Condom and bareback discrepancy

[pubic_assistance]

9 hours ago, ShortCutie7 said:

Flexibility” meaning a lack of commitments/responsibilities and constraints.  

So...people who don't care if they die from sexually transmitted diseases (as long as it's not HIV) because they don't have any responsibility to anyone else.

Maybe that's why I'm of a very different attitude on the subject. I have a wife and children and other family and friends that rely on me. So..yes..I can't be so careless about my health.

Maybe its lonliness that leads other to playing Russian Roulette with their sex life.

Edited November 2, 2024 by pubic_assistance
spelling

[ShortCutie7]

33 minutes ago, pubic_assistance said:

So...people who don't care if they die from sexually transmitted diseases (as long as it's not HIV) because they don't have any responsibility to anyone else.

Maybe that's why I'm of a very different attitude on the subject. I have a wife and children and other family and friends that rely on me. So..yes..I can't be so careless about my health.

Maybe its lonliness that leads other to playing Russian Roulette with their sex life.

Yes, that is basically what I’m getting at.

[SirBillybob]

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? 

Edited November 2, 2024 by SirBillybob

[LookingAround]

12 hours ago, pubic_assistance said:

Why would you be envious of people playing Russian Roulette with their health? There's an outbreak of anti-biotic-resistant gonorrhea, chlamydia and syphilis going around because of people who run around barebacking everyone they meet.

Russian roulette? Don't be dramatic. 

[SirBillybob]

3 hours ago, LookingAround said:

Russian roulette? Don't be dramatic. 

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.

Edited November 2, 2024 by SirBillybob

[+ DrownedBoy]

22 hours ago, pubic_assistance said:

.Maybe that's why I'm of a very different attitude on the subject. I have a wife and children and other family and friends that rely on me.

Yup, we have to mention the wife and family as if the closet makes you superior 🙄

[mike carey]

Closet? @pubic_assistance? I must have been misunderstanding things here to an epic level.

[LookingAround]

38 minutes ago, DrownedBoy said:

Yup, we have to mention the wife and family as if the closet makes you superior 🙄

Every other post mentions it and every post mentions bi. Did you know he was bi?

[SirBillybob]

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? 

Edited November 3, 2024 by SirBillybob

[pubic_assistance]

1 hour ago, mike carey said:

Closet? @pubic_assistance? I must have been misunderstanding things here to an epic level.

Me too ! 😆

[pubic_assistance]

27 minutes ago, SirBillybob said:

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? 

Certain gay men can't help but feel their inferiority when someone they think is superior reminds them of why they feel inferior.

That said...my statement simply meant that some of us have responsibilities to others and some of us don't.

As @SirBillybob pointed out we ALL have a responsibility to ourselves to mitigate risk. The trade-off risk for a minor bit of additional dick-sensitivity pleasure may likely correlate with how much you don't care about your health because nobody else cares.

[+ Vegas_Millennial]

On 11/3/2024 at 5:41 AM, DrownedBoy said:

Yup, we have to mention the wife and family as if the closet makes you superior 🙄

I'm sure there are many things about @pubic_assistance that make him superior!  To his point on personal responsibility, I have known a few grown men who changed their health habits when they unexpectedly had children at an older age.  They wouldn't change their habits to become healthy for themselves, but they would change habits to make sure they'd be around for their children as long as they could.

[marylander1940]

Several escort friends have told me that all of the sudden more and more clients (even though they are on PrEP) are asking the provider to use condoms for anal. 

[+ 7829V]

On 11/2/2024 at 12:06 PM, SirBillybob said:

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.

The ‘Russian roulette’ analogy seems overly dramatic. In Russian roulette, pulling the trigger with a bullet leads to immediate death, while an HIV infection today is treatable, allowing individuals to live long, healthy lives. So yes, the analogy does feel exaggerated.

[+ ApexNomad]

37 minutes ago, 7829V said:

The ‘Russian roulette’ analogy seems overly dramatic. In Russian roulette, pulling the trigger with a bullet leads to immediate death, while an HIV infection today is treatable, allowing individuals to live long, healthy lives. So yes, the analogy does feel exaggerated.

It might seem like an exaggeration, but after watching so many of my brothers die from AIDS, getting HIV felt like an immediate death sentence. The fear of getting it, the uncertainty… it was something we all carried in those days. I understand the analogy. 

[Luv2play]

8 hours ago, ApexNomad said:

It might seem like an exaggeration, but after watching so many of my brothers die from AIDS, getting HIV felt like an immediate death sentence. The fear of getting it, the uncertainty… it was something we all carried in those days. I understand the analogy. 

Yes but the analogy is now obsolete. The emergence of effective treatment for HIV meant that getting infected went from a death sentence to a life sentence. 
 

Then the emergence of Prep meant that whether one was hivpos undetectable or neg on prep, meant that each took a single pill a day to maintain their relative health status. 

[+ ApexNomad]

4 minutes ago, Luv2play said:

Yes but the analogy is now obsolete. The emergence of effective treatment for HIV meant that getting infected went from a death sentence to a life sentence. 
 

Then the emergence of Prep meant that whether one was hivpos undetectable or neg on prep, meant that each took a single pill a day to maintain their relative health status. 

I’m not debating the efficacy of treatments or the game-changer that is PrEP, but rather the understanding of the analogy and the emotion behind it. Treatment may have changed, but the fear remains. For those of us who lived through it, that sense of a “death sentence” is etched in our bones. Some things progress can’t erase.

[pubic_assistance]

1 hour ago, ApexNomad said:

For those of us who lived through it, that sense of a “death sentence” is etched in our bones. Some things progress can’t erase.

There are too many gay men who are under the false impression that both HIV preventative and HIV positive treatment pharmaceuticals are 100% efficient with no detrimental side effects to their health.

[marylander1940]

48 minutes ago, pubic_assistance said:

There are too many gay men who are under the false impression that both HIV preventative and HIV positive treatment pharmaceuticals are 100% efficient with no detrimental side effects to their health.

most of them gay men in the down low pretending to be straight. 

 

[pubic_assistance]

3 minutes ago, marylander1940 said:

most of them gay men in the down low pretending to be straight. 

 

So...you think men on the DL are the only ones who think that a pill is going to solve all their HIV risk ? I am confused by that statement.

[marylander1940]

2 minutes ago, pubic_assistance said:

So...you think men on the DL are the only ones who think that a pill is going to solve all their HIV risk ? I am confused by that statement.

no, I'm just saying that before and after PrEP "most" of them were in denial about many things including HIV/STDs.

[SirBillybob]

15 hours ago, 7829V said:

The ‘Russian roulette’ analogy seems overly dramatic. In Russian roulette, pulling the trigger with a bullet leads to immediate death, while an HIV infection today is treatable, allowing individuals to live long, healthy lives. So yes, the analogy does feel exaggerated.

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. 

Edited November 13, 2024 by SirBillybob

[SirBillybob]

3 hours ago, Luv2play said:

Yes but the analogy is now obsolete. The emergence of effective treatment for HIV meant that getting infected went from a death sentence to a life sentence. 
 

Then the emergence of Prep meant that whether one was hivpos undetectable or neg on prep, meant that each took a single pill a day to maintain their relative health status. 

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. 

Edited November 13, 2024 by SirBillybob

[SirBillybob]

3 hours ago, ApexNomad said:

I’m not debating the efficacy of treatments or the game-changer that is PrEP, but rather the understanding of the analogy and the emotion behind it. Treatment may have changed, but the fear remains. For those of us who lived through it, that sense of a “death sentence” is etched in our bones. Some things progress can’t erase.

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. 

Edited November 13, 2024 by SirBillybob

[SirBillybob]

12 hours ago, 7829V said:

The ‘Russian roulette’ analogy seems overly dramatic. In Russian roulette, pulling the trigger with a bullet leads to immediate death, while an HIV infection today is treatable, allowing individuals to live long, healthy lives. So yes, the analogy does feel exaggerated.

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. 

Edited November 13, 2024 by SirBillybob