Groundbreaking Prep information released today

[Guest ChrisW]

Here in my home state of Washington we are hosting the largest HIV conference in the world this week. Today was the prep portion and holy cow batman...

 

Drug resistance has been a worry of a lot of people myself included but the guidelines for prep greatly reduce it and here is why. The guidelines for prep specify that patients go in every 3 months for testing which means that you can get spotted hopefully before you develop drug resistance. Even if you do develop drug resistance your put on other medications that reduce your viral load so your not infectious. You may end up having a truvada resistant strain but because your not infectious the chances of passing it are nearly non existent as long as your on ART (antiretroviral therapy).

 

There was no major uptake in STI acquisition rates so turns out taking truvada doesn't make you a *****. I am kinda bummed about that one I am going to have to throw out my t-shirt now.

 

Please a good look at this article. Prep isn't for everyone but if your having a lot of sex, protected or bareback, it might be a good option for you.

 

The side effects for Truvada are well known. While there may not be information on the long term effects 20 years down the road I seriously doubt I will still be on it 20 years from now.

 

Feel free to keep the cognitive dissonance going on this topic going if it gets you through the day but the science is there.

 

http://www.aidsmap.com/Pre-exposure-prophylaxis-stops-86-of-HIV-infections-in-PROUD-study/page/2947319/

[marylander1940]

A few years ago there was a huge HIV/Aids conference in DC, a local escort told me that all of the sudden the BB requests from would-be-clients visiting from out of town sky rocketed...

 

I know hypocrisy is our national sin but after losing so many friends to HIV in the 80's I can't believe those guys where here asking for help $ while barebacking all over town.

[Guest ChrisW]

So...

http://www.aidsmap.com/No-one-with-an-undetectable-viral-load-gay-or-heterosexual-transmits-HIV-in-first-two-years-of-PARTNER-study/page/2832748/

 

People with undetectable viral loads don't transmit HIV. If they want to bareback they certainly can and its their right. I know many people that are at this conference going on right now that are poz and do bareback but they are on meds. You can try to shame them all you like but people are going to do what they want without your approval.

 

I know many people that lost so many folks during the plague that they have PTSD. I had a daddy once and when I would spend the night his partner would wake up ever night screaming. He lost so many partners and friends that he was never quite the same. It sounds like you lost a lot of good people perhaps it might be advantageous to seek counseling.

[+ Gar1eth]

Chris the problem is just because someone says they are undetectable doesn't mean they are undetectable. And what if they were undetectable last week but skipped pills this week?

 

I just read a statistic that Truvada was 86% effective at preventing HIV infections. But medical statistics are only good for large study populations. The statistics don't mean anything to the poor SOB who happens to be in the 16%.

 

But I'm glad you are getting rid of the t-shirt. I find the word wh*re offensive.

 

Gman

[Guest ChrisW]

Keep reading

 

As for your worry that someone is skipping pills what is your point? What are you trying to draw out? I have never met a poz guy who is casual about taking his meds AND sober. If your worried about someone skipping pills chances are you have a lot more to worry about than just the skipped pills...

 

As long as you maintain about 95% adherence you can miss a few doses here and there and its not a big deal because there is still enough meds in your system for it to be effective

[+ deej]

I have never met a poz guy who is casual about taking his meds AND sober.

 

So you've never met a poz guy who does not know he's poz? Chances are good you have, cupcake, but you (and he) don't know it.

 

Guys who don't know they're poz are a pretty rampant attack vector for new infections.

 

You dismiss way too much here.

[Guest ChrisW]

So you've never met a poz guy who does not know he's poz? Chances are good you have, cupcake, but you (and he) don't know it.

 

Guys who don't know they're poz are a pretty rampant attack vector for new infections.

 

You dismiss way too much here.

 

This is supposed to be a substantive discussion on public health if you want to detail it with snark go right ahead.

[+ deej]

This is supposed to be a substantive discussion on public health if you want to detail it with snark go right ahead.

 

So stop being snarky.

[+ purplekow]

Did anyone say do not use condoms?

[SteveEscort]

So you've never met a poz guy who does not know he's poz? Chances are good you have, cupcake, but you (and he) don't know it.

 

Guys who don't know they're poz are a pretty rampant attack vector for new infections.

 

You dismiss way too much here.

 

I've probably had sex with men in the the three figures now that are poz and don't know it. I have only every seen one person in all my time as an escort who told me he was poz, the other 99 didn't, probably because they didn't know themselves.

 

I am asked for bareback at least twice a month and sometimes from guys I've seen many times. One guy even emailed me the other day asking if it was his decision as to whether we barebacked or not. I told him he didn't have any say in the matter and he suddenly stopped emailing. I am one of the responsible ones and although as Chris mentions three monthly testing on PrEP, I volunatrity test every month whilst not on PrEP.

 

I was asked in 2014 to be part of a trial in England. I declined it. No one knows the long term health risks from this drug and I plan to retire from escort work in the next five to ten years. I've had sex with thousands of men, as an escort and I've never caught as much as a sexually transmitted infection.

 

When you're working as an escort your immune system is at an all time high, were fighting off infections at a much higher rate than general members of the public. Everyday I am subjected to infections like the common cold, bacteria from saliva, rimming and foreplay, foreign dna from semen and many more viruses that enter my body because of heightened intimate sexual contact. I have not had a cold or flu virus in over six years and I put that down to the fact I'm subjected to different strains of the virus on a daily basis and build up an immunity to it before I receive a huge dose of it. By saying this I am not claiming I am immune to anything but I do know that sex workers have an immune system that works wildly overtime.

 

I don't wish to be part of a PrEP trial or to take the drug. I don't take risks as a sex worker and I've kept myself safe all of this time. The responsible thing for any sex worker to do is get monthly tests and make sure you are as safe as you can possibly be for his safety and peace of mind, as well as your own.

 

A guy on another forum I post on said to me last month that he thought all sex workers should be on PrEP but he didn't think he should be, as a client, because he's top only and that's a much lower risk. Right.......real sensible argument. I'll just bring the Russian roulette gun over and you play nicely with it whilst the rest of us have a pizza instead.

[jimboivyo]

Keep reading

 

As for your worry that someone is skipping pills what is your point? What are you trying to draw out? I have never met a poz guy who is casual about taking his meds AND sober. If your worried about someone skipping pills chances are you have a lot more to worry about than just the skipped pills...

 

As long as you maintain about 95% adherence you can miss a few doses here and there and its not a big deal because there is still enough meds in your system for it to be effective

 

Can't disagree with what you said but what about the many guys who go off meds when there's an insurance issue or funding change?

 

deej has a good point about making this a black and white issue. tons of gray space on this. tons.

[Daverwr]

Chris, I appreciate your post. The articles answered a lot of questions I had about PrEP. I think it is an excellent conversation gay and bi men should continue to have. I think the more information, the better.

 

For several years, I was a counselor on the National AIDS Hotline. This was many years ago when information was just being discovered. Later, I volunteered on the GMHC AIDS Hotline. For both organizations it was important to note that if you were having sex, the best you could do was make it Safer, Not Safe. For some, PrEP may be part of that Safer equation. I'll admit, there are certainly times when I could have been safer (as some of you know ). But, I don't have enough information yet to make an educated decision. That's why I appreciate this discussion.

[Steven_Draker]

PrEP is like asking someone to take a pill, so they don’t have to take

one

 

Shaun Robinson, Executive Director, New Zealand AIDS Foundation discusses perspectives around Pre-Exposure Prophylaxis (PrEP) and need for being realistic in its limitations.

 

There are many reasons not to see PrEP as a way of preventing HIV at a community level, but probably the most obvious is this – PrEP is asking gay men to take pills so that they won’t have to take pills. It is saying to gay and bisexual men ‘take HIV medication and take it regularly or you will catch HIV and then have to take HIV medication and take it regularly’.

 

That is rather ridiculous. These medications are pretty heavy-duty despite improvements over the last decade and you really have to ask why many people would want to take them if they don’t have to. The failure of people to take them in PrEP trials tends to prove this point. Adherence to medication is an issue for many who have HIV and they have very strong incentives to be regular with their meds, so we can be pretty sure that PrEP as a regular thing for men will be problematic.

 

We need to remember that studies on drugs and treatments are often conducted in a controlled environment. Real life seldom mirrors controlled conditions and human behaviour varies vastly so what guys will do around PrEP in the real world may vary a lot form what happens in clinical trials.

 

Even if three monthly injections evolve there are still major problems with PrEP as a way to stop HIV. If you are having sex with a guy how will you really know if he has taken PrEP properly whether by injection or pills? How many straight guys do you know how have become fathers unwittingly thinking their girlfriend was ‘on the pill’? By contrast you know if your partner has put a condom on because you can see it.

 

Besides, PrEP by an injection or a pill won’t protect you from Syphilis and Gonorrhoea (Syphilis cases in Melbourne have more than doubled in gay men since 2010 for example!). Condoms do offer the best protection against a host of Sexually Transmitted Infections (STIs) very effectively. What we want from any preventive effect of medications is to add that to the preventive effects of our condom culture. We don’t want the community to be worse off overall which is what will happen if guys rely on medications for prevention and stop using condoms.

 

We can also see that PrEP is not effective globally; countries that have reduced their emphasis on condom use are experiencing alarming increases in HIV amongst gay men (a 32% increase in Australia since 2010 for example). There are alarming increases in HIV ...

 

source: http://www.nzaf.org.nz/assets/ee-uploads/files/PReP_Shaun_Robinson_comment_01042014.pdf

[Daverwr]

I've never understood people's aversion or "forgetfulness" in taking prescribed medication. I've been taking medication for life-threatening issues since high school: diabetes, hypertension, heart issues and such. It has always been "natural" for me, just as breathing or waking. I get up and take a handful of pills; I get ready for bed and take some shots and another handful of pills - easy-peasy. I just don't get the issue. :confused:

[Rudynate]

 

We can also see that PrEP is not effective globally

 

This is news to me. My impression is that PrEP is still relatively cutting-edge. I wasn't aware that it had been adopted on a global scale. Both New York and San Francisco have adopted PrEP as crown jewels in their strategy to reduce HIV transmission essentially to zero by 2020.

[LookingAround]

To say that "It is not effective globally" is poorly worded and/or misleading. It is effective as long as people take the pill daily. In some places (e.g. parts of Africa) where they have studied PrEP, adherence was very poor, and therefore infection rates were higher. The medication was effective but if there is poor adherence, then the outcome is different. Its not that the medication isn't effective, its that adherence was poor in some places.

[+ Gar1eth]

One article I read said that only in the USA was it approved for prophylaxis. So apparently none of the European countries have officially approved Truvada for that yet.

 

Another thing to point out is that again % reductions in risk are really only pertinent on large studies/population scale. Unless a medication is perfect, what does 86% effective mean when you are one of the 14%? And while we don't know about adherence- there are people in the studies who have been infected while on Truvada. To me Truvada is useful as a back up condom in a sense or for a rare case of slipping up and not for carte blanche barebacking.

 

Gman

[Steven_Draker]

See French study IPERGAY about on-demand PrEP

 

http://www.companyofmen.org/showthread.php?101162

 

http://www.companyofmen.org/showthread.php?101240

 

Note that 34% of the participants in the study IPERGAY have contracted another STI like syphilis, gonorrhea, chlamydia or Hepatitis C.

 

http://sante.journaldesfemmes.com/magazine/1261304-sida-qu-est-ce-que-le-truvada-ce-traitement-preventif-qui-suscite-tant-d-espoirs/ (in french)

 

Finally don't get fooled by the OP: Truvada is a heavy-duty drug, not a candy.

 

http://www.companyofmen.org/showthread.php?99844

[rguer]

 

Another thing to point out is that again % reductions in risk are really only pertinent on large studies/population scale. Unless a medication is perfect, what does 86% effective mean when you are one of the 14%?

 

It means a lot if you one of the 86%!

And while we don't know about adherence- there are people in the studies who have been infected while on Truvada. To me Truvada is useful as a back up condom in a sense or for a rare case of slipping up and not for carte blanche barebacking.

 

 

Exactly. There are too many other infectious diseases around. HIV will probably not be the last killer to appear.

[Guest ChrisW]

phew

 

At least everyone didn't stick there head in the stand when presented with new information about HIV. I was worried after the initial comments...

 

As for the 86%, I talked to one of the HIV specialists at the Seattle conference as this information was coming out and that number is misleading. I know its easy to look an article and see a stat and jump on but folks this is your health and your communities health. Take some time to actually read through the articles coming out on these studies and get a better understanding of how prep works as well as its effectiveness. In one of the 2 studies only 3 people seroconverted, one of which was suspected to have already been positive going in and the other 2 were missing appointments to get there prescriptions which means they had a lapse in medication. Basically 2 people out of a case study of over a 1000 seroconverting because they weren't on there meds says a lot. If you take this medication its very very effective. Whether or not its a fit is for you to determine.

 

I am groggy and going back to sleep. I apologize for any spelling or grammatical errors