Escorts on PreP

[Rudynate]

I get it at Kaiser for a $35.00 co-pay. And with a total health insurance cost of $10K per year, I don't have a bit of guilt about "burdening the healthcare system."

[+ quoththeraven]

And with a total health insurance cost of $10K per year, I don't have a bit of guilt about "burdening the healthcare system."

 

As in you're paying $10K, or your employer is paying $10K? Or the total cost is $10K and you're both paying part of it?

 

Note, I'm not questioning the $10K figure. Back in 2008, when I last worked in the field of employee benefits, the cost of single coverage under a group plan was close to $10K and the cost of coverage for more than one person, no matter how denominated, was more than that.

[Rudynate]

As in you're paying $10K, or your employer is paying $10K? Or the total cost is $10K and you're both paying part of it?

 

Note, I'm not questioning the $10K figure. Back in 2008, when I last worked in the field of employee benefits, the cost of single coverage under a group plan was close to $10K and the cost of coverage for more than one person, no matter how denominated, was more than that.

 

I'm self-employed. I pay the whole thing.

[Rudynate]

I'm self-employed. I pay the whole thing.

 

 

As costly as it is, I can't complain. I have some semi-serious health challenges for which I see specialists and take some costly prescription drugs. My plan with Kaiser is an old-style Kaiser plan from before they ever offered high-deductible plans or HSA compliant plans, that was grandfathered into Obamacare. It covers nearly everything. My benefit level is better than gold, but not quite platinum.

 

I did the math as many different ways that I could, talked to independent health insurance agent, and so on, and for the benefit level, I can't do better.

[LookingAround]

I, too, pay my own insurance (close to 10k per year also) and my co-pay for PrEP is $35.00 per prescription.

[Rudynate]

I, too, pay my own insurance (close to 10k per year also) and my co-pay for PrEP is $35.00 per prescription.

 

I will soon be able to get it filled for 90 days, and the copay will go down to $70.00 for the three months.

[Rudynate]

 

The big thing about undetectable is that there will be spurts where the virus is detectable in the system that we don't know of. It's not like the person is always undetectable if their one blood test says undetectable.

 

True, but think about the PARTNER study. In two years, the incidence of HIV transmission from a positive partner to a negative partner was substantially zero. At least some of the poz partners are bound to have experienced those spurts during the study period, and yet, there was, substantially, no HIV transmission between partners.

[bobnyc]

True, but think about the PARTNER study. In two years, the incidence of HIV transmission from a positive partner to a negative partner was substantially zero. At least some of the poz partners are bound to have experienced those spurts during the study period, and yet, there was, substantially, no HIV transmission between partners.

 

I just looked up the study. There are a couple of things that make this result less impressive. 16% of patients excluded from the study actually became detectable and were excluded from analysis and the study. To qualify for the study you only had to sometimes not use condoms, and it was only around 1/3 of the time that barebacking happened between the gay couples.

 

It's a cool study, I think it demonstrates that there is a reduced risk but it's hardly definitive proof that an undetectable count means that you're not going to transmit.

[sincitymix]

I get it at Kaiser for a $35.00 co-pay. And with a total health insurance cost of $10K per year, I don't have a bit of guilt about "burdening the healthcare system."

 

If your paying 10k a year for the insurance.. due to paying it yourself? then you are still saving money.. I think a 90 day supply full cost for most HIV meds is like 8-10k for a 90ds.

[Rudynate]

Truvada is about $14K for a year. I can' t complain. I take an absurd number of prescription drugs - 10 or 11 at last count. Full retail for one year for all would be about $25K.

[ZhenXBear]

Having started delving into some of the clinical trial information and education for healthcare providers, it seems like the data is pretty promising. It would, however, be prudent to note that these drugs aren't without their own sets of side affects. People can experience kidney dysfunction and impairment, decrease in bone density making one more prone to osteoporosis as they age, some drug interactions and body fat redistribution.

 

I guess you'd have to weigh the benefits of the drug with the known possible side affects and make a decision, based on your sexual promiscuity, propensity for riskier behavior, ability to adhere to a regiment 100% compliance, etc. . before deciding if you wanted to launch into this measure.

[Rudynate]

Having started delving into some of the clinical trial information and education for healthcare providers, it seems like the data is pretty promising. It would, however, be prudent to note that these drugs aren't without their own sets of side affects. People can experience kidney dysfunction and impairment, decrease in bone density making one more prone to osteoporosis as they age, some drug interactions and body fat redistribution.

 

I guess you'd have to weigh the benefits of the drug with the known possible side affects and make a decision, based on your sexual promiscuity, propensity for riskier behavior, ability to adhere to a regiment 100% compliance, etc. . before deciding if you wanted to launch into this measure.

 

Monitoring liver enzymes and kidney function is part of the scenario. Urinary n-telopeptide is a good marker for early bone loss. Fat redistribution with nucleotide/nucleoside RTI's is rare. Lipodsytrophy was a problem with early protease inhibitors, but is largely a thing of the past.

[ZhenXBear]

Monitoring liver enzymes and kidney function is part of the scenario. Urinary n-telopeptide is a good marker for early bone loss. Fat redistribution with nucleotide/nucleoside RTI's is rare. Lipodsytrophy was a problem with early protease inhibitors, but is largely a thing of the past.

 

See, that's what perplexes me Rudy. Truvada really isn't a new drug in the sense that it's core components Tenofovir (2001) and Emtricitabine (2003) have both been approved by the FDA for over a decade. The only "magic" here is that they've been conveniently combined into a single pill, along of course, with a rather thorough study regarding the efficacy of pre-treatment prophylaxis, and a new patent for Gillead. Lipodystrophy is lower in risk for both of these drugs than some others, but the clear distinction being 'lower'.

 

My true hope is that people aren't viewing these as a silver bullet that's going to allow them to avoid some of the safer sex practices the study included to reach its efficacy claims.

[mike carey]

Today an Australian soldier posted on our Defence Gay and Lesbian Information Service that he had asked for and the Defence Health Service had agreed to prescribe him PrEP as an extra measure on his safer sex regime. He will receive it as part of the normal free health cover that military personnel receive. I'm gratified to hear that the Defence Force here is prepared to do this.

[Rudynate]

Lipodystrophy is lower in risk for both of these drugs than some others, but the clear distinction being 'lower'.

 

My true hope is that people aren't viewing these as a silver bullet that's going to allow them to avoid some of the safer sex practices the study included to reach its efficacy claims.

 

Think about the history. Until protease inhibitors, lipodystrophy among people taking antiretroviral drugs was rare. The big problem back then was wasting syndrome. Then, suddenly, with the early protease inhibitors, men taking them started developing big guts, skinny arms and legs and buffalo humps. One rarely sees that anymore. My partner, on crixivan, developed a bit of a thick torso and skinny arms and legs. He hasn't taken crixivan in years and his physiognomy returned to normal long ago.

 

.

[+ quoththeraven]

My true hope is that people aren't viewing these as a silver bullet that's going to allow them to avoid some of the safer sex practices the study included to reach its efficacy claims.

 

My understanding is that those practices had to be included for ethical reasons. They were testing a medical intervention whose efficacy was unknown when an already tested and effective prevention method was available. The choice of foregoing the latter has to be the participant's, not the study designer's. For more, see this article, which is the basis for my conclusion - for myself alone - that the slim (though statistically significant) marginal utility of Truvada as PrEP isn't worth the cost or potential side effects. Direct quote:

The marginal utility of PrEP is fairly unimpressive; this can be seen if one looks closely at the actual study results. In the iPrEX placebo group, the infection rate was 5.2 percent over the study period (144 weeks), or about 1.9 percent per year [footnote and citation omitted] -- only slightly higher than the 1.6 percent rate typically used by modeling teams as an estimate of annual risk for "high risk" gay men [citation omitted]. The iPrEX treatment group's seroconversion rate was 2.9 percent over the same time frame, or about 1.05 percent annually. Those averted infections would certainly add up at the level of whole populations, but in everyday terms, the touted 44 percent reduction (the difference between the non-annualized figures of 5.2 percent and 2.9 percent) actually only amounts to less than one person in 100 per year.

The article also makes the point that Truvada was tested under the assumption that condom fatigue is due to people who are knowledgeable about and educated in the use of condoms failing to use them without first engaging in studies to test that hypothesis. Since the big condom education push occurred awhile ago, education efforts aimed at those who came of age since then and other underserved communities might have helped. Or they might not have. In the absence of studies, we don't know. I recognize that there's an argument that things were dire enough that waiting for such studies would be counterproductive, but that isn't an especially good argument against conducting studies on both.

 

There's more in this post on a previous thread discussing Truvada: http://m4m-forum.org/threads/opinion-piece-on-truvada.101767/#post-947442

[ZhenXBear]

Yes, but it sounds like HIV treatment is just as effective as Truvada in protecting against condom breaks IF treatment results in undetectable viral load. The other thing this makes clear is that the emphasis still needs to be on getting people with HIV diagnosed and treated.

 

If Truvada leads prople to think they can go bareback people who are undiagnosed and/or untreated and have viral loads it could actually lead to infection.

 

So very true, since Truvada only provides 2 of 3 drug types necessary to significantly mitigate viral replication. A person could theoretically have an undiagnosed partner on Truvada with a high viral load.

[+ stevenkesslar]

So very true, since Truvada only provides 2 of 3 drug types necessary to significantly mitigate viral replication. A person could theoretically have an undiagnosed partner on Truvada with a high viral load.

 

This was a very informative thread. Thanks to everybody for sharing personal details about your coverage and preferences.

 

It confirms to me that for me condoms combined with the hope that HIV+ people are on meds that make them undetectable are the best odds. Of course there's no way of knowing for sure anyone is undetectable, nor is there anyway of knowing for sure they are on PreP.

[Rudynate]

The marginal utility of PrEP is fairly unimpressive; this can be seen if one looks closely at the actual study results. In the iPrEX placebo group, the infection rate was 5.2 percent over the study period (144 weeks), or about 1.9 percent per year [footnote and citation omitted] -- only slightly higher than the 1.6 percent rate typically used by modeling teams as an estimate of annual risk for "high risk" gay men [citation omitted]. The iPrEX treatment group's seroconversion rate was 2.9 percent over the same time frame, or about 1.05 percent annually. Those averted infections would certainly add up at the level of whole populations, but in everyday terms, the touted 44 percent reduction (the difference between the non-annualized figures of 5.2 percent and 2.9 percent) actually only amounts to less than one person in 100 per year.

 

But the 44 percent reduction included all levels of compliance, from people who weren't taking the drug at all, to those who were fully compliant. When the data were stratified according to level of compliance, a different picture emerged. Among those whose blood level of the drug indicated substantially full compliance, the incidence of seroconversion was reduced by over 90%. Some don't think this really means much, but I don't see why not. Presumably, they started out with clean data, more or less uncontaminated by bias. Why couldn't you slice and dice the data to learn more about sub-populations within the treatment arm? My doc and I argued about this. He doesn't think the stratified data can be relied on because there may have been confounding effects that weren't accounted for. For example, the high-compliance group may have used condoms more because of a generally greater concern for their health and well being.

[doitb4ugo]

I am not a statistician nor am I a medical professional. On a personal level the argument for me comes down to whether the introduction of PreP will lower the incidence of HIV. The level of new infections in the US has remained relatively stable at roughly 50,000 new infections per year. Clearly, for me, this indicates that an awful lot of sex was/is going on without condoms. For this population, I hope PreP reduces the level of new infections.

 

In addition, clearly the insurance companies has run the numbers to suggest that PreP is more cost-effective than treating Hiv/AIDS at a later date.

 

I wish PreP were available for me when I contracted HIV.

[Rudynate]

I am not a statistician nor am I a medical professional. On a personal level the argument for me comes down to whether the introduction of PreP will lower the incidence of HIV. The level of new infections in the US has remained relatively stable at roughly 50,000 new infections per year. Clearly, for me, this indicates that an awful lot of sex was/is going on without condoms. For this population, I hope PreP reduces the level of new infections.

 

In addition, clearly the insurance companies has run the numbers to suggest that PreP is more cost-effective than treating Hiv/AIDS at a later date.

 

I wish PreP were available for me when I contracted HIV.

 

 

Both New York and San Francisco have adopted the goal of reducing HIV transmission to zero by 2020. Both are counting on PreP to get them there.

[+ stevenkesslar]

Both New York and San Francisco have adopted the goal of reducing HIV transmission to zero by 2020. Both are counting on PreP to get them there.

 

I hope so, too, but there has to be a huge PR campaign. I am not the most ignorant man in the world, and I was pretty much ignorant about this prior to this thread, other than hearing that maybe if you take this pill you can't get HIV. As this thread makes clear, it is a lot more complicated than that. I hope Message # 1 is still based on the KISS principle: use rubbers, always, and then kiss as much as you can.

[Rudynate]

I hope so, too, but there has to be a huge PR campaign. I am not the most ignorant man in the world, and I was pretty much ignorant about this prior to this thread, other than hearing that maybe if you take this pill you can't get HIV. As this thread makes clear, it is a lot more complicated than that. I hope Message # 1 is still based on the KISS principle: use rubbers, always, and then kiss as much as you can.

 

I don't believe the goal is to get the entire population on PreP. In San Francisco, there is a specific target. I don't remember exactly what it is - several thousand.

[Rudynate]

That's one of the good things about Kaiser, they are considered a Golden Standard. Not many insurances follow suit though. Its usually the insurance who says we wont cover xxx yyy.. and/or the client (the employer) usually says we agree, make the insurance plan for us to save us the most money.. or the client says you cover xxx yyy, we don't want to cover xxx yyy.. insurance benefit manager, Yes sir! we will not cover xxx yyy at your instructions!

 

Historically, there have been issues with Kaiser's standards of care. They have been required to pay enormous amounts in fines to the State of California as a result of their substandard care. Approximately 10 years ago, the State came in and shut their organ transplant program down because it was so badly mismanaged. Almost every Kaiser member has a Kaiser horror story. I have mine, but I won't bore anybody with it. Service and care quality have improved drastically since the the ACA took effect. Their marketing people realized that if they were going to attract and retain all of those people newly insured under ACA, they would have to raise standards. It's a whole different place since then. My PC doc actually picks up the phone and calls me occasionally.

[rvwnsd]

Interesting reading, particularly regarding the efficacy of PrEP and the infection rate discussed in the QTR's quote. However, I disagree with the conclusion made when comparing annualized infection rates. A reduction from 1.9% to 1.05% is still a 44% reduction in the infection rate. The notion that the reduction amounts to less than 1 person in one hundred is technically accurate, but if we apply that principle to the infection rate we could draw the conclusion that HIV infection is not a problem because fewer than two people per hundred become infected each year.

 

Ask yourselves: would you seriously consider the opinion of an author who would make such a statement?