Truvada May Not Be 99% Effective In Preventing HIV

[LookingAround]

Steven. I asked you a direct question also. If you are not taking truvada why not. You insist Chris answer you. His about answering me. I've now asked thrice.

[Guest]

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 (sic), 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 (sic) down the road, yes there will be. Until then for those that choose to use it, more power to them.

 

Unfortunately, if Truvada is used as an excuse to forgo condoms (and, if one reads some of the drivel on this string, it will), it will result in a net loss of lives, not a gain. In addition, the adverse effects of the medication alone will shorten the lives of those who take it, as a whole. Yes, I was in college when the syndrome of AIDS was discovered. We didn't know that it was caused by HIV at the time, but those who denied the possibility that it could be caused by an STD ("It's just poppers!") and "kept on partying" were simply fools, and many of them died. Smart people used condoms.

 

http://lh6.ggpht.com/-8tD8fOTyyKI/UB5f3GKP81I/AAAAAAAAIig/2EYZyol-jUg/Denial_thumb%25255B2%25255D.jpg?imgmax=800

[Steven_Draker]

Steven. I asked you a direct question also. If you are not taking truvada why not. You insist Chris answer you. His about answering me. I've now asked thrice.

 

I'm glad to answer your question again.

 

I did answer it 4 days ago here in the other open thread about Truvada in the "Ask an Escort" section.

 

Nothing has changed since that time.

[+ Gar1eth]

We didn't know that it was caused by HIV at the time, but those who denied the possibility that it could be caused by an STD ("It's just poppers!") and "kept on partying" were simply fools, and many of them died. Smart people used condoms.

 

Unicorn,

 

I'm not saying you are wrong. But except for the denial, I wasnt part of any gay lifestyle back then. So I dont know what thoughts were going through the community at the time. I was only 19 in 1980 which was I believe when the '1st' documented case occurred. At that point I think I only suspected I was gay/was hoping I wasn't. It didnt really matter. The idea of all sex scared me, and I remained a virgin until the age of 41. But was it really immediately obvious that it was an STI in the first few years of the plague? I mean they did accuse poppers. And there is a big leap between the idea of poppers and intercourse/sharing needles. I mean these were health professionals talking about poppers. If I had used them, I might have felt safe by stopping. Would using condoms have necessarily occurred to me if most guys didnt use them? And I remember there was also an accusation against Haitians and their slaughter of chickens which wouldn't support the idea of an STI.

 

Gman

[jawjateck]

My "safer" sex practices:

1....condoms

2....avoid/abstain from intoxicating/impairing substances

3....exercise discretion in my hiring choices

 

14 years and ### sex sessions later, I'm still neg and std-free. Luck? I think not. Certainly not fool-proof, but safer sex really does promote fun and good health. :-)

[bigvalboy]

You're nuts. I am taking it.

 

+1....

[Steven_Draker]

+1....

http://www.clipartsfree.net/svg/man-vomiting-icon_Clipart_svg_File.svg

[Steven_Draker]

... 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.

 

Alas too many men are selfish and only think of their own pleasure.

 

In the end someone ... the society ... the taxpayer ... has to pay the $13,000 a year.

[bigvalboy]

Alas too many men are selfish and only think of their own pleasure.

 

In the end someone ... the society ... the taxpayer ... has to pay the $13,000 a year.[/color]

 

How does the taxpayer or society have to pay 13K a year if a person has private insurance? I've been paying into my personal health insurance for 38 years. Health care costs are monitored through a health care fund. Monthly cost and coverage vary depending on the years you have paid in. Because of the years that I have paid in, my monthly payment is only $125 for complete coverage. And as Newtothis mentions, insurance companys aren't paying 13K, they pay a lower rate.

[Steven_Draker]

Again, you're too selfish. Can you think further than your nose?

 

Truvada as PrEP Outside the U.S.

While some international groups have drafted guidelines for the use of daily Truvada as PrEP, it is noteworthy that no regulatory authority other than the U.S. FDA has approved daily Truvada as PrEP.

 

In resource-limited settings, specifically sub-Saharan Africa, the trajectory for PrEP implementation is much less clear. PrEP and ARV-based microbicide trials have taken place in several countries, including Botswana, Kenya, South Africa, Uganda and Zimbabwe. Proposed PrEP demonstration projects in these countries will help inform World Health Organization (WHO) guidelines on PrEP in resource-limited countries, expected to be released in 2015. The WHO guidelines would potentially pave the way for some countries to include PrEP programs in their national response to HIV. Yet many questions would still need to be answered, including how programs would be funded and what policies would need to be developed for PrEP access in countries with waiting lists for HIV treatment programs.

 

source: http://www.gmhc.org/files/editor/file/r_ti_0613.pdf

[LookingAround]

Sadly, Steven, if you have to resort to sub-saharan Africa to illustrate where Truvada is not being supplied, well....we could put a LONG list of medications and treatments (e.g. chemotherapy agents, and on and on and on) on this board not really available in sub-saharan Africa.

 

Steven, I suppose you are committed to your judgmental attitude and your name calling aspersions and you will not listen to reason.

 

For the rest of the men here, may I offer a couple of useful links discussing the "Truvada Wh0re" negative and judgmental perspective that Steven has adopted which has been renounced by even the guy who coined the term:

 

http://www.out.com/entertainment/popnography/2014/05/20/why-i-am-truvada-*****

 

http://www.hivplusmag.com/prevention/2014/06/23/please-feel-free-call-me-truvada-*****

 

The message center deletes the word "wh0re" (modified spelling to get it to print)...you will have to supply that manually in your browser for the articles to appear.

 

I love this from the second article: "If PrEP reduces any chance of transmission, we should be praising it, instead of name-calling those who are doing something to protect themselves. Truvada as PrEP is saving lives, and helping reduce the spread of HIV."

 

Steven, even if you do not wish to stop with messages of shame, judgment and negativity, at least let's the light of reason shine....read these articles guys.

[Steven_Draker]

The following message is posted here as a PSA and not in any way directed at any particular poster.

 

10 things you need to know about the pill to prevent HIV

 

 

It's been called, simultaneously, a medicine to "end the HIV epidemic" and a "party drug:" Pre-exposure prophylaxis, or PrEP for short, refers to a daily antiviral treatment that prevents HIV.

 

That's right: People who don't have the virus can take a pill a day to save themselves from getting infected.

 

Haven't heard about PrEP? You're probably not alone. The drug-maker, Gilead, doesn't advertise Truvada (its brand name) for prevention, and the Centers for Disease Control and Prevention only endorsed it this past May—two years after it hit the market.

 

Going forward, however, you'll be hearing a lot more. On Friday, the World Health Organization backed the antiviral, recommending all HIV-negative men who have sex with men consider taking it as part of a strategy to reduce the global incidence of the disease. But there's a lot more to the story. Here's what you need to know:

 

 

1) Public health officials are NOT recommending this pill for "all gay men," despite what the headlines say

 

The pill is "for people who do not have HIV but who are at substantial risk of getting it," according to CDC guidance. "At substantial risk" means you regularly have unprotected sex with partners of unknown HIV status. This can include men who have sex with men, heterosexual men and women, injection drug users, sex workers, and people in couples with an HIV-positive partner. In other words, not simply "all gay men."

 

The latest headlines about Truvada were so misleading that the WHO had to issue a clarification noting that they support PrEP "as an additional choice"—again, not for all men who have sex with men.

 

 

"WE KNOW FROM SURVEILLANCE THAT CONDOM USE IS NOT AS HIGH AS IS NECESSARY TO CONTROL THE EPIDEMIC"

 

 

2) Truvada is not a condom replacement

 

Public-health officials are not endorsing Truvada as an alternative to other forms of protection. "We are suggesting that for people who are already not using condoms, we have another option to help protect them from HIV infection," says the CDC's Dawn Smith, biomedical interventions implementation officer. "It's part of being practical and realistic." So the hope is that those who get prescriptions are folks who just aren't using anything to protect themselves. "We know from our surveillance systems that condom use is not as high as is necessary to control the epidemic," Smith added.

 

 

3) We don't yet know exactly how the drug will be used in real life

 

Still, this public-health message hasn't stopped some activists and AIDS campaigners from worrying aloud that the pill will undermine traditional advocacy messages about condoms—especially at a time when HIV infections are on the rise among gay men. And the truth is, we don't yet know what kind of impact PrEP will have on people's behavior.

 

To find out, there are now "demonstration trials" being run around the world. These will look at how Truvada works outside of clinical trials, the impact of non-daily use of the drug, and whether the antiviral encourages more risky sexual behavior or leads to an increase in other sexually-transmitted infections.

 

 

4) We do know Truvada only works effectively when taken every day

 

A three-year clinical trial of PrEP in HIV-negative men who have sex with men found that users got much more protection when they took the drug every day. Participants who took the drug less than half the time had a 50 percent reduction in HIV acquisition; daily users cut their risk by more than 90 percent. These results have been supported by other studies in a range of populations—from injection-drug users to heterosexual men and women. The trouble is, most people don't take their medications as their doctors prescribe.

 

 

DRUG-RESISTANT STRAINS OF HIV HAVE EMERGED WHEN PEOPLE WITH ACUTE, UNDETECTED INFECTION WERE GIVEN TRUVADA

 

 

5) Truvada can cause drug-resistant HIV infection

 

Drug-resistant strains of HIV have emerged when people with acute, undetected infection were given PrEP. This means they were positive when they started the medicine, but levels of the virus in their blood were hardly detectable because their infections were so new. They hadn't made enough antibodies to show up in a test and so they were prescribed the drug anyway.

 

There's some question about how serious this risk is for individuals and public health. For now, doctors are asked to confirm the HIV status of patients and to do follow-up and re-testing throughout treatment.

 

When asked how much of a concern drug resistance is, Smith of the CDC said, "We don't know yet. That's one of the things we'll learn as the first few demonstration projects begin telling us."

 

 

6) Besides that, it's pretty safe

 

Though Truvada for the prevention of HIV was only licensed by the Food and Drug Administration in 2012, it was first authorized in 2004 to treat HIV positive patients. That's right: the same drug used for these two purposes. Since it has been on the market as a treatment for over a decade—with very minimal side effects and harms—doctors are pretty confident in its safety profile for preventative use. There seem to be few side-effects with Truvada for prevention, the most common one being nausea.

 

 

PEOPLE HAVE BEEN SLINGING THE TERM 'TRUVADA WH0RE' AROUND, AND THE HEAD OF THE AIDS HEALTHCARE FOUNDATION CALLED THE PILL A 'PARTY DRUG'

 

 

7) "Truvada wh0res" are a thing

 

Because of the questions about whether PrEP will cause people to have risky sex and ditch condoms, there's some related stigma in the gay community. People have even been slinging the term "Truvada wh0re" around, and the head of the AIDS Healthcare Foundation called Truvada a "party drug." In response, one PrEP activist created a #TruvadaWh0re t-shirt campaign to reclaim the word.

 

Many have pointed out that this divide parallels the early days of the birth control pill and suggestions that the medication would encourage promiscuity.

 

 

8) Uptake has been slow—but that's not the full story

 

According to data from the drugmaker Gilead, by March 2013 there were approximately 1,774 people in the US taking the drug. But it's important to put this number in context. First of all, these findings were not published and peer-reviewed; they were presented at a scientific conference last year. When studied, we'll have a better picture of the PrEP landscape and it may look quite different. Secondly, Truvada has only been on the US market for prevention since 2012, a year after these numbers were gathered. It often takes decades for innovations to penetrate a market, especially in the conservative field of medicine.

 

 

9) The drug is expensive

 

Without insurance, Truvada can cost up to $14,000 a year, according to the CDC. But for most people, it is covered in their insurance programs and there's only a co-pay. There are also medication assistance programs across the US for the uninsured that will cover the entire cost of the medication.

 

 

10) HIV remains a socioeconomic crisis in America and around the world

 

Globally, men who have sex with men, prisoners, injection-drug users, and sex workers are still the groups most affected by HIV. The picture is similar in America, where the number of HIV infections has stagnated for about a decade. Here, men who have sex with men and African Americans are most affected by the virus.

 

 

If PrEP is going to have a chance at nudging down the HIV rate, the sub-groups most impacted by HIV will need to have better access to the health system: to get tested, see their doctors, and learn about this option; to have regular health care with proper monitoring and follow up. Unless Truvada is a miracle drug, it's not clear how a pill will do that.

 

source: http://www.vox.com/2014/7/14/5896887/explainer-about-the-pill-to-prevent-hiv-aids-Truvada?utm_medium=social&utm_source=facebook&utm_name=share-button&utm_campaign=vox&utm_content=article-share-bottom

[LookingAround]

As far as I can see, you're the one alleging it is a condom replacement. Certainly I never said that. But the data show that only 15% of men who have sex with men consistently and always use condoms. That leaves a pretty big number left, Steven.... Do you think the remaining 85% should be shamed?

[bigvalboy]

Again, you're too selfish. Can you think further than your nose?[/color]

 

Truvada as PrEP Outside the U.S.

While some international groups have drafted guidelines for the use of daily Truvada as PrEP, it is noteworthy that no regulatory authority other than the U.S. FDA has approved daily Truvada as PrEP.

 

In resource-limited settings, specifically sub-Saharan Africa, the trajectory for PrEP implementation is much less clear. PrEP and ARV-based microbicide trials have taken place in several countries, including Botswana, Kenya, South Africa, Uganda and Zimbabwe. Proposed PrEP demonstration projects in these countries will help inform World Health Organization (WHO) guidelines on PrEP in resource-limited countries, expected to be released in 2015. The WHO guidelines would potentially pave the way for some countries to include PrEP programs in their national response to HIV. Yet many questions would still need to be answered, including how programs would be funded and what policies would need to be developed for PrEP access in countries with waiting lists for HIV treatment programs.

 

source: http://www.gmhc.org/files/editor/file/r_ti_0613.pdf

 

Not sure if this post was responding to my post, since you are not being clear who your directing your comments to, but I was responding to your comments about those with insurance that you wrongly assumed are burdening taxpayers and society with this rumored 13K cost that you brought up. It appeared you were talking about the situation within the US. Slinging insults, accusations, and posting old posts of mine designed at trying to shame me, does nothing to further the conversation. I rather suspect that indeed Newtothis was correct in his assumptions.

[Steven_Draker]

Not sure if this post was responding to my post, since you are not being clear who your directing your comments to, but I was responding to your comments about those with insurance that you wrongly assumed are burdening taxpayers and society with this rumored 13K cost that you brought up. It appeared you were talking about the situation within the US. Slinging insults, accusations, and posting old posts of mine designed at trying to shame me, does nothing to further the conversation. I rather suspect that indeed Newtothis was correct in his assumptions.

 

-1

 

In what your posts contribute something to the discussion?

[Frankly Rich]

Steven, I suppose you are committed to your judgmental attitude and your name calling aspersions and you will not listen to reason.

 

For the rest of the men here, may I offer a couple of useful links discussing the "Truvada Wh0re" negative and judgmental perspective that Steven has adopted which has been renounced by even the guy who coined the term:

 

http://www.out.com/entertainment/popnography/2014/05/20/why-i-am-truvada-*****

 

http://www.hivplusmag.com/prevention/2014/06/23/please-feel-free-call-me-truvada-*****

 

The message center deletes the word "wh0re" (modified spelling to get it to print)...you will have to supply that manually in your browser for the articles to appear.

 

I love this from the second article: "If PrEP reduces any chance of transmission, we should be praising it, instead of name-calling those who are doing something to protect themselves. Truvada as PrEP is saving lives, and helping reduce the spread of HIV."

 

Steven, even if you do not wish to stop with messages of shame, judgment and negativity, at least let's the light of reason shine....read these articles guys.

 

Arrogance and rudeness do not contribute to a good discussion. Why not just stick to the facts?

[bigvalboy]

-1

 

In what your posts contribute something to the discussion?[/color]

 

You're not having a discussion, you're having an argument.

[Newly]

O judgment! Thou art fled to brutish beasts...And men have lost their reason. Never thought I'd actually get to use these words.

[Steven_Draker]

You're not having a discussion, you're having an argument.

 

-2

 

It's not just that you didn't contribute anything positive but you're adding nothing of value to this thread. You and a few other posters are just being catty.

 

Anonymity of the internet bring out the worst in certain people.

[+ Funguy]

Please see my new post re: AIDs rates:

Included in the recommendations: "Preexposure prophylaxis should be part of an integrated risk-reduction strategy, so its use may become unnecessary if a person’s behavior changed."

 

Integrated risk-reduction includes condoms as well, esp. to go along with part 2 of my post re: syphilis, etc.

 

We are going to go around and around re: Truvada just as we did with birth control measures, free condoms being given out, and the HPV vaccine.

 

IMHO we are beating a dead [something] until we have have much more in the way of numbers and evidence.

What one person decides to do is his business and only his - issues are not always spoken about.

 

Funguy

[+ Funguy]

O judgment! Thou art fled to brutish beasts...And men have lost their reason. Never thought I'd actually get to use these words.

 

Oh My Lord! :-))

[armadillo]

http://towleroad.typepad.com/.a/6a00d8341c730253ef01a511bc67dc970c-pi

[Guy Fawkes]

Those who continue to snipe at each other rather than contribute to the topic will be taking a Holiday. Are we clear on this?

 

http://media-cache-ak0.pinimg.com/236x/19/18/a2/1918a281a79d3740734f42965ad5457d.jpg

[wisconsinguy]

I really was new to the drug. But, going to the Truvada web sites, including the companies prescribing information, this would be a no brainer for me. If I take the drug. I would use a condom, and insist my partner do as well. All a matter of choice?

[Steven_Draker]

New York’s health department has launched an advertising campaign to promote HIV-preventative drugs on hookup apps.

 

According to Newsday, the New York City health department has spent $500,000 to promote the use of controversial PrEP drug Truvada, – a daily pill which reduces the risk of HIV infection by up to 99%.

 

The ‘Share the Night, Not HIV’ campaign predominantly targets users of hookup apps including Grindr and Scruff, as well as hay men on Twitter and Facebook.

 

Dr Demetre Daskalakis, the Assistant Commissioner of the Bureau of HIV/AIDS Prevention and Control, said the campaign is hoping to target at young black and Latino men, who are statistically more at risk of HIV transmission.

 

He added: “There’s not a lot of doctors who can say, ‘I’ve done thousands of HIV [blood] tests with my hands in dark sex clubs’. I have done that.”

 

However, Michael Weinstein, head of the AIDS Healthcare Foundation – which opposes the use of PrEP on the grounds that it is less effective if the pill is not taken every day – attacked the health department.

 

Mr Weinstein said: “The first order of business in medical ethics is ‘do no harm,’ and what the New York City Health Department’s doing is doing harm, because there are people who are going to take this drug intermittently, who are going to think they’re protected, who are going to not be protected.”

 

“Could there be an increased rate of STIs? Yeah. Absolutely. Ultimately PrEP is a harm-reduction approach, not a harm-elimination approach.”

 

source: http://www.pinknews.co.uk/2014/10/03/us-new-york-health-department-advertises-prep-on-grindr/