Truvada May Not Be 99% Effective In Preventing HIV

[Newly]

Are you having some sort of a breakdown? It's actually impossible to take you seriously at this point.

[Guest ChrisW]

I was dating someone who seroconverted while we were together and that wasn't going to be a deterrent for sharing intimacy with him so I went on prep to protect myself.

 

I stay on prep because I am high risk due the line of work I'm in.

[Guest ChrisW]

You are playing pure and an expensive Russian Roulette with this drug.

 

Yes some people are and quite frankly your opinion and others doesn't matter to them. People are going to do what ever they want and I for one think they should engage in harm reduction which exactly what Prep is. I am concerned about the community at large, shaming people for there actions has no place in a productive discussion about a public health issue and is counter productive to reducing infections.

[+ deej]

shaming people for there actions has no place in a productive discussion about a public health issue and is counter productive to reducing infections.

 

This.

 

This is what has perpetually impeded HIV prevention progress. It impedes progress when some in governing positions withhold funding for HIV prevention research, treatment research (or, actually, science in general) by shaming the participants, and it's no less an impediment when we do it to ourselves.

[Frankly Rich]

It may well be that an escort who has lots of sex is protecting himself by taking Truvada, assuming that he is religious about taking it. But, otherwise, my opinion is that narcissistic gay men who cannot be bothered to use a condom are willing to take a highly expensive route instead. $13,000 a year. Tell that to some starving kid. Gee, kid, I can't be bothered to use a condom, too bad you're hungry. Statistics show that not so many of these gay men will be religious about taking this pill, so many will end up on the dole, with the rest of us paying because he couldn't be bothered to use a condom. Speed kills.

[Newly]

Frankly Rich, it's not just the escort taking Truvada, it's the client taking it. As the client you know if you're taking it correctly and by so doing you're protecting yourself without having to count on the escort's claims. Even if you only see one escort a year you're in a high-risk group because that esvcort has had sex with lots of random partners. It's not just the condom part, there are risk in oral sex also, and I'm sure very few of us use condoms with oral sex. The "cost" of 13K isn't true if you have health insurance, since most insurance companies cover it. By the way, the insurance company isn't paying anywhere near 13k for it, they pay a reasonable price. It's just a consequence of our screwed up health system that those without insurance pay absurd prices for medicine. As for the hungry kids, you make a good point, but nothing is more hedonistic and selfish than hiring escorts - and 13k is a pittance with this hobby, so shouldn't you be swearing off escorts and sending the money to the starving kids?

[Steven_Draker]

Chris, do you take Truvada in addition to condoms or instead of condoms?

[+ quoththeraven]

It seems as though several different issues are getting mixed up here, the first of which is the efficacy of condoms and whether and to what extent to use Truvada as a backup. The bottom line is risk reduction and risk aversion. Some people are only comfortable with the belt-and-suspenders approach (that is, Truvada and condoms); others consider the belt-and-suspenders approach wasteful and continue to rely on condoms only.

 

Given the efficacy of condoms when used properly (98-99%, from what I remember) and personal experiences of those who have relied on condoms only -- and that includes long-time porn performers as well as escorts -- and the clear position of public health authorities that condoms alone are sufficient (the failure to use condoms all the time being the avowed reason for their recommendation for the use of Truvada), can we stop casting aspersions on those who rely on condoms only?

 

It's also disingenuous to call escorting high-risk because of the number of sex partners if an escort always uses condoms. Whether someone is telling the truth about that in his comments on this board is a different issue entirely. In any event, it's up to the client to determine whether condoms are used. From what I've read here, escorts don't insist on barebacking in the face of client opposition, and to do so would be stupid.

 

So use of condoms alone is a reasonable way to balance the risks. Adding Truvada is a belts-and-suspenders approach for those concerned about condoms ripping, inadequate application or size (i.e. seepage/spillage) or spilling during removal. Rips and tears are at least theoretical possibilities, and it's perfectly understandable (and not neurotic) for people not to want to have to think about them, but I wonder how often they actually occur. Has anyone had this happen to him? I suspect problems with application and removal are far more frequent -- i.e., problems over which the user has some control. So maybe Truvada use is indicated for those who have trouble applying condoms properly or finding the right size condoms.

 

Another reason for using Truvada is when one's partner has seroconverted. Presumably this would also be in conjunction with the use of condoms, but irrespective, a risk that was previously less than 100% (and in most cases probably presumed to be zero because of the relationship) is now 100%. I don't care how many times someone repeats the mantra to treat everyone as if they're HIV+, that's (a) not always how people act and (b) as an absolute factual matter is never true, which is one reason we don't always act that way. Moreover, other factors may be present that minimize or eliminate risk. In the interest of keeping this short(er), I'm not going to list them here, but you can probably think of at least some of them yourself. And IMO it's really shitty to search through people's past posts in order to call them out for hypocrisy. It's just as shitty as implying that an escort not using Truvada as well as condoms is acting unreasonably.

 

So the real crux of the issue is someone who doesn't always use condoms. In addition to partners of those who've seroconverted, they're the ones for whom Truvada was approved. If they're already doing without condoms, what is the harm in their using Truvada? Or must they seroconvert first before it's moral for them to receive anti-retrovirals?

 

This is where I stop and discuss healthcare economics. The problem is that other than Truvada's manufacturer absorbing the cost of medication for the uninsured, Truvada ups the cost for insurers. It requires the payment of co-pays. As I understand it, Truvada is not entirely new; it's been used for AIDS treatment for around ten years (I could be off by few years), so the side effects are pretty well known and the manufacturer has presumably recouped most, if not all, of the cost of research and development. The problem is that Truvada plus condoms takes more resources (in the form of money) than condoms alone, and from what I understand, the difference is not an insignificant amount. In the US, insurers recoup their costs from employers, employees, and individuals maintaining their own insurance policies. In countries with government-subsidized healthcare, government recoups the cost from taxpayers. (That's also true in the US for those covered by Medicare and Medicaid.) That means everyone's cost increases proportionately. It's not unreasonable to ask whether this is the best use of limited resources.

 

But one thing we know is that cost to other people (or even, sometimes, to oneself) is not something most people take into account before engaging in risky but pleasurable behavior. This increases with the use of mind-altering substances (and yes, alcohol is as or more culpable than drugs). So thinking that this is going to change the behavior of those already taking risks is like expecting the moon to fall out of the sky. Maybe programs to get people to rely less on drugs and alcohol while having sex would be more helpful than lectures. After all, within reason, sex is more fun (and more easily accomplished) when one is not so wasted that one can't perform, appreciate, or remember it.

 

What about those people who bareback because they're in a relationship with someone who's HIV negative? (Presumably they've at least both been tested, preferably twice, before doing without condoms.) There are two pitfalls here: one is the assumption of monogamy. The other is the assumption, in an open relationship, that the other person always uses a condom (or insists that his partner use a condom) when having sex outside the primary relationship. It seems to me that it's perfectly reasonable for men in a relationship to dispense with condoms after testing. To say otherwise is to say gay men, unlike straight people, aren't worthy of having sex without a condom. Moreover, the risk-averse belts-and-suspenders crowd ought to applaud them for using Truvada as a backup just in case.

 

The real problem is convincing people who already use condoms to continue using them and to minimize the number of people who are already HIV+ but don't know it from taking Truvada because of the risk of creating Truvada-resistant strains of HIV. The only way to deal with the latter is regular HIV testing. I'm not sure what to say about the former. While condoms are an impediment to enjoyment for me with vaginal sex but not with anal sex (there, I said it), I can see where it would diminish sensitivity for the top. (And maybe other people's experiences are different from mine.) There are also psychological motivations for going bare, not the least of which is intimacy. Anyone interested in more on this, read SUNY Buffalo professor Tim Dean's study of barebacking and barebacking porn, Unlimited Intimacy (University of Chicago Press).

[Guest ChrisW]

It may well be that an escort who has lots of sex is protecting himself by taking Truvada, assuming that he is religious about taking it. But, otherwise, my opinion is that narcissistic gay men who cannot be bothered to use a condom are willing to take a highly expensive route instead. $13,000 a year. Tell that to some starving kid. Gee, kid, I can't be bothered to use a condom, too bad you're hungry. Statistics show that not so many of these gay men will be religious about taking this pill, so many will end up on the dole, with the rest of us paying because he couldn't be bothered to use a condom. Speed kills.

 

Keeping judgment and shame out of this public health discussion is the only way to get a handle on this disease.

[LookingAround]

Chris, do you take Truvada in addition to condoms or instead of condoms?

 

Why would it matter in terms of harm reduction? He's engaging in harm reduction. Unless Dominee Draker wants to preach a sermon.

 

Steven represents the old "truvada wh0re" view which has been renounced by those once espousing it.

[LookingAround]

Exactly.

 

"Everyone should play safe, except me" read "Everyone should be on Truvada but me". Right, bigvalboy?

 

Isn't it hypocritical when "newtothis", "LookingAround" and "bigvalboy" insist that other people should be on Truvada, while themselves (given the two examples above) are not taking it?[/color]

 

http://www.sendmeamirror.com/userfiles/images/normal/62.jpg

 

You're nuts. I am taking it.

[Guest]

Why would it matter in terms of harm reduction? He's engaging in harm reduction. Unless Dominee Draker wants to preach a sermon.

 

Well, I would have to agree with our Flemish friend that taking Truvada instead of using condoms is quite foolish. According to Wikipedia...

The drug has been approved for pre-exposure prophylaxis against HIV infection. A Cochrane review found that both tenofovir alone, as well as the tenofovir/emtricitabine combination, decreased the risk of contracting HIV by 51% (RR 0.51; 95% CI 0.30 to 0.86; 8918 participants). The Food and Drug Administration approved it for prophylactic use on July 16, 2012. In studies, tenofovir reduced the incidence of HIV infection, especially in high-risk individuals, (by 42% in MSM in the iPrEX study) but produced conflicting results in other studies (notably the FEM-PrEP study in heterosexual African women). One study estimated through mathematical modeling that daily intake of Truvada could potentially achieve a 99% of risk reduction of contracting HIV in high risk individuals, though this level of protection has never been demonstrated in clinical trials.

In certain studies, the drug has demonstrated rare side effects including: transient nausea, dizziness, loss of appetite and loose stools.

 

According to the Truvada website:

Serious side effects of TRUVADA may also include:

 

New or worsening kidney problems, including kidney failure. Your healthcare provider may do blood tests to check your kidneys before and during treatment with TRUVADA. If you develop kidney problems, your healthcare provider may tell you to take TRUVADA less often, or to stop taking TRUVADA.

Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones.

Changes in body fat can happen in people taking HIV-1 medicines.

Changes in your immune system. If you have HIV-1 infection and start taking HIV-1 medicines, your immune system may get stronger and begin to fight infections. This may cause minor symptoms such as fever, but can also lead to serious problems. Tell your healthcare provider if you have any new symptoms after you start taking TRUVADA.

The most common side effects of TRUVADA are:

 

In people taking TRUVADA with other HIV-1 medicines to treat HIV-1 infection, common side effects include: diarrhea, nausea, tiredness, headache, dizziness, depression, problems sleeping, abnormal dreams, and rash.

In people taking TRUVADA to reduce the risk of getting HIV-1 infection, common side effects include: headache, stomach-area (abdomen) pain, and decreased weight.

 

I suppose if a guy has regular sex with HIV + men, either because his regular sexual partner is HIV + or because he a sex worker, one could argue that the costs and medical risks with taking daily Truvada in addition to condom use might be reasonable, to provide additional protection. But to take Truvada instead of condom use is a little crazy. It provides far less protection that properly-used condoms, costs tons more, and puts the user at risk of bone fractures, kidney failure, and changes in fat/body shape.

HIV drug regimens containing nucleoside reverse transcriptase inhibitors (NRTIs), including Truvada, can cause increased fat levels (cholesterol and triglycerides) in the blood, and abnormal body-shape changes (lipodystrophy; including increased fat around the abdomen, breasts, and back of the neck, as well as decreased fat in the face, arms, and legs). These side effects of HIV drug therapy are reviewed in our lessons on Lipodystrophy, Facial Lipoatrophy, and Risks To Your Heart (Hyperlipidemia).

http://ih.constantcontact.com/fs020/1101823881298/img/13.jpg?a=1101825972178

[Frankly Rich]

Keeping judgment and shame out of this public health discussion is the only way to get a handle on this disease.

 

If you feel shamed by what I say, that's your issue, but judgment has a place here when priorities are skewered so that gay men can fuck bare while kids can't eat.

[+ quoththeraven]

If you feel shamed by what I say, that's your issue, but judgment has a place here when priorities are skewered so that gay men can fuck bare while kids can't eat.

 

Isn't that a false comparison, though? It's not as though the money saved by not spending it on Truvada is going to go toward starving children. Money saved by not spending it on Truvada mostly will go elsewhere in the healthcare system (insurance payments or government spending) or into individual's pockets (co-pays). Besides, individuals don't generally think of money they don't spend as a source of funds unless it's a matter of replacing one expenditure with another, and I don't see someone replacing a prescription drug co-pay with a charitable contribution.

[Guest ChrisW]

If you feel shamed by what I say, that's your issue, but judgment has a place here when priorities are skewered so that gay men can fuck bare while kids can't eat.

 

I feel no shame merely an observation and the added note of kids not being be able to eat so gay men can have bareback sea it seems a bit irrational but asking for a candid conversation about human sexuality these days seems impossible if our current political discourse on reproductive rights is any indication.

[Frankly Rich]

"The "cost" of 13K isn't true if you have health insurance, since most insurance companies cover it. By the way, the insurance company isn't paying anywhere near 13k for it, they pay a reasonable price. It's just a consequence of our screwed up health system that those without insurance pay absurd prices for medicine. As for the hungry kids, you make a good point, but nothing is more hedonistic and selfish than hiring escorts - and 13k is a pittance with this hobby..."

 

It's like Santa Claus is gonna come and put Truvada under the tree! It's free! If you don't like my starving kids analogy, how about people who cannot afford health insurance? Do you think providing Truvada to thousands of horny gay men is going to cause rates to go up, or down?

[Frankly Rich]

I feel no shame merely an observation and the added note of kids not being be able to eat so gay men can have bareback sea it seems a bit irrational but asking for a candid conversation about human sexuality these days seems impossible if our current political discourse on reproductive rights is any indication.

 

 

Irrational? Are you kidding me? The priorities here are totally screwed up. We have money to give Truvada away, but not food to kids? Forget kids. There are so many other places that money could go if guys would just use a condom.

[Guest ChrisW]

Perhaps you should write to your congressmen if your that upset about healthcare costs

[LookingAround]

Does anyone else find it ironic that a discussion of money for starving children versus truvada is occurring on a site devoted to men spending hundreds and thousands of dollars for sex?

 

For those arguing that money is better spent on food for starving children versus truvada I would respond that many people would say the same about spending $200 or $300 for an hour of sex. That money would be better spent donating to charity. Don't spend $1000 for an overnight. Donate it to charity instead.

[Guest]

Does anyone else find it ironic that a discussion of money for starving children versus truvada is occurring on a site devoted to men spending hundreds and thousands of dollars for sex?

 

Speak for yourself. I spend a lot more on charities than I do on escorts. Are insurance companies really paying for Truvada in healthy men? If it encourages barebacking, that's a super bad investment.

[Steven_Draker]

Chris, do you take Truvada in addition to condoms or instead of condoms?

 

Why would it matter in terms of harm reduction? He's engaging in harm reduction. Unless Dominee Draker wants to preach a sermon.

 

Steven represents the old "truvada wh0re" view which has been renounced by those once espousing it.

 

I asked Chris whether he uses condoms in addition to condoms or instead of condoms, because it's important for our candid conversation about human sexuality.

 

Is your name Chris?

[Scorpio]

Exactly.

 

"Everyone should play safe, except me" read "Everyone should be on Truvada but me". Right, bigvalboy?

 

Isn't it hypocritical when "newtothis", "LookingAround" and "bigvalboy" insist that other people should be on Truvada, while themselves (given the two examples above) are not taking it?

 

 

You're nuts. I am taking it.

 

I asked Chris whether he uses condoms in addition to condoms or instead of condoms, because it's important for our candid conversation about human sexuality.

 

Is your name Chris?

 

No Steven, actually you persumed that LookingAround wasn't taking it. He was correcting your persumption. You should really keep a better handle on your own narrative.

[desertguy1954]

It seems to me, that it boils down to a matter of personal choice. The safest way of prevention is making sure that condoms are used. Also, sad but true, you must assume that your partner is positive and he the same with you. Though, if there is a pill such as truvida, then I feel it becomes that individuals right to use or not to use. If it helps save only one life then it is worth it.

I am for anything that can possibly help stop this. I am an older guy and I can still remember reading those first news paper articles in the early 80's. We ignored them at first and kept right on partying. I have lost to many friends. Will there be something more effective than truvida down the road, yes there will be. Until then for those that choose to use it, more power to them.

[Steven_Draker]

No Steven, actually you persumed that LookingAround wasn't taking it. He was correcting your persumption.

 

Yes, you are correct. I wrongly presumed that LA wasn't taking it, which at this point of the conversation doesn't really matter.

 

I asked ChrisW directly a question. See posts #32 and #35.

[Frankly Rich]

ChrisW only wants to call others irrational. He can't answer direct questions.