Poking a sleeping dragon

[Steven_Draker]

CARTE BLANCHE FOR UNPROTECTED SEX?

 

Last month the big news in the battle against HIV was that the FDA had approved the drug Truvada for use by HIV-negative people engaged in high-risk behavior, as a means to prevent infection.

 

The announcement was met with enthusiasm by the LGBT media and many AIDS advocates and health-care workers, who saw it as a vital tool in keeping people from seroconverting. But as prescriptions start to be written for perfectly healthy gay men, we have to wonder: is this a good idea?

 

First there’s the psychological hurdle: The idea is that someone who engages in high-risk behavior, like bareback sex, can keep from acquiring HIV by taking Truvada daily. (It’s called PrEP, or pre-exposure prophylaxis.)

 

But if someone can’t be relied on to use condoms regularly, can they be relied on to take a pill every single day for the rest of their sex lives? Even if they can, how would a potential sex partner know who was actually on PrEP and who was just claiming to be?

 

Then there’s the scientific concern: We’re seeing strains of gonorrhea that are resistant to almost all forms of antibiotics, in part because of how frequently such drugs are given to people for a host of maladies. And we know HIV is a wily virus—is it too far-fetched to think PrEP might help facilitate a Truvada-resistant strain of HIV?

 

There’s a host of other concerns. As Lawrence Ferber explains in Next magazine:

 

According to several clinical trials, Truvada’s success in reducing infections has varied widely between 42%–84% percent. That’s far from 100%. The cost of the medication itself is substantial, ringing in at as much as $16,000 per year, while bimonthly doctor’s office visits and blood work to monitor kidney and liver function are also required.

 

As with all HIV medications, PrEP can also take a heavy toll on the body in immediate unpleasant side effects (nausea, bloating and abdominal pain, headaches, dizziness) and serious long-term ones (liver and kidney problems/failure, fat redistribution, loss in bone density).

 

And obviously, Truvada won’t protect you from any of the other STIs that are out there.

 

We’re uncomfortable with the idea of keeping a medication that could save lives out of the hands of people who need it the most. But will Truvada or other PrEP medications make those who take them think they have carte blanche to have unsafe sex?

 

source: http://www.queerty.com/question-should-prep-treatments-like-truvada-be-encouraged-for-hiv-negative-people-20120815

[Steven_Draker]

5 Things to Know About Truvada:

 

"Doctors now have another weapon against HIV/AIDS in their arsenal, and it’s a potent one. For the first time, the U.S. Food and Drug Administration (FDA) approved a drug treatment that will prevent infection in healthy people.

 

The drug, called Truvada, which is already approved for the treatment of HIV in infected patients, works by lowering the amount of virus circulating in people’s blood. But clinical trials show that it can also protect uninfected high-risk people from acquiring the virus, if they take the drug daily before and after exposure.

 

The approval is controversial. Some public health experts argue that allowing the drug to be used for prevention will foster a false sense of security among users, leading people to believe mistakenly that they are immune to the virus and reduce their use of condoms. However, the FDA determined that the benefits of expanding the pool of people who may use Truvada to protect against HIV made it worth approving. Here’s what you need to know.

 

 

 

Who can take Truvada?

The drug, made by Gilead Sciences Inc., is approved for healthy, uninfected people who are at high risk of contracting HIV through sex. These include sex workers and people with partners who are HIV-positive or engage in high-risk behaviors, such as using IV drugs.

 

 

How effective is the drug in preventing HIV?

In one study, healthy gay and bisexual men who took Truvada daily and were counseled about safe sex practices lowered their risk of becoming infected by up to 42%. In another study involving heterosexual couples in which one partner was HIV-positive, the uninfected partner had a 75% lower risk of contracting HIV if they took Truvada.

 

 

Does Truvada cure AIDS?

No. The drug can treat people who are infected with HIV by lowering the amount of virus in their bodies and slowing down the progression of the disease. In healthy, uninfected people, the drug can thwart HIV’s ability to take hold in healthy cells and start an infection, by blocking the activity of an enzyme that the virus needs to replicate.

 

 

Why is the approval controversial?

Some experts believe that healthy people may not take the drug correctly — it needs to be taken daily to be effective — which would encourage HIV to become resistant to the medication. Public health officials also worry that people may engage in more risky behaviors when they are on the drug, believing they are protected completely against HIV, which they are not. However, patients who receive Truvada prophylactically will be expected to participate in a comprehensive HIV protection plan involving regular HIV testing, condom use and prevention counseling and support. Clinical trials have not shown that users are more likely to engage in risky sexual behavior.

 

Researchers also can’t explain why in one study involving female sex workers, those who took Truvada to prevent HIV were not protected against infection. The authors think that the participants did not take the drug in the right doses, but it’s also possible that something about the vaginal environment makes the drug less effective.

 

 

Why is the approval important?

Approving a drug to prevent HIV marks a big step toward controlling the spread of HIV and AIDS, not just in the U.S. but worldwide as well. Once Truvada is used as a preventive measure domestically, U.S.-backed AIDS programs in the developing world may also begin to roll out the pill for healthy people who are at high risk of contracting HIV. Public health experts are eager to build up all effective prevention strategies, noting that the only way to stop the epidemic is by preventing new infections as well as treating existing ones."

 

source: http://healthland.time.com/2012/07/17/truvada-5-things-to-know-about-the-first-drug-to-prevent-hiv/

 

 

http://www.rogertatoud.com/wp-content/uploads/2009/07/HIV-Prevention2.png

[marylander1940]

...

 

According to several clinical trials, Truvada’s success in reducing infections has varied widely between 42%–84% percent. That’s far from 100%. The cost of the medication itself is substantial, ringing in at as much as $16,000 per year, while bimonthly doctor’s office visits and blood work to monitor kidney and liver function are also required.

 

As with all HIV medications, PrEP can also take a heavy toll on the body in immediate unpleasant side effects (nausea, bloating and abdominal pain, headaches, dizziness) and serious long-term ones (liver and kidney problems/failure, fat redistribution, loss in bone density).

 

 

I agree with you SD when it comes to safe sex, as I said before on a previous forum: if we ALL use condoms we'll defeat HIV.

 

http://1.bp.blogspot.com/_5P6BsLLz1y8/S7wupTqZ_1I/AAAAAAAADo8/vwR07NJgFs8/s1600/IMAG0085.jpg

[Steven_Draker]

if we ALL use condoms we'll defeat HIV.

 

Ok, ok ...

 

http://calicorockumc.com/wp-content/uploads/2013/09/unrealistic.jpg

 

Look up the graph on HIV Prevention posted above.

[+ purplekow]

I wouldn't be too harsh on that poster, who is also a health care provider. It's most probably an unintentional typo.

 

We all make mistakes, when in a hurry, myself included.

As I mentioned, it may well have been a typo but that further emphasizes that the internet is not the place to get medical information. There is not necessarily fact checking and editting. So that even a knowledgeable person may wind up supplying incorrect information.

[+ Funguy]

This is definitely true. For example, there is a posting on here which says there is no treatment for Hepatitis A and C and only bad treatment for Hepatitis B. The most glaring error there is the no treatment for Hep C. There are recent medications for Hep C which are oral and relatively short course, think weeks rather than more than a year with the old treatment which was administered once a week. The posting may have been a typo, but even so, that is further proof that the best place to get information is directly from a well educated and well informed care provider. For any serious medical issues, a second opinion is a must, time permitting.

 

Yes...I will have to mea culpa to the typo.

The fact remains, this thread is really about condom usage and it hasn't been blown out of the water.

CLEARLY, there are a lot of people out there who are sorely in need of information. I heartily agree the internet is NOT the place to start or even rely on so, people, find those physicians with whom you can have a candid conversation and pull educational materials.

[Guest ChrisW]

No one is suggesting that anyone stop being sexually active. What is being asked is to stop being sexually stupid, Having safer sex using a condom has the benefit of lower cost. Just because it doesnt come out of your pocket directly doesnt mean you arent paying real dollars for it indirectly. Someone is paying the bill Condoms also do not have the side effects that drugs have. The sensitivity may be less, but when used properly, condoms are cheap, safe and effective.

Truvada is effective as well. When taken faithfully as diected. And fortunately young men out to have sex are notorious for always responsible in taking medication And just because you are taking Truvada, doesnt mean that you cannot use a condom as well.

Condom use has decreased in gay men. partly due to apathy, partly due to ignorance, partly due the belief that science will save us with the next new thing.

Those who do not learn from the past are destined to repeat it. Not worrying about resistence is short sighted and foolish. Resistance will develop there is no may in that. It is a matter of when and the real question is whether there will be something else to use by the time the resistance becomes an issue.

My advice, use a condom. If you choose to use Truvada do it as well not instead. I saw many beautfiul young men become gaunt and hollow and then slip away. Perhaps you would feel differently about the importance of being safe if you knew first hand the terror of the uncertainty of the early years of HIV.

But hey, i am an old fuck that made it through, what the hell do I know.

Chris, i notice that you title here is Novice, it seems Daddy got that one right.

 

I have said it twice on this post and I will say it again, keep your emotional diarrhea to yourself. It posted this topic to get a conversation started that needs to be discussed. HIV is an incredibly loaded topic that has affected our community in a very profound way that is bound to make people feel emotional but those emotions hinder the conversation. I wanted to provide a safe place to ask questions but if you are seriously considering taking Truvada please talk to a healthcare provider to get questions you may have answered.

 

As for typo's I will make sure to put my glasses on the next time I post. Without them I can't see!

[Guest ChrisW]

Something to think about

 

“If their friends all died like mine did, maybe they would think twice before having sex without a condom,” goes a typical remark, drenched in self pity and tenuous logic.

 

This statement misrepresents our lost friends and oversimplifies the state of HIV today. It projects our grief in the direction of those who bear no responsibility or resemblance to what we experienced. It subtly blames our departed friends for their mistakes, and then tries to equate them with a new generation of gay men who are much too smart to buy into it.

 

http://marksking.com/my-fabulous-disease/stop-bludgeoning-young-gay-men-with-our-aids-tragedy/

[+ Funguy]

No one is suggesting that anyone stop being sexually active. What is being asked is to stop being sexually stupid, Having safer sex using a condom has the benefit of lower cost. Just because it doesnt come out of your pocket directly doesnt mean you arent paying real dollars for it indirectly. Someone is paying the bill Condoms also do not have the side effects that drugs have. The sensitivity may be less, but when used properly, condoms are cheap, safe and effective.

Truvada is effective as well. When taken faithfully as diected. And fortunately young men out to have sex are notorious for always responsible in taking medication And just because you are taking Truvada, doesnt mean that you cannot use a condom as well.

Condom use has decreased in gay men. partly due to apathy, partly due to ignorance, partly due the belief that science will save us with the next new thing.

Those who do not learn from the past are destined to repeat it. Not worrying about resistence is short sighted and foolish. Resistance will develop there is no may in that. It is a matter of when and the real question is whether there will be something else to use by the time the resistance becomes an issue.

My advice, use a condom. If you choose to use Truvada do it as well not instead. I saw many beautfiul young men become gaunt and hollow and then slip away. Perhaps you would feel differently about the importance of being safe if you knew first hand the terror of the uncertainty of the early years of HIV.

But hey, i am an old fuck that made it through, what the hell do I know.

Chris, i notice that you title here is Novice, it seems Daddy got that one right.

 

Purple, now that I have my glasses on, my morning coffee in front of me, I find that even you need to proofread your posts for typos, too.

Oops, I shouldn't get bitchy. Really, the point of this thread is to disseminate information to those who need the information. My post should have read, No treatment for Hep A, B and only non-curative treatment for Hep C. Sorry.

 

Chris may be a novice when it comes to some things but he is smart enough to ask for info when he doesn't know the answers. That puts him way in front of the pack!

 

Lighten up, gentlemen! We take for granted that everyone knows what we know. Well, everyone doesn't. Let's at least point them in the right direction and then they, too, can be….

 

Funguy

[Okliehomo]

From the title of the thread, I thought this was going to be about the "Game of Thrones" finale.

 

Boy, was I wrong.....

[Newly]

Ok, here's part of what makes this so hard. When you see that Truvada is 47-99 percent effective, you go, wow, that's not very safe. But when you dig deeper, it turns out that the 47% and lower numbers are when the person skips pills! when taken as directed the safety factor goes up to almost 99.9% - that's a huge difference. How do you know if the other party is taking it as directed? You don't...but if you take it yourself you're in control of how safe you are, right? By the way, when you've gone to the same doctors for years and know them socially it's hard to leave them for a new doctor. I'm not saying it shouldn't be done, but especially for long term relationships it's hard to change. And with all the electronic back and forth of medical records now it's really uncomfortable to have your doctor know that you're going to a new one without even considering the fact that your insurance may not cover a provider that far away.

[+ Funguy]

From the title of the thread, I thought this was going to be about the "Game of Thrones" finale.

 

Boy, was I wrong.....

 

Maybe not….

[+ Funguy]

Ok, here's part of what makes this so hard. When you see that Truvada is 47-99 percent effective, you go, wow, that's not very safe. But when you dig deeper, it turns out that the 47% and lower numbers are when the person skips pills! when taken as directed the safety factor goes up to almost 99.9% - that's a huge difference. How do you know if the other party is taking it as directed? You don't...but if you take it yourself you're in control of how safe you are, right? By the way, when you've gone to the same doctors for years and know them socially it's hard to leave them for a new doctor. I'm not saying it shouldn't be done, but especially for long term relationships it's hard to change. And with all the electronic back and forth of medical records now it's really uncomfortable to have your doctor know that you're going to a new one without even considering the fact that your insurance may not cover a provider that far away.

 

There is never a GOOD reason for not going to the healthcare provider who will give you the best care. If you are concerned with the social implications and you also find that the physician you have been seeing is uncomfortable with gay health issues, and you are out to him, then he will be relieved you are going elsewhere.

 

There are ways to opt out of electronic record sharing between physicians. Once you leave a physician, he is no longer entitled to your ongoing records. Unless there is something important in your records at doctor #1 (e.g. relevant laboratory/x-ray results, immunization dates) there is also no need to have the record "transferred." If those relevant studies are in the record, just ask your doctor for a copy "for your records."

 

Yes, the insurance bugaboo - usually, that can be worked around. Generally, you are not required to pick a primary care provider in the city in which you live but, at least in California, it used to be that it had to be within 26 miles of the hospital you pick. If you want to see a doctor 200-300 miles away as your PRIMARY care physician, you have to pick a hospital, etc. in that area. Being able to see that physician is what's important in your situation. Maybe a one-time consultation would be all that's necessary. If that "gay doc" could be considered a specialist, then the visit is a consultation that your present doctor could make as a referral.

 

On the other hand, if you simply want information/consultation, maybe your present doctor will make a referral to a LGBT center. If one is not in your area to be covered by your insurance, often insurance companies will have to cover one elsewhere. Also, if you are going to pay out of your pocket, many of these clinics or centers have sliding scales and very reasonable fees. It is also nice to have a relationship somewhere BEFORE you really need it.

 

Good luck!

[marylander1940]

Ok, ok ...

 

http://calicorockumc.com/wp-content/uploads/2013/09/unrealistic.jpg

 

Look up the graph on HIV Prevention posted above.[/color]

 

I did read it, condoms are an indispensable part of it, unless we believe we're all negative.

 

http://www.dispatch.com/content/graphics/2012/03/26/safesex.jpg

[Steven_Draker]

I did read it, condoms are an indispensable part of it

 

Let's try to face the reality.

 

HIV/AIDS activists have been advocating for condom use since the eighties, yet less and less sexually active men wear condoms nowadays. According to a CDC study, "only 15% of gay men use condoms consistently enough to derive substantial benefit from them". So, what did we do wrong? Where did we fail?

 

unless we believe we're all negative.

 

I assume that everyone but me is positive. That's why I protect myself.

 

Sometimes I have a feeling you're preaching to the choir, MD1940. ;-)

[instudiocity]

Let's try to face the reality.

 

HIV/AIDS activists have been advocating for condom use since the eighties, yet less and less sexually active men wear condoms nowadays. According to a CDC study, "only 15% of gay men use condoms consistently enough to derive substantial benefit from them". So, what did we do wrong? Where did we fail?

The cynic in me wants to say, "We stopped dying those horrible, wasting, ugly deaths.

 

I saw beautiful, sexy, virile friends die of full-blown AIDS & related disorders, I shall never play without a condom.

[Steven_Draker]

http://marksking.com/my-fabulous-disease/stop-bludgeoning-young-gay-men-with-our-aids-tragedy/

 

Chris, it looks like the author of that article is biased.

 

There is something about the simplicity of PrEP (a pill a day! no condom negotiation! no guilt or judgment!) that is driving older gay men up the wall, considering their resistance to it and spurious claims of inefficacy, cost, and side effects. Tellingly, younger gay men have voiced fewer objections.

The facts are these: PrEP is at least as effective as condoms when used properly. The drug currently used for PrEP, Truvada, is well tolerated with few side effects. And despite fears and misinformation, it is being covered by insurance providers (do you know of even one claimant that has been denied?). For those without insurance, Gilead, the maker of Truvada, has a generous patient assistance program that allows you to earn a sizeable income and still get the medication.

To me it reads like a paid advertisement from Gilead.

[marylander1940]

Let's try to face the reality.

 

HIV/AIDS activists have been advocating for condom use since the eighties, yet less and less sexually active men wear condoms nowadays. According to a CDC study, "only 15% of gay men use condoms consistently enough to derive substantial benefit from them". So, what did we do wrong? Where did we fail?[/color]

 

 

 

I assume that everyone but me is positive. That's why I protect myself.

 

Sometimes I have a feeling you're preaching to the choir, MD1940. ;-)

 

I know, we agree on something right? We're on the same side on this subject, get over it.

 

Let's celebrate it, don't you think?