PrEP: an episcopal priests experience

[LookingAround]

I thought this was interesting.

 

http://myprepexperience.blogspot.com/2014/08/episcopal-priest-and-ceo-of-chicago.html?m=1

[tyro]

This was interesting. Thanks for posting.

T

[Diverdan]

Thanks for posting.... great to see someone share their personal experience. Also interesting that his insurance is covering this, as I have heard so many different stories from other friends about insurance coverage for PrEP.

[+ quoththeraven]

Here are some more general articles on Truvada I've been meaning to post but didn't want to because I knew I'd be away last weekend and in the meantime the Forum was down. I figure this is as good a place as any. Apologies to LookingAround if this winds up hijacking the thread.

 

The first is from New York Magazine. and is entitled "Sex Without Fear." I found out about it courtesy of a friend's tweet.

 

http://nymag.com/news/features/truvada-hiv-2014-7/

 

Excerpts:

 

For the past several years, the conversation about gay life has been, to a large degree, a conversation about gay marriage. This summer—on social media, on Fire Island, at the Christopher Street pier, and in certain cohorts around the *country—what many gay men are talking about among themselves is Truvada. And what’s surprising them is how fraught the conversation can be. For some, like Jacobs, the advent of this drug is nothing short of miraculous, freeing bodies and minds. For doctors, public-health officials, and politicians, it is a highly promising tool for stopping the spread of HIV.

 

But for others, a drug that can alleviate so much anxiety around sex is itself a source of concern. They worry that Truvada will invite men to have as much condom*less sex as they want, which could lead to a rise in diseases like syphilis. Or they fret that not everyone will take it as religiously as they ought to, reducing its effectiveness and maybe even creating resistance to the drug if those users later become HIV-positive and need it for treatment. And just as the birth-control pill caused single women in the sixties to wonder whether they’d be seen as “sluts” and to internalize that real and imagined shame, some gay men wonder how Truvada will play in the straight world; it sends a strikingly different message from the one in the “Sunday Styles” wedding announcements. Other gay men worry that the very existence of such a drug is a kind of betrayal: of those who’ve died in the epidemic; of fealty to the condom, an object alternately evoking fear and resilience, hot sex and safe-sex fatigue; and of a mind-set of sexual prudence that has governed gay-male life since the early ’80s. Even after treatments for HIV made it a manageable disease for many, gay men have absorbed the message that a latex sheath is all that stands between them and the abyss. Meaning not only HIV infection but everything it implies: loss of self-control and personal dignity, abdication of civic responsibility....

 

 

 

[Gabriel] hadn’t been wearing a condom when they had sex, and in the morning, he woke up wanting nothing more than to regain control over that moment. Gabriel is a 32-year-old real-estate broker. He had tested negative for HIV the last time he’d been to a clinic. Terrified that might change, he went to Callen-Lorde, a health clinic in Chelsea, where he was placed on a 28-day course of a full HIV-medication regimen. When taken within three days of exposure, it dramatically reduces the chances of infection—something like the morning-after pill for HIV. Gabriel didn’t react well to the course: He felt nauseous and drained the whole time.

 

He never wanted to go through that again—neither the physical or the psychological anguish. So Gabriel got a prescription from his doctor for Truvada. Truvada is a ten-year-old HIV-treatment pill that, in 2012, quietly became the first drug to be approved by the FDA for a new use: to prevent HIV infection. The drug has the potential to dramatically alter the sexual behavior—and psychology—of a generation. When taken every day, it’s been shown in a major study to be up to 99 percent effective. For Gabriel, it was like switching to birth control instead of Plan B.

 

Several months after starting the drug, Gabriel says it’s allowed him to be bolder and more unapologetic in his desires, to have the kind of joyfully promiscuous, liberated sex that men enjoyed with one another in the decade or so after the Stonewall riots brought gay life out from the shadows and before the AIDS crisis shrouded it in new, darker ones.

 

For some men, Truvada’s new use seems just as revolutionary for sex as it is for medicine. “I’m not scared of sex for the first time in my life, ever. That’s been an adrenaline rush,” says Damon L. Jacobs, 43, a therapist who has chronicled his own experience with the drug on Facebook so enthusiastically that some assume Gilead, the drug’s manufacturer, must be paying him. (It’s not, say both he and Gilead.)

 

“I stayed the night with a guy I knew, whom I believe to be HIV-negative,” he tells me. “We passed out, too drunk to fuck.” In the morning, they tried again, without a condom. “He was getting close to coming,” Jacobs relates, “and he said, ‘Do you want me to pull out?’ and I said, ‘No.’ I thought, I want this experience. I deserve this.” ...

 

 

Nathan, a 24-year-old hairdresser friend of Gabriel’s who had initially told him the dance-floor slipup probably wasn’t a big deal, sought out Truvada around the time Gabriel did. The man who is now Nathan’s boyfriend—an older, wealthy guy with a Chelsea penthouse—told him to go on it after Nathan had condom-free sex with someone who had said “I’m fine.” Later, the guy divulged that he’d meant HIV-positive but undetectable. (HIV-*positive people on regular medication suppress HIV in their blood to levels that don’t even show up on tests, rendering them nearly uninfectious.)

 

“It’s taken away the taboo of barebacking being a naughty thing,” says Nathan. But, he adds, “now that I’m on it, I’m buying condoms. I don’t want to be one of the guys who’s like, ‘I’m on PrEP, so come over and find me blindfolded and fuck me bareback.’ ”

 

Some are taking Truvada to do just that—behave without inhibitions. These are people who claim for themselves the epithet, found on T-shirts and in Instagram captions these days, “Truvada *****.” But for others it’s a simpler question, leading them to have the same (mostly) condom-protected sex they’ve always had, only for once in their lives without dread. For the generation of gay men who came of age post-AIDS, anxiety has essentially preceded lust as a first response to thoughts of sex. Sarit Golub, a Hunter College psychology professor, is leading a study at Callen-Lorde that indicates that half of gay men think of HIV all or most of the time during sex. “That, to me, is a psychological tragedy,” she says....

 

 

When Adam and I met up, he’d taken his first dose of Truvada the day before. He felt fatigued, but he’d also underslept, so he wasn’t sure it was the drug. The night before, he’d invited over a regular hookup who has told him he’s HIV-*negative. “I had wanted him to cum in my mouth,” Adam says, “but I knew that the PrEP doesn’t take full effect for seven days.”

 

Matthew, another friend of Nathan’s, who works in tech, went on PrEP for extra protection, too. Twice he’s had a condom break. He’s a little older—48—and says he’s watched close friends who’ve been HIV-positive for years struggle with the disease and the meds.

 

Gabriel, Nathan, and Matthew all say they’ve had no side effects so far. They get labs done every three months to make sure they are still HIV- and STD-free, and twice a year doctors check that their kidneys are okay. (Truvada has been linked to mild kidney damage in a small percentage of people who take it as part of their HIV-treatment regimen.) But that fear of the unknown has kept their friend Lorenzo, a 23-year-old M.B.A. student and go-go dancer, from seeking a Truvada prescription. “I’d rather let them be the lab rats and wait a few years,” he says. “I’m very sex-positive, but … a condom is a wall. It keeps me away from you.”

 

That, to him, is a good thing....

[+ quoththeraven]

More excerpts from the New York Magazine article:

 

ome HIV activists feel that Gilead is quietly funding a surge in HIV-negative takers of Truvada—whose list price is about $1,300 a month—while not having to take flak from PrEP opponents for implicitly promoting condomless sex. “If they came out advertising it, they would’ve been attacked,” says Sean Strub, the 56-year-old HIV-positive founder of Poz, the magazine for people affected by HIV and AIDS.

 

Gilead’s approach seems to be working. At the end of June, during Pride weekend, Governor Cuomo, who has made gay rights a strategic part of his platform, said he wanted to make wider access to the drug part of a new effort to eradicate the AIDS epidemic in the state by 2020. Daniel O’Connell, the state’s HIV-initiatives czar, told me New York expects to put out a public-information campaign about it by year’s end, which will be the first of its kind for PrEP.

 

Most insurers—both private and public, such as Medicaid—have covered the cost of Truvada-for-PrEP (as they generally do once drugs are FDA-approved for specific uses), and the potentially controversial issue has flown under the public radar. Some bloggers have wondered if the Supreme Court’s Hobby Lobby ruling, which says that private employers can block contraceptive coverage for workers on the grounds of religious belief, might lead some bosses to block Truvada reimbursement on their plans.

 

Truvada is for everyone at risk of getting HIV, both men and women. But PrEP has been studied in and discussed largely among gay men because the highest HIV rates remain stubbornly within that group, especially among young gay men of color. In 2010, the Centers for Disease Control reported that 20 percent of U.S. gay men had HIV, compared with about .3 percent of the total population. Nearly half didn’t know it—an ignorance that rendered them highly infectious. In 2012, the agency reported that HIV rates in gay men between ages 13 and 24 rose 22 percent in recent years. In an independent analysis of that data, a top researcher projected that if HIV infections continue at current rates, half of young gay men will have HIV by age 50. Cuomo’s stated goal, then, is very ambitious.

 

Truvada doesn’t, of course, protect against other STDs. Especially for those who were around at the dawn of AIDS, when a mystery microbe appeared out of nowhere, there’s a fear that reverting to pre-condom habits might be tempting fate again. “Mother Nature’s a bitch,” Dr. Martin Markowitz, a veteran of the Aaron Diamond AIDS Research Center, told me. “Don’t underestimate her.”

 

The idea of prep can be especially fraught for older gay men, particularly HIV-positive ones. Larry Kramer, now 79, in poor health and HIV-positive since the 1980s, has been the most prominent voice projecting contempt and bafflement. In a May New York Times article about the HBO version of his 1985 play The Normal Heart, he was quoted as saying, “Anybody who voluntarily takes an antiviral every day has got to have rocks in their heads. There’s something to me cowardly about taking Truvada instead of using a condom. You’re taking a drug that is poison to you, and it has lessened your energy to fight, to get involved, to do anything.”

 

PrEP advocates exploded, saying, in part, that Kramer was grossly exaggerating the toxicity of Truvada. (Side effects in HIV-negative takers seem limited so far. Most often, that can mean an initial few weeks of mild nausea and diarrhea—though, as with any new treatment, only time will tell if preventive Truvada has long-term effects.) Andrew Sullivan, who is HIV-positive, wrote on his blog in response: “Imagine a scene [in the play] when someone rushes into a [Gay Men’s Health Crisis, which Kramer helped found in 1981] meeting and declares that there’s now a pill that will make you immune to HIV if you take it once a day. Would Larry seriously have said that anyone who then took it had ‘rocks in their heads’? I think of how it might have saved me.” Michael Lucas, the gay-porn mogul who recently switched from being an ardent condom advocate to a PrEP-taker who now allows bareback sex in his films, wrote on the Out-magazine blog: “Larry Kramer is a hero in many ways, but this time he’s fighting on the wrong side of history.”...

 

 

Another HIV longtimer—a Chelsea store manager named Steve, 58, diagnosed in 1996—tells me frankly that, though he supports Truvada usage in theory, it mostly just pisses him off on a visceral level.

 

“I was at the Eagle a couple months ago,” he says, referring to the West Chelsea leather bar, “and this hot little muscly Latin guy told me that he was on PrEP and that I could fuck him raw. Boom, he just said it so easily.” Steve has lost many people he loved to AIDS. He finds even the effervescent celebrations of Gay Pride tough to witness. “I want people to understand why they’re able to take this right now,” he says. “It’s on the backs of people who have died and suffered. All that needs to be learned and honored.”

 

Walter Armstrong, 57, is an ACT UP veteran who also lost many friends to AIDS. (He is HIV-negative himself.) “AIDS as a huge crisis for middle-class gay men ended in the ’90s,” he says, “but I don’t think I’m the only gay man in my generation who will never get over it.” Still, he hopes PrEP makes condoms obsolete. “There, I said it!” he says, raising his voice. “There’s something really ugly about how some older gay men who’ve lived through AIDS say to younger guys, ‘After all we’ve been through, I can’t believe you would take PrEP and risk your life for sex.’ When I consider all we’ve been through, I can’t believe anyone wouldn’t take it—or at least think about it.”

 

But old community habits are hard to give up. Photographer and videographer Michael Wakefield, 51 and HIV-negative, has been hosting condom-only sex parties for 20 years. “I’ve seen him literally pull guys off each other if they weren’t using condoms and throw them out of the party,” says Daskalakis, who has often worked alongside Wakefield to offer health access, such as meningitis vaccines, at the venues. “I’ve actually eroticized condoms,” Wakefield tells me. “They mean that something exciting is going to happen. Someone’s about to get fucked.

 

“But I feel like I’m becoming a dinosaur about condoms.”...

 

 

Young black gay men have been very resistant to the idea of PrEP,” I was told beforehand by Steven-Emmanuel Martinez, 25, who is Afro-Latino and has done lots of PrEP outreach in his job at the AVAC, which does vaccine advocacy work. (Progress on the vaccine front, in case you’re wondering? Slow, in a word.) “I plan to go on PrEP myself even though I have very safe sex,” he’d said. “I want guys to trust that I am telling them about it not just because I’m getting paid to, but because I’m experiencing it. For many guys, it just sounds too good to be true.”...

 

 

The target of subtle Truvada promotion is often the HIV-negative gay man in a relationship with an HIV-positive one. Several experts have told me they think it’s redundant for an HIV-negative guy in a mixed-status relation-ship to go on PrEP if his partner is undetectable. But it’s a lot less controversial than targeting someone interested in having unprotected sex with multiple partners....

 

When they got back to the city, Herrera was faced with a dilemma. He wanted them to sleep together without a condom, but Beard’s HIV undetectability wasn’t enough to ease his mind. Herrera started looking into going on PrEP.

 

“I felt an incredible loss of control, constrained,” says Herrera. “I thought previously I’d go on PrEP for every slut in New York City, then I found myself thinking of going on it for just one guy. I felt like I was being pulled into a big public-health trend, not to mention Gilead’s coy indirect marketing. Was it really the best thing for me?”

 

Beard would say to Herrera only that it was his body and his decision to make, but says he wasn’t comfortable having condomless sex, as a top, unless Truvada was involved.

[+ quoththeraven]

The other article is a roundtable from Buzzfeed entitled "How We Fuck Now" that I discovered via a tweet from porn star Conner Habib.

 

http://www.buzzfeed.com/saeedjones/what-is-sex-now

 

Excerpts:

 

If HIV-negative gay men take Truvada once a day, they drastically reduce their chances of acquiring HIV. (Antiretrovirals can also be taken up to 72 hours after an unsafe sexual encounter — this is known post-exposure prophylaxis, or PEP — but people should be aware that the evidence for whether this kind of HIV “morning-after pill” works is much less solid.) Personally, I’m still learning and making up my mind about whether or not Truvada is an option I’d like to act upon. But it is great to know that I at least have a new option. Still, though, I was a bit taken aback when Larry Kramer told the New York Times: “There’s something to me cowardly about taking Truvada instead of using a condom.” ...

 

I’ve certainly seen a big generational difference in how people respond to HIV, especially in reporting the story about Michael Johnson. (Johnson, a former college wrestler, is awaiting trial on one count of “recklessly infecting another with HIV” and four counts of “attempting to recklessly infect another with HIV,” felonies in the state of Missouri.) Some young activists asked me after reading the story why I hadn’t written about Truvada, or PrEP. However, the truth is that this is all very new to the public. The men I wrote about having bareback sex in St. Louis did not know about Truvada in early 2013. Most probably don’t still. Safe sex to them was simply a matter of using condoms. I questioned the school in that story, Lindenwood University, about why it didn’t have condoms available for free or for sale on campus. A year and a half later, Truvada is only barely starting to register as an option for people who are highly informed about HIV/AIDS in major metropolitan areas. I think this summer will be looked back upon as a turning point in using Truvada as a major tool for HIV prevention, especially considering the Centers for Disease Control and Prevention’s recent endorsement for all sexually active gay men to take it and a study presented last week at the International AIDS Conference that showed how effective taking the drug can be. But we’re not there yet. I mean, while working on the story, I met someone in St. Louis who said his doctor refused to prescribe Truvada because it was a “*****’s drug.”...

 

 

I think the introduction of Truvada for HIV prevention has definitely been really challenging for guys of my generation, and Larry’s — I’m 57, so I’m quite a bit younger than him. It’s upended the basic assumptions we’ve lived with for 30-plus years. (Can it really be 30 years?) I had my first sexual experience with a guy when I was 21, in 1978. I didn’t feel comfortable having sex at all at first, but by the time I was starting to, the epidemic was already getting underway. In those days — the early ’80s — I pretty quickly became terrified to have sex at all. Could you kiss? What about blow jobs? Fucking felt too fraught to think about. What could you do? It really froze my budding sex life in place. I’d missed the wild days of the 1970s, or rather, I just caught the very end of it. And that terror stayed with me for years. And now, it’s a completely different world. We were, basically, terrorized into using condoms. You were a bad community citizen if you didn’t. And of course, those of us who adhered to the “condom code” did not get infected, thankfully. But the price we paid was that sex was always — always — accompanied by great fear and second-guessing. I think many men of my age cohort think, If we could use condoms faithfully, why can’t you?...

 

 

The experience of sex was always a tug-of-war between my desire and my fear, which sounds similar to what Steven has said. I wanted to have sex because I thought sex was what it meant to be gay. There weren’t a lot of images of out gay men that didn’t portray them as purely sexual beings so I figured, OK, I guess that’s who I am now. So I had sex and often it was pretty great. I always used a condom. I tried to be as careful as one can be when hooking up. But afterward, I’d get overwhelmed with feelings of shame and guilt. By the time I was a college student, I started wondering if I had a sex addiction. It wasn’t until I had more gay friends who were sex-positive and able to talk intelligently and candidly about sex did I realize 1) I wasn’t a sex-crazed maniac, and 2) the shame had much more to do with American culture than it did with me. The only thing that turns Americans on more than sex itself is shaming people who enjoy sex. When straight men talk about enjoying sex, America pats them on the back and says, “Boys will be boys.” When gay men talk about enjoying sex, we’re sex-hungry animals and perverts. And I should say, this attitude is perpetuated by gay men as well as straight people....

 

 

I was pretty late in coming to terms with my own sexuality and wasn’t having much sex at all until my mid-twenties. I do wonder how much my anxiety about HIV played a role in this, as I grew up in a time (as a friend of mine put it) after the AIDS crisis started but before Will and Grace made the word “gay” acceptable for broadcast on NBC. When I finally got around to sex, I was talking to my partners about safe sex and sexual histories, and I was also engaging in a lot of exceedingly, excruciatingly safe sex. Your story, David, and Tim’s in New York made me think about how much HIV and the pharmaceutical industry have played a role in the sex lives of gay men (who are both HIV positive and negative). Tim’s story also points out that, in addition to possibly improving public health, Truvada could potentially transform gay men’s sex lives emotionally and psychologically. I am a very nervous person by nature, including sexually. I worry not only about condoms breaking, but about risks I know are scientifically unfounded. Something like Truvada might help nervous people like me.

 

But I haven’t decided to go on it, and it (like most things!) makes me nervous too. I worry about the side effects. All medications have side effects, and sexual medications (like birth control pills) have medical, political, and emotional side effects that will play out for generations. (I mean, who’d have predicted that 50 years after the Pill came out, a craft store would use it as a tool to limit health care access? Is Gay Inc. ready to defend “Truvada *****s” when Hobby Lobby undoubtedly uses them as fodder to further dismantle Obamacare?) Perhaps the side effects will be worth the overall benefit. One thing that fascinated me in the Michael Johnson story is that no one seemed to be having sex with fear. Michael didn’t seem to be. The young gay men I interviewed who had lots of bareback sex with lots of people just after asking them if they were “clean” didn’t seem to be afraid. The young straight men seemed to think, remarkably for 2014, that AIDS was still only a “gay disease.” Like you said earlier, David, I don’t want these young people to be afraid, but I recognize that they’re quite different from me. Not better or worse, they’re just different. They don’t have my fears. And I don’t want them to! But I do want them to be safe. If Truvada can help make them more safe, I think it should be considered....

 

I asked my doctor about Truvada six months ago. I told him I was considering it. He has a large practice of gay and HIV-infected men, and he wasn’t too excited about the idea. He asked if I was in danger of not being safe, and I said, well, in terms of getting fucked without a condom, no. So he asked why, then, I’d want to take it. And I said that, well, I want to be able to have sex again and not have that fear lurking around. Sex and fear have been yoked together in my life since the epidemic began. At this point, the fear is more a function of habit and a mind-set that I had to adopt at an impressionable age. Before I get too old to have sex at all — and I hope I never get to that point! — I’d like to experience what it’s like not to have that linkage in my mind. Anyway, I didn’t push it at that point, but told him I’d want to revisit the question next time I see him, which should be this fall. I’m still not 100% sure I want to do it, because I don’t particularly want to take an antiviral open-endedly. But I’ll be curious to see if his attitude toward it has changed, if he’s more comfortable about it.

 

 

Among friends, and guys I’ve spoken to personally, I’ve yet to meet someone who didn’t encounter some kind of challenge from their health care provider regarding Truvada — either [it] hasn’t been covered by insurance companies or doctors themselves have argued against it. None of this helps my uncertainty. Also, it’s not like I’m excited about the prospect of taking a prescription pill every day, but as I said before: It’s about having the option....

 

Because we’ve been taught that couplehood equals monogamy in heterosexual marriages (even when that’s not true), a lot of gay men in partnerships have bareback sex more with their partners than single guys do with other single guys. Two single dudes are more likely to use condoms than two partnered dudes. And if half of all gay couples are not monogamous, this makes them more susceptible to STIs than single guys. A lot of people, marriage equality activists among them, have falsely advanced the idea that couples are more safe and more deserving because they are monogamous. Levels of monogamy could change over the coming generation, as legal recognition of gay union happens. Truvada could alter how susceptible couples are to HIV. But as of today, gay couples shouldn’t be assumed to be monogamous, and their risks for HIV transmission ought to be considered seriously.

[Steven_Draker]

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.

 

When it comes to race, the same is true for youth.

 

 

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

[+ Gar1eth]

There was also the article from the NYT that reported that Truvada may not be 99% effective in preventing HIV infection. Don't get me wrong though. If I could afford it, I'd probably be on it.

 

http://www.companyofmen.org/showthread.php?99583-Truvada-May-Not-Be-99-Effective-In-Preventing-HIV&highlight=Truvada

 

Gman

[+ Gar1eth]

I Apologize In Advance

 

It's definitely an important topic. But to be totally shallow for a second, am I the only one to notice what a handsome guy that priest is? And no I'm not going to make some lewd religious double entendre here. But lucky Episcopalians!!!

 

Gman

[LookingAround]

http://men.prepfacts.org

[Guest ChrisW]

Claim: PrEP is just an excuse to bareback. PrEP will lead to riskier sex. PrEP is a “party drug”

 

FALSE. A study discussed at the latest AIDS Conference, the iPrEx OLE study looked at men who went on PrEP and found that they did not change their sexual behavior. If they were already using condoms, they kept using condoms.

 

If you are already using condoms, you should continue to use them even after you start PrEP. The protection provided by using both at the same time is better than either one of them alone, and you will have the peace of mind that you are as well protected as it is possible to be.

 

If you are not using condoms now, or not using them 100%, you are at a higher risk of contracting HIV, and you should seriously consider PrEP.

 

Source: "Large Study Confirms Taking Pills To Prevent HIV Doesn’t Lead To Riskier Sex" http://thinkprogress.org/.../346.../truvada-study-risky-sex/

 

Claim: PrEP will lead to Truvada-resistant HIV

 

FALSE. It is only possible to develop HIV resistant to Truvada if you are already HIV+. If you do not have HIV, how can your HIV develop resistance? And, part of the PrEP regime is HIV testing twice before going on treatment, and regularly thereafter.

 

Source, the "Federal PrEP Guidelines" section of "Pre-Exposure Prophylaxis" from the CDC http://www.cdc.gov/hiv/prevention/research/prep/

 

Claim: Condoms are good enough

 

FALSE. Lots of people assume that condoms work 100%. They assume that as long as they use a condom every time, they are not at risk. That is bullshit, as many studies prove. That is why it’s called “safer sex” and not “safe sex”. I got HIV while using condoms 100% of the time. So did many thousands of other men.

 

In fact, condoms kind of suck when it comes to HIV. They were the best we had before PrEP came along, and we didn't like to say out loud that they were imperfect, because we want people to use them anyway. Some studies come up with effectiveness rates as low as 70%. At *best* they are 90-95% effective, when used every time and used correctly. Most studies say they are around 80-85% effective. Source: “Effectiveness of condoms in preventing HIV transmission” http://www.ncbi.nlm.nih.gov/pubmed/9141163, or google "HIV condom effectiveness", then read and weep.

 

Besides, condoms only work if you can get men to use them. And only ONE IN SIX men who have sex with men use condoms every time. One. In. Six. No matter how well condoms work when used every time, most men are just not using them. The community has voted with its dicks, and they are saying no to condoms. We have to offer these men an alternative, not just say, well, they deserve HIV.

 

And, condoms only work when the top keeps it on. If you are a bottom meeting tops through websites, or Scruff or Grindr, ask yourself, how much do you trust him? Are you sure he wouldn’t sabotage the condom? It happens often enough to have a name: “stealthing”. You can find advice for tops who want to secretly bareback you at “Top 10 Stealthing Tips" http://iblastinside.com/2012/06/top-10-stealthing-tips/ Many bottoms can relate at least one incident when that has been attempted. If you take PrEP, *you* are in control of your health. You don’t need to trust anybody else to keep you safe.

 

Source: "Consistent condom use in anal sex stops 70% of HIV infections, study finds" http://www.aidsmap.com/Consistent-condom.../page/2586976/

 

Claim: PrEP is only 42 or 44% effective

 

FALSE. That number includes the 50% of study participants who were on placebo. Of course, for that half of people, the PrEP worked 0% of the time. It was a sugar pill. Those who quote this number know it is meaningless, but they use it anyway as they intend to mislead you.

 

Among those who took their pills daily, it worked every time. Every single time. NOBODY who took their pills daily got HIV. Out of thousands of people in multiple studies. Nobody. We call that 99% effective because no study can ever prove anything 100%.

 

Of those who took 4 pills per week, PrEP was 94-95% effective, depending on the study. If taken 3 times per week, 90% effective. THINK ABOUT THAT FOR A MINUTE: even when taken only thrice per week, PrEP is still at least as effective as condoms used properly every time.

 

Source: "AIDS 2014: New Report Says PrEP 90% Effective With as Few as 3 Doses Per Week" http://www.frontiersla.com/.../aids-2014-new-report-says...

 

Claim: Men won’t take it daily as required

 

FALSE. This one is from Michael Weinstein, who thinks adherence in a study is the same as adherence in the real world. Anyone who does clinical research can tell you that's not true. Besides, whether other people can adhere to the regimen or not should not have any bearing on YOUR decision. What matters when deciding to go on PrEP is, can YOU stay on it.

 

Even if you miss an occasional dose, PrEP is still more effective than condoms, as long as you take at least 3 per week (see above). 90% effective with 3 doses per week, and 94-95% with 4 doses per week.

 

So how many people will actually adhere to the regimen? We don’t really know exactly. But consider this: In order to get on PrEP, you have to have two HIV tests, get the prescription, usually go through an approval process with your insurance company, pay a copay every month, and go to your doctor for regular HIV and STD testing as long as you are on it. Doesn’t it make sense that the people who would go through all those barriers, are likely to be highly motivated to stay HIV-? And therefore highly motivated to take their Truvada?

 

It is true that adherence is crucial to maximum effectiveness. If you don’t take your meds, they won’t work as well. If you honestly don't think you can stick to the regimen, then maybe PrEP isn't for you. It isn't for everyone, and nobody says it is. But don't blame that on the drug, accept responsibility for yourself.

 

Source: "Good adherence seen in study of intermittent PrEP” http://www.aidsmap.com/page/2893389

 

-----------

 

So, those are the facts. Those of you who are spreading misinformation should be ashamed of yourselves. Do you WANT to see more men infected? Because what you are doing, trying to scare people off of the best preventative we have for HIV, is going to result in more infections. Let them be on your heads.

 

No, PrEP is not for everyone. But everyone at risk should take a look and decide based on the facts, not on lies and scare tactics. The more men go on PrEP, the fewer HIV infections there will be.