Escorts on PreP

[Rudynate]

I am an advocate for Safe / Safer Sex Only. And those that don't practice it, I don't 'affiliated' with.

 

It may be a marketing ploy and have nothing to do with his safe sex practices.

[Guest ChrisW]

P.S. To the extent that there seems to be an implied assumption that the condom-only escorts are safer because they're HIV negative to begin with, I'd point out that that's a very dangerous leap to make.

SHHHHH! Don't tell the pearl clutchers on this forum that there are some bits of information that are to big for people to handle

[mike carey]

*Clutches pearls*

 

There is a risk with any sex. STIs, HIV, any number of things. Condoms, PrEP, bareback all figure. Just know the risks of everything and don't resort to evidence-free condemnation of people's choices.

[Steven_Draker]

PrEP also does away with the sometimes embarrassing experience of having to openly purchase condoms at convenience, pharmacy, and other stores. Some people are embarrassed to even be seen on line purchasing them. Picking up a nondescript prescription is far more discrete.

 

"Embarrassing experience" of having to openly purchase condoms? ... I have a feeling I'm hearing some 14-year-old girl talking.

If you're so "embarrassed" you can order them online. They will be delivered to you in a discreet(!) package.

 

Or you can get them for free at any gay bar or club. Moreover HIV service organizations, sexual health clinics, family planning organizations have them readily available.

 

For people like myself, who have no problem adhering to daily PrEP (only 2 pills missed in nearly 16 months of daily use).

 

Adherence, as measured by the proportion of patients with drug levels detectable in plasma ranged from 82% in the Partners PrEP study to as low as 30% in VOICE

 

see table: http://www.biomedcentral.com/1741-7015/11/186/table/T1

 

Like any medical intervention, PrEP works only when it is taken, and we have learned from HIV-infected patients how adherence to ART is crucial for achieving optimal outcomes. The same is also true for PrEP, as its efficacy in trials seemed to be strongly correlated to adherence with this daily regimen (Table 1). Therefore, differences in adherence rates between PrEP trials are likely to be the main reason for these discrepant efficacy results. Indeed, adherence, as measured by the proportion of patients with drug levels detectable in plasma ranged from 82% in the Partners PrEP study to as low as 30% in VOICE. We also learned from these trials that adherence measured by self-report or pill count was not reliable, and overestimated real adherence as measured by plasma drug levels. In iPrEx, adherence measured by plasma drug level was only 51%, but post hoc analyses showed that only 7% of those infected in the active arm had the drugs detectable in plasma at the time of infection, which the authors translated into a 92% (95% CI 40–99) efficacy of PrEP in those with drugs detected in plasma 7]. However, such a post hoc analysis is no longer protected by randomization, and those individuals with high adherence to PrEP might also be those most adherent to the other preventive tools made available in the trial. Because it is not possible to compare HIV incidence among patients with high adherence to both PrEP and placebo (although including a tracer in the placebo could be an option), such an analysis should be taken with caution. Indeed, 31% of participants in the active arms of the Partners PrEP trials became infected while having detectable, sometimes high, levels of drugs in their plasma, and such a correlation between plasma drug levels and treatment efficacy did not seem to be present in the VOICE trial 8,11].

 

We know that PrEP doesn't protect you from all other forms of STIs. But did you know that 34% of the participants in the study IPERGAY have contracted another STI: syphilis, gonorrhea, chlamydia or Hepatitis C?

 

PrEP raises questions about side effect risks and long-term repercussions in HIV-negative people. See important information here:

http://www.companyofmen.org/threads/weighing-risks-of-tdf-ftc-prep-side-effects-in-people-without-hiv.99844/

 

 

I believe that it would have likely saved countless lives from the lost 1980s and 1990s generation of gay men and trans women

 

In the 1980s we didn't have highly active antiretroviral therapy (HAART). Truvada exists today because millions of people died of AIDS (39 million to this day).

It looks like hard lessons were forgotten.

 

... what my sex partners do on their own time, is largely irrelevant, at least with respect to my HIV protection. I find that to be very empowering.

 

What is empowering is that Truvada gives you carte blanche for barebacking.

 

I talk to many people in the gay community. 100 % of the people I talked who are on PrEP do activily bareback and seek to have unprotected bareback encounters, which confirmed a similar statement posted by another member in this Forum. I haven't found a single person who takes PrEP as an extra precaution to condoms.

[rvwnsd]

There are plenty of pearl clutchers on both sides of the topic.

[+ SundayZip]

I am an advocate for Safe / Safer Sex Only. And those that don't practice it, I don't 'affiliated' with.

 

Ok, that makes sense. A couple weeks ago I hired a guy whose ad said he was on PrEP. The ad also said he was negative and gets tested for STIs once a month. And he practices safe sex. I hired him for a second, longer date a week ago and am considering going for a third. I was wondering if there was a reason for not hiring him simply because he stated he was on PrEP.

 

Thanks!

[thickornotatall]

SHHHHH! Don't tell the pearl clutchers on this forum that there are some bits of information that are to big for people to handle

I like a pearl necklace....smeared....no cream cheese...no clutching

[Steven_Draker]

Of course, just because an escort says that he uses PrEP doesn't mean he that forgoes condom use altogether.

 

Many do ! Ask them and they will tell you in private.

[mike carey]

"Embarrassing experience" of having to openly purchase condoms?

When I was younger I was embarrassed at the prospect or buying condoms, I'm not now. Or not so much! I can adjust to all of that!!

[LookingAround]

Many do ! Ask them and they will tell you in private.

 

Steven how do you know?

[Strafe13]

Many do ! Ask them and they will tell you in private.

 

Steven, people have, for decades, been making the same tired arguments about how various forms of contraception will give others carte blanche to have sex that those who are passing judgment don't believe they should be having. The same objections were/are made to providing women easy access to birth control pills and IUDs, providing young people easy access to condoms (I personally experienced this in high school), and even in the current U.S. debate over contraception being included in health care plans. I especially remember such objections were made to innoculating young people against the sexually transmitted virus that causes cervical and throat cancer.

 

As to your claim that some PrEP-using escorts might not always use condoms even if they publicly say that they still do, there's never any way to know for sure what people do with other sex partners. You'd also have no way to know if a purported condom-only escort actually uses condoms each and every time with each and every partner. You seem to be making a lot of assumptions there.

 

And your dismissiveness of the shame some people feel in purchasing condoms is irrelevant. People have consistently reported that, as well as inconvenience and interruption of the mood, as reasons or excuses for failing to be 100% condom-compliant. We have to deal with people the way they are, not as we think they should be if they just adopted what to you seems like an easy way around certain inconveniences.

 

Condom usage has never been the perfect solution for everyone, and that's why PrEP is a valuable additional tool in the arsenal for safer sex and HIV prevention. Sexually active gay men, particularly those in the sex worker field, deserve the widest array of options, so as to keep themselves (ourselves) safe. Some, like yourself apparently, may be fine with just condom use as your method of safer sex, and that's fine. Others will choose PrEP only. Still others, like myself, will choose both. There's no need to denigrate or pass judgment on those who choose a different method of prevention. We should be supporting each other.

[Steven_Draker]

Let me reiterate: I talk to many people in the gay community. 100 % of the people I talked who are on PrEP do activily bareback and seek to have unprotected bareback encounters, which confirmed a similar statement posted by another member in this Forum. I haven't found a single person who takes PrEP as an extra precaution to condoms.

[Steven_Draker]

People have consistently reported that, as well as inconvenience and interruption of the mood, as reasons or excuses for failing to be 100% condom-compliant.

"inconvenience" and "interruption of the mood" because the subject is under alcohol/drug influence?

There's no need to denigrate or pass judgment on those who choose a different method of prevention.

 

Yes, I agree. There's no need to denigrate and judge me either.

 

I presented some arguments and facts to the assumptions that were made here.

[LookingAround]

Once again Steven I find your moralism and judgmental attitude appalling. I know it well as I am from a Dutch Calvinist background. But I don't let it control me.

 

I'm glad you can be 100% sure. It's not very often that I ask people their opinion on what they do and get 100% the same response from every individual. You are one lucky man.

[Steven_Draker]

Instead of attacking the poster, why not attack the issue?

 

Tell us what's your experience with PrEP and condom use?

[+ SundayZip]

Steven, Should I assume that an escort who says he's on PrEP and also says he practices safe sex (ie, uses condoms) is lying?

[Steven_Draker]

Steven, Should I assume that an escort who says he's on PrEP and also says he practices safe sex (ie, uses condoms) is lying?

 

Never ASSUME. Ask.

[LookingAround]

Instead of attacking the poster, why not attack the issue?

 

Tell us what's your experience with PrEP and condom use?

I proudly use both.

[Strafe13]

Let me reiterate: I talk to many people in the gay community. 100 % of the people I talked who are on PrEP do activily bareback and seek to have unprotected bareback encounters, which confirmed a similar statement posted by another member in this Forum. I haven't found a single person who takes PrEP as an extra precaution to condoms.

 

My experience has been different. I myself use both, and I've had condom encounters with escorts and non-escorts who have told me that they are also on PrEP. I guess it depends on who you speak with. Some people just aren't very comfortable using condoms, some only do so inconsistently, some do so most of the time with occasional slip ups. For anyone in those categories (be they escorts or not), PrEP is a very good option. Even those who have no problem being 100% condom-compliant may find that they benefit from PrEP as a backup, given the inherent limitations in condom efficacy, particularly if they have high numbers of sexual encounters. You seem to be setting up two mutually exclusive scenarios (condom-only not on PrEP vs PrEP-only never uses condoms), but it's a much greyer and more nuanced subject.

 

As an example, the dominant theme on this forum seems to be that most people despise using condoms for oral sex. Although oral sex is considered very low risk for HIV, the medical community has never said that it's no-risk, and as one recent thread exemplifies, at certain times one may be more vulnerable. One who uses condoms for all anal sex encounters, but never for oral sex, may still benefit from the additional protection PrEP offers. Of course, he'd weigh the low risk inherent in condom-less oral sex versus the potential extra hassel of obtaining PrEP and staying compliant, but it's still a legitimate and viable option.

[Steven_Draker]

My experience has been different. I myself use both, and I've had condom encounters with escorts and non-escorts who have told me that they are also on PrEP. I guess it depends on who you speak with. Some people just aren't very comfortable using condoms, some only do so inconsistently, some do so most of the time with occasional slip ups.

 

... and some never use condoms and only seek bareback sex.

 

You seem to be setting up two mutually exclusive scenarios (condom-only not on PrEP vs PrEP-only never uses condoms), but it's a much greyer and more nuanced subject.

 

I'm aware that the situation is much greyer. I never implied that there are two distinctive groups. I said that I haven't met someone on PrEP who doesn't bareback.

 

[LookingAround]

Perhaps you should get out more.

[Strafe13]

... and some never use condoms and only seek bareback sex.

 

 

 

I'm aware that the situation is much greyer. I never implied that there are two distinctive groups. I said that I haven't met someone on PrEP who doesn't bareback.

 

When I said that it depends on who you speak with, I was trying to be a bit nicer than Looking, who said, matter of factly, "Perhaps you should get out more." Relying solely on your own anecdotal experience is not the best way to make sound conclusions, particularly on such important public policy issues.

 

Far more disturbing is what appears to be the implicit judgmental attitude towards those who either don't like using condoms or find adhering to them all the time to be difficult. I refuse to put down those people who like having bareback sex, or don't like using condoms, or find their use to be difficult or cumbersome. Having sex without condoms is actually "natural," and people who like or prefer to do so aren't "nasty," "dirty," "selfish," or traitors to the gay community. When I first became sexually active less than 20 yrs ago, I looked at condom use as a necessary evil, and always thought that it was unfortunate that we had to use them lest we expose ourselves to HIV. I don't know any of my straight friends who have an aversion to condom-less sex, nor do they put down others who engage in it, despite the fact that worldwide, heterosexuals lead in HIV infections. We're all just people here, trying to make it through this world, and we should be supporting one another instead of hurling insults or slut-shaming those of our gay brothers who like having sex like others do.

 

I'm too young to know first-hand what the gay community went through in the 1980s and 1990s before ARV medicines changed HIV from the nearly always fatal disease to a modern day manageable condition. However, from what I've seen in movies and documentaries, when it was discovered that HIV was transmitted through the exchange of bodily fluids, and that anal sex was a very convenient mode of said transmission, it was incredibly difficult to get gay men to either "stop fucking!" (as Julia Roberts's character yelled in that HBO movie) or to use condoms each and every time so as to save lives. It seems like that message finally did get through (thank God!), but perhaps due to extreme sex-shaming and judgment. That may have been a necessary evil to protect us at that time, but sometimes it feels as if the pendulum's swung too far now, causing us to blindly ignore the new advances like PrEP, and also act like condoms are some 100% foolproof form of protection that works equally well for everyone. They are not, and that's why PrEP is great to have as an additional tool.

 

In one of the new debates I saw concerning resistance of many in the gay community to PrEP, one person lamented that if, 30 years ago, doctors told us that by taking one pill a day, we could protect ourselves from HIV, everyone would have jumped for joy. Now that it's here, people seem to be bending over backwards to shame those who use it, and who may prefer non-condom anal sex. Like using condoms properly each and every time, adherence to the daily PrEP regimen is not for everyone. But it's far better that we can choose amongst multiple, highly effective methods of HIV protection. In particular, those escorts who take PrEP should be applauded for being so responsible about their health with respect to HIV. It's a shame that admitting to using it might cause them to lose some clients, as this thread exemplifies, but you win some and lose some. I hope they will gain more in the long run.

 

***And now, let me step down off my soapbox. My imitation of the inimitable Mr. Kesslar is done. :-) ***

[Rudynate]

 

I'm too young to know first-hand what the gay community went through in the 1980s and 1990s before ARV medicines changed HIV from the nearly always fatal disease to a modern day manageable condition. However, from what I've seen in movies and documentaries, when it was discovered that HIV was transmitted through the exchange of bodily fluids, and that anal sex was a very convenient mode of said transmission, it was incredibly difficult to get gay men to either "stop fucking!" (as Julia Roberts's character yelled in that HBO movie) or to use condoms each and every time so as to save lives.

 

I was there, I can tell you what it was like. Some people just weren't up to it. They shrugged their shoulders and said, "Everybody's got to die from something." To others, it just seemed an impossible task - to go the REST OF YOUR LIFE, without having normal sex.

 

Many went completely without sex for months and years. In the early 80's, before they had isolated HIV and identified it as the causative agent, it was postulated that cytomegalovirus caused AIDS and the earliest safe sex guidelines were based on this assumption. People infected with CMV shed virus in saliva, urine, blood, semen, sweat - so you can imagine what those early guidelines were like. People would stand facing each other, not touching, not kissing and watch each other beat off.

 

And it was very easy to fall victim to sexual guilt - to think, "Oh, we really weren't supposed to be doing all those great things with each other all that time."

 

It wasn't a great time.

[jimboivyo]

regarding condom buying, if you're too embarrassed to buy em', you probably shouldn't be having sex in the first place

 

grow a pair and buy a rubber. it could save your life.

[Steven_Draker]

... an escort just because he advertises that he uses PrEP. To the contrary, particularly in that line of work, I'd say he's being the most responsible he can to protect himself and his clients.

How someone who barebacks with others is being "most responsible" towards the health of his clients?

 

One who uses condoms for all anal sex encounters, but never for oral sex, may still benefit from the additional protection PrEP offers.

Some posters sound like a promotional machine for Gilead.

For people like myself, who have no problem adhering to daily PrEP ...

 

"Relying solely on your own anecdotal experience is not the best way to make sound conclusions."

 

Many studies show that adherence to PrEP ranged from 82% in the Partners PrEP study to as low as 30% in VOICE

 

see table: http://www.biomedcentral.com/1741-7015/11/186/table/T1

 

Moreover, PrEP reduces the risk up to 92% and there's a substantial early dropout rate, especially in young people.

 

In particular, those escorts who take PrEP should be applauded for being so responsible about their health with respect to HIV. It's a shame that admitting ...

 

 

What I find shameful and dangerous is painting a "rosy" picture in the Forum that is far from reality. I'd invite everyone to carefully consider such statements.