Condom and bareback discrepancy

[MscleLovr]

2 hours ago, Luv2play said:

The emergence of effective treatment for HIV meant that getting infected went from a death sentence to a life sentence. 

Just asking for information please. Being retired, I’m no longer up to date with research/statistics.

I do recall that some years ago, there were reports of a number of people for whom the treatment was NOT effective. Is that no longer the case?

(For the record, I always use condoms. I have a much younger partner and I want to make sure he stays healthy.)

[+ ApexNomad]

32 minutes ago, SirBillybob said:

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 risk is simply what us important. 

I understand the intention behind the analogy, and I appreciate that PrEP has changed the landscape around HIV risk today. My perspective is more about the lasting emotional weight for those who saw HIV as a death sentence in the past. Even with today’s advances, that fear and impact still linger for many of us.

[SirBillybob]

26 minutes ago, MscleLovr said:

Just asking for information please. Being retired, I’m no longer up to date with research/statistics.

I do recall that some years ago, there were reports of a number of people for whom the treatment was NOT effective. Is that no longer the case?

(For the record, I always use condoms. I have a much younger partner and I want to make sure he stays healthy.)

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. 

Edited November 13, 2024 by SirBillybob

[pubic_assistance]

2 hours ago, SirBillybob said:

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. 

This has been argued here on C.o.M. multiple times with multiple dreamers chastising me for raining on their parade. They all want to believe that PreP is 100% effective when every study has shown its definitely NOT anywhere near that high.

[LookingAround]

Prep is 99% effective. 

Pre-Exposure Prophylaxis (PrEP) | HIV Risk and Prevention | HIV/AIDS | CDC

WWW.CDC.GOV

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PrEP is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill...

 

[+ Jamie21]

20 minutes ago, LookingAround said:

Prep is 99% effective. 

Pre-Exposure Prophylaxis (PrEP) | HIV Risk and Prevention | HIV/AIDS | CDC

WWW.CDC.GOV

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PrEP is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill...

 

Add the very important element: ‘when taken as prescribed’. It often isn’t taken as prescribed. 

[ChipHolder]

24 minutes ago, Jamie21 said:

Add the very important element: ‘when taken as prescribed’. It often isn’t taken as prescribed. 

👀 This!

And…99% is really high, but it’s still only 99%. 

[SirBillybob]

1 hour ago, LookingAround said:

Prep is 99% effective. 

Pre-Exposure Prophylaxis (PrEP) | HIV Risk and Prevention | HIV/AIDS | CDC

WWW.CDC.GOV

---

PrEP is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill...

 

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.

Edited November 17, 2024 by SirBillybob

[TorontoDrew]

3 hours ago, Jamie21 said:

Add the very important element: ‘when taken as prescribed’. It often isn’t taken as prescribed. 

And that is the part that concerns me.  I can't take Prep so I always require a condom.  It's not a perfect solution either but it's best I can do.

[pubic_assistance]

1 hour ago, TorontoDrew said:

I always require a condom.  It's not a perfect solution either but it's best I can do.

I've been fucking my brains out with thousands of people over the past 33 years. I've been using condoms and no pharmaceuticals. Never a single STI. So yeah...not 100% effective but more broad spectrum effectiveness than relying on PreP only and winging it with all the other STIs.

[LookingAround]

What exists here and what happens in the gay world is like night and day. This isn't the real world. 

[SirBillybob]

16 hours ago, LookingAround said:

What exists here and what happens in the gay world is like night and day. This isn't the real world. 

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.

Edited November 18, 2024 by SirBillybob

[LookingAround]

I'm not a layperson. And of course each person must appraise his own level of acceptable risk. 
That wasn't the subject of my statement which seems lost on you. 

[pubic_assistance]

On 11/18/2024 at 10:33 AM, SirBillybob said:

No big shock that lack of consensus, mirroring substandard knowledge translation by the clinical community, would manifest in a predominantly layperson message board.

Not to mention the desire of Pharmaceutical companies wanting to sell their product.

Misrepresenting the efficacy does a lot to sell product and does a lot to put people at more risk than they may willingly take were they more informed of the accurate data.

[marylander1940]

On 11/17/2024 at 8:08 AM, Jamie21 said:

Add the very important element: ‘when taken as prescribed’. It often isn’t taken as prescribed. 

Agreed, as prescribed and also lifestyle, diet, etc. I doubt many guys on PNP remember taking it daily

[+ Jamie21]

6 hours ago, marylander1940 said:

Agreed, as prescribed and also lifestyle, diet, etc. I doubt many guys on PNP remember taking it daily

I remember to take it every day! If I miss a day I take two. They told me that is how to restart after a break. 

[SirBillybob]

19 hours ago, LookingAround said:

I'm not a layperson. And of course each person must appraise his own level of acceptable risk. 
That wasn't the subject of my statement which seems lost on you. 

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.

Edited November 20, 2024 by SirBillybob

[pubic_assistance]

44 minutes ago, SirBillybob said:

To suggest that a message board that celebrates MSM intimacy is in no way a representative microcosm of the broader community is, well, peculiar. 

I agree. The fact that we are all here discussing paying for sex disregards the otherwise broad range of demographics.

[SirBillybob]

9 hours ago, Jamie21 said:

I remember to take it every day! If I miss a day I take two. They told me that is how to restart after a break. 

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. 

Edited November 20, 2024 by SirBillybob

[+ Jamie21]

2 hours ago, SirBillybob said:

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. 

Couple of questions: Was that study funded by the maker of Apretude? Have you any affiliation with them? 

[LookingAround]

Somebody here made an accusation of misquoting stats. Who here has done that?

I take the Apretude injection every other month. Total compliance. Not difficult. 

[SirBillybob]

On 11/20/2024 at 1:11 PM, Jamie21 said:

Couple of questions: Was that study funded by the maker of Apretude? Have you any affiliation with them? 

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?

Edited November 21, 2024 by SirBillybob

[+ Jamie21]

1 hour ago, SirBillybob said:

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?

I’m in UK. It’s free at the point of use on NHS for me. 

[+ sniper]

I thought I had read that when they took blood samples from the people who seroconverted in PreP studies the evidence indicated they pretty much just weren't taking it at all, not just they missed a dose here or there. Someone too undisciplined to take a pill isn't likely to consistently put on a rubber either.

There are now generics for PreP that are like 30 bucks a month. The only reason there is still major money made in PreP is the ACA mandates full coverage and pharmacy benefit managers steer the formularies to the expensive brands. That's the real scam. I got a prescription and was shocked when I saw how much my employer paid.

Edited November 21, 2024 by sniper

[SirBillybob]

1 hour ago, Jamie21 said:

I’m in UK. It’s free at the point of use on NHS for me. 

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

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The National Institute for Health and Care Excellence (NICE) does not recommend the injectable HIV...