t both eligible PrEP users and non-users existing within their respective microcosms irrespective of location? If you are a provider the trend would be diligently assortative and comfortably using the tools at your disposal with high levels of self-efficacy. However, if you falsely superimpose your assumptions of impressively high PrEP uptake levels among a selective subset of MSM on the totality of those at-risk and unprotected you may actually reinforce erroneous risk perceptions. This is not unlike the Sullivan paper. Inflating the media-centric obviously positive consequences of PrEP on population rates of infectivity inadvertently blows back on those less schooled, relatively disenfranchised, that quantify risk based on impressive-seeming stats utilized to galvanize access activism. 40% risk reduction is not terrible in the context of seasonal influenza vaccination and hordes of people step up for the jab and feel protected. 40% less HIV infection gets easily conflated with effectiveness, but case incidence reduction is not efficacy. One less incidence of any entity can represent 100% reduction within an arbitrary denominator of 1 billion. That’s of course an extreme example of narrative spin. Guys acquiring HIV infection are lacking the complex personal finesse and systemic resources required for prevention far more than being victims of specifically selective partner mendacity.

Right, Sullivan’s paper, which I actually read recently, not just the reference to it, aligns with my post in terms of estimates of PrEP uptake among eligibles. Of course there is a dose response effect according to uptake rates. Why else would one want to uptick use from what his group deems problematic levels of non-prophylaxis? We now have oodles of data that demonstrate that anecdotal impressions of majority MSM PrEP uptake are bunk. Moreover, note (in the actual The Lancet HIV ) they use the descriptor “modest” for overall HIV incidence reduction attributable to uptake. It’s 2.4 cases per 100,000 capita decade to decade. It's only statistically significant with enormous population denominators that confer adequate statistical power. At the best state-cluster case reduction levels delineated, that translates to a reduction from 38 per million in baseline year to 24 per million 10 years on. Naturally 14 less cases with that capita denominator is of value. One point of the paper, put softly however, was to imply it is a poor showing owing to the problem of low PrEP overall uptake and the failed imperative of pushing for improved and regionally equivalent access and consumption. But percentages are often misleading as bullet points and can overblow absolute or objectively meaningful change. PrEP is laudable to the extent enough is dispensed and taken to put a meaningful dent in HIV case incidence. The low impact to date is downplayed in the reference article, paradoxically, so it is not shapeshifted to complacency among policy makers that could influence higher uptake levels. The relation between uptake levels and (albeit mediocre) case reduction is highlighted to forward the improvement agenda. This paper is positioned contemporaneously with threats to resource allocation globally. Surely risk perception is influenced by distorted assumptions about what proportion of MSM eligibles take PrEP. At the point-of-intercourse level false assumptions that more than a quarter of seronegative partners are prophylaxis-positive is really bad. Risk perception in studies highlights the degree to which those sexually active believe they can be infected more so than the degree to which infection consequences are serious these days.

PrEP uptake rates among eligible at-risk MSM have been studied meta-analytically. They remain disturbingly low especially among younger males. The subpopulation proportions that are PrEP consumers based on solid candidacy are so poor in number that one might say differences regionally are comparable according to bad versus very bad. Appended is an example of the negligible true impact of country position on the theoretical low/middle/high income gradient in which resource access is typically subsumed. PrEP non-uptake in spite of appropriate indication is so poor that it essentially overrides much of the association between condom use and non-PrEP insofar as substantial proportions of MSM have completely unprotected sex without partialized prophylaxis.

My last 50 sexual partners, all well established in the MSM category, without knowledge of my condom use preference, had condoms on their person. Since I accept and value condom use I don’t bother to assess options for application or not. The only way to validate that everybody is on HIV PrEP and unconditionally barebacks is to ascertain that no condoms exist within a reasonable physical radius for a majority of the cohort with whom you are sexually active. They tend not to be decorative, for brand placement, or erroneously conflated with lube packets of similar dimension. Condoms are often, if obviously not always, the default and there’s no fault in looking around without blinders for a balanced assessment not loaded with personal preferential bias. The most I can say without sounding dumb is that some guys use condoms and others don’t, circumstantially according to a host of factors including serostatus, PrEP, and TasP.

There seems to be some question as to the variability of condom use applicability according to specific sexual acts, outside of pharmacological prophylaxis considerations. Receptive vs Insertive anal intercourse is a relatively simple binary divider for risk metrics. In contrast, the three anatomical sites for the most common and frequently referenced bacterial STIs may determine the overt signals of infection that prompt diagnosis tests beyond routine lab evaluation time period iterations. What can seem to be a random contradiction in prophylaxis preference or insistence may actually reflect more method in madness than appears at face value. Similarly, lack of accurate and undistorted knowledge in terms of such complex transmission, symptomatology, and treatment amenability factors may yield confusing behavioural contradictions where naïve ignorance legitimately passes as nonclinical madness. What a juggling act for all of us.

I decided a few years ago as a senior that I would take a single dose of Gardasil 9 at out-of-pocket cost, based on emerging research and opinion at the time on immunogenicity and effectiveness, and of course the bridging considerations with respect to being of an age outside the bounds of study cohorts. I’m not American but I believe that CDC continues to align with Merck’s product monograph indicating multiple doses. In Québec my discussion and rationale all occurred only with the pharmacist, not my MD, as pharmacists here have extended prescription and dispensing privileges in particular clinical areas. For anybody planning additional doses be sure to be aware of the dosing intervals, as the clinical guidance suggests a nullification of desired benefit if not followed to the letter; that said, the imperative of more than one is under review by most jurisdictions. The latency of non-uptake consequences, that is, non-vaccination leading to greater probability of malignancy way down the line naturally renders nailing down the threshold of adequate dosing frequency a challenge. The Power of a Single Dose: Evidence for a Single-Dose HPV Vaccine Schedule | International Vaccine Access Center PUBLICHEALTH.JHU.EDU

Since the eighties, knock on wood into my nineties.

Mileroticos is highly disorganized and repeats ads by latest dates or same guy different ad with same number. A tip: scroll through and redden the heart outline with a click for each one whose single profile photo catches your eye. Then just go through the red-hearted list you created by clicking the red-outlined white heart at the very top of the platform page that will pull up your highlighted choices as a shortlist. Consolidates duplicates and avoids endless back and forth between a single profile view and the thumbnail list. I also Google the phone number of a prospect for red flags such as same number different profile.

Depends on your rewind/replay trends.

Right, effectiveness and immunogenicity bridging assumptions are applicable without knowing what risk-tier subtype infections have already left the station. In fact, the lower bounds of confidence intervals even for youth in some studies represent surprisingly poor outcomes. Nevertheless I took Gardasil at out-of-pocket cost past age 65; one can live several additional decades and, perhaps more importantly, augment protectionism with respect to intimacy with unvaccinated young adults. Some degree, latency notwithstanding, of herd immunity contribution if not directly conferred absolute transmission prevention to individual partners.

Not to undermine the well-intentioned purpose of the thread, but at first glance the heading inquiry appeared to be leading to ‘getting throat-banged’, which would be rather odd for this forum and its population share of boomers. 😏

Were the two of you characteristically monogamous and with happy feet for a single breeding season?

YouTube user utilization, hence a surrogate marker for social media awareness etc, around the time frame of the scene, about 2010, was about 5% what it is today. So sue the evidently unplugged Mr Hollander. Product branding within that platform was just getting started. The scene was also meant to contrast the Canadian’s mother’s key managerial role playing somewhat against type in her son’s career, the father more a tag-along with values less oriented to undue pressuring his son, while the Russian player’s father a pushy taskmaster.

You likely won’t be asked to produce ID documentation, but wise to carry a passport copy. (Something more official than a xerox if you want to ride public transport for free, if of senior age.) The Clube 117 venue rates usually vary on discount Wednesdays, for which that sedate day’s Instagram banner ad simply denotes ‘weekly promotion’, and the famous free room let Tuesdays, for which you are expected to be fair with your share and not extend occupancy, as the queue is substantial. On normal days and discount quarta-feira the house may round up the added price for the final consecutive 40-minute iteration utilized in open-ended sequence even if it’s partial. Be reasonable in pushback if it seems unfair such as merely a few minutes into the last iteration. I believe it is all computer automated by item, perhaps even clocked according to the room key location from point of issue to return, so likely a binary tally programmed for each 40-minute block where the final 77 reais will be added or removed by the cashier at their discretion, not easily subject to partialized rate negotiation. You can view all the charges on the screen. You may gently appeal according to what is reasonable on both sides with respect to the final fractionated period if relevant. Note that most of the room clocks are non-functioning.

Commiserations. Your loss consolidates my strategy. I also just left Barcelona. I wear two layers of lightweight hiking trousers. Inside pants pockets hold everything I’m not prepared to have lifted. Outer pair basically empty pockets including my 22.00-ish Euro T-usual transit card that I also keep in the inner pants pocket even after scanning it. Recently a group of four adults that looked like they were together but of differing ages embarked at Plaça de Sants station. I was standing at the centre pole of the car because I was only going a few more stops northwest. I frequently take the subway at home and in other cities. I thought, however, there was a lot of brief but unnecessary brushing and jostling against me by these folks in Barcelona. I wasn’t directly obstructing the space they would have needed to occupy. How they seemed to game it was looking rushed and flustered as if they had had to dash to get on, but I don’t think that was the case. Another time an unfortunate young guy eating near my table in Plaça Espanya got up for a few seconds to get a napkin or something steps away at the service counter. His knapsack was promptly lifted from under his table; neither of us noticed the act. As most know it is a circular arena structure and he had to quickly choose a direction in the lower food court to try to give chase, ultimately futile. Imagine the smoothness of operators that are that prepared to pounce on a random break in guardedness.

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Next time, sex o’clock. No, that isn’t my accent.

Gotta watch those Canadians, and an occasional jealous waf here and there.

But those faces look quite contorted, with gag-induced tears and extremely flushed complexion, not so representative of resting face.