Prep or Pep?

[keithhardy]

Truvada was approved for use and is intended to be used in conjunction with other safer sex practices (i.e., condoms). The clinical trials for Truvada were conducted with (and the drug is only supposed to be prescribed with) required counseling on safer sex practices. I take it, and still require my partners to use condoms.

 

 

 

Respectfully beg to differ. I do a lot of HIV counseling with teens and twenty-somethings. At least from my anecdotal experience, the overall perception of the big blue pill is that it a fail-safe alternative to condoms.

 

 

 

I don't disagree that there are many that take it as an alternative to condoms, but to say all do is not fair and that is what was insinuated earlier in this thread. And even if they do use it that way would we rather not have PrEP. Its remarkable to me that people actually think its a bad thing, I would bet the majority of those that don't use condoms on PrEP weren't using condoms to begin with.......would we rather have them become POZ?? Bareback sex is natural, its been that way for eternity, its never going to change for some people....why would we argue a preventive to HIV. Especially an argument from people that watch friends die from this awful disease. This topic is important to me, I do a lot of work in HIV and it gets at me when people look negatively on something that is preventing people from becoming HIV positive. I have had conversations with people in this field that have spoken to the older population and many have determined there is a little bit of a jealousy factor, because they only had condoms to use through life, so should everyone else. I just can't wrap my head around why anyone thinks PrEP is a bad thing.....yes I get other STD's......maybe if people stigmatized those like they do HIV maybe people would think twice about not using condoms.........we as a cultural often dictate many things

[keithhardy]

I don't disagree that there are many that take it as an alternative to condoms, but to say all do is not fair and that is what was insinuated earlier in this thread. And even if they do use it that way would we rather not have PrEP. Its remarkable to me that people actually think its a bad thing, I would bet the majority of those that don't use condoms on PrEP weren't using condoms to begin with.......would we rather have them become POZ?? Bareback sex is natural, its been that way for eternity, its never going to change for some people....why would we argue a preventive to HIV. Especially an argument from people that watch friends die from this awful disease. This topic is important to me, I do a lot of work in HIV and it gets at me when people look negatively on something that is preventing people from becoming HIV positive. I have had conversations with people in this field that have spoken to the older population and many have determined there is a little bit of a jealousy factor, because they only had condoms to use through life, so should everyone else. I just can't wrap my head around why anyone thinks PrEP is a bad thing.....yes I get other STD's......maybe if people stigmatized those like they do HIV maybe people would think twice about not using condoms.........we as a cultural often dictate many things

[+ WhamIAm]

I just can't wrap my head around why anyone thinks PrEP is a bad thing.

 

I agree = PrEP itself is an awesome, major advance in HIV prevention that was pretty much unimaginable during the plague and its aftermath. It is a gamechanger for serodiscordant couples, it provides an additional level of security for monogamous or monogamish couples. [And, to clarify what I said above, I use condoms and PrEP almost always -- a long-term FWB whom I trust completely and I rely on PrEP only).

 

It's the perception of PrEP that concerns me -- on both ends of the spectrum. Someone who makes a fully informed choice to forego condoms for PrEP in their lives is neither evil nor stupid. OTOH, I question the degree to which many gay men, especially younger ones, are fully informed or have fully digested the risks and benefits when they make that choice.

[keithhardy]

I agree = PrEP itself is an awesome, major advance in HIV prevention that was pretty much unimaginable during the plague and its aftermath. It is a gamechanger for serodiscordant couples, it provides an additional level of security for monogamous or monogamish couples. [And, to clarify what I said above, I use condoms and PrEP almost always -- a long-term FWB whom I trust completely and I rely on PrEP only).

 

It's the perception of PrEP that concerns me -- on both ends of the spectrum. Someone who makes a fully informed choice to forego condoms for PrEP in their lives is neither evil nor stupid. OTOH, I question the degree to which many gay men, especially younger ones, are fully informed or have fully digested the risks and benefits when they make that choice.

I couldn't have said it better myself!

[keithhardy]

Well, you did mention "straight", so I guessed you had at least a drive-by encounter with vag. I have never been sexual with the opposite gender--that was what I understood defined "Gold Star Gay".

Lol. no I am not Gold Star....lol. I was caught up with other drama when you said that.....I did have the VAG when I was "straight" and married

[rguer]

 

And no, you definitely should not do PEP every time after sex as a routine method for prophylaxis. PEP is not only truvada but a combination of medications and many -if not most people- experience a lot of strong side effects. They often describe their PEP month as a terrible, terrible month of diarrhoea, nausea, cramping and aches.

 

Perhaps practices are different in Canada, but here, Truvada (or the same two drugs taken separately) is the most commonly used drug for both PEP and PrEP, and most people do not experience a lot of strong side effects.

 

I hadn't realized, before your comment caused me to look it up, that so many different drug combinations are recommended for PEP ( http://www.projectinform.org/publications/pep/ ). I would not be surprised if some of those combinations cause side effects.

[rguer]

Truvada was approved for use and is intended to be used in conjunction with other safer sex practices (i.e., condoms). The clinical trials for Truvada were conducted with (and the drug is only supposed to be prescribed with) required counseling on safer sex practices. I take it, and still require my partners to use condoms.

 

Saying that Truvada must be used in conjunction with condoms was probably the only way to get it approved by the FDA. Should people use both? I think so, and I would use both, but I don't believe for a moment that either the manufacturer or the FDA expected that 100% compliance with that guideline would happen.

[mike carey]

I have never been sexual with the opposite gender--that was what I understood defined "Gold Star Gay".

I had not heard the term 'gold star gay' until recently. In the same conversation I discovered that apparently I am a platinum gay.

[marylander1940]

Saying that Truvada must be used in conjunction with condoms was probably the only way to get it approved by the FDA. Should people use both? I think so, and I would use both, but I don't believe for a moment that either the manufacturer or the FDA expected that 100% compliance with that guideline would happen.

 

I agree with you, there's something called reality out there... I'm sure folks who use PrEP in many cases don't use condoms, and that's their main reason to take the "pill".

 

I agree = PrEP itself is an awesome, major advance in HIV prevention that was pretty much unimaginable during the plague and its aftermath. It is a gamechanger for serodiscordant couples, it provides an additional level of security for monogamous or monogamish couples. [And, to clarify what I said above, I use condoms and PrEP almost always -- a long-term FWB whom I trust completely and I rely on PrEP only).

 

It's the perception of PrEP that concerns me -- on both ends of the spectrum. Someone who makes a fully informed choice to forego condoms for PrEP in their lives is neither evil nor stupid. OTOH, I question the degree to which many gay men, especially younger ones, are fully informed or have fully digested the risks and benefits when they make that choice.

 

You're smart, good choice. Unfortunately other younger men can't even imagine what some generations lived in the 80's.

[Kuriousity]

Truvada was approved for use and is intended to be used in conjunction with other safer sex practices (i.e., condoms). The clinical trials for Truvada were conducted with (and the drug is only supposed to be prescribed with) required counseling on safer sex practices. I take it, and still require my partners to use condoms.

 

 

 

Respectfully beg to differ. I do a lot of HIV counseling with teens and twenty-somethings. At least from my anecdotal experience, the overall perception of the big blue pill is that it is a fail-safe alternative to condoms.

 

 

 

You are not alone. Vaginas = icky.

 

Oh I do not think them "icky".....I just have no interest. If I had an interest, then I would not be gay.

[Kuriousity]

Lol. no I am not Gold Star....lol. I was caught up with other drama when you said that.....I did have the VAG when I was "straight" and married

 

Well, better late than not at all....

[Kuriousity]

I had not heard the term 'gold star gay' until recently. In the same conversation I discovered that apparently I am a platinum gay.

 

I keep forgetting you are Australian.....

[mike carey]

I keep forgetting you are Australian.....

I don't know whether that's the reason, maybe I just don't get out enough. I looked up 'platinum star gay' in the Urban Dictionary and the example cited was:

Did you know that Mike is gold star gay? No, he is a platnium [sic] star gay because he was born by c-section.

[LADoug1]

Thanks for the education guys. I actually had hoped to use it as an extra layer of protection with condoms. The liver issues are troubling, and in my brief online research found that it may cause bone loss.

I was considering PrEP but tests showed I had a predisposition for Osteoporosis. Between this and my overall risk factor I decided to not start the regimen. I'll just continue my safe sex practices.

 

Regarding PEP - I have a friend who went to Kaiser to get PEP after a potentially risky encounter and he was shamed for not having safe sex. It really upset him. Also he had quite a few side effects from taking PEP.

 

On the positive side, Kaiser has set up a PrEP clinic now where it makes the process of discussing/getting access to the drug easy and comfortable. It seems Kaiser is very much in favor of the regimen.

[LADoug1]

You should discuss this with your primary Doctor as well educate yourself on the background about the drug and its use.

 

Don't worry about this. Your doctor has likely heard it all before

 

Not necessarily so. I've found many doctors who are not adequately trained in the usage of PrEP. And some shame patients. You have to have the right doctor.

[+ ArVaGuy]

Not necessarily so. I've found many doctors who are not adequately trained in the usage of PrEP. And some shame patients. You have to have the right doctor.

 

You are absolutely correct. My doctor was up front and said he did not have the proper background regarding use of PrEP. He had also received an advisory from the DC government and FDA that best practice was to refer such cases to an infectious disease specialist. My doctor referred me to an ID specialist with HIV experience.

 

I've been out to my doctor since our first appointment 20 years ago. He's straight as well. We've never had an issue and I would fire him if he gave me any flack about sexual issues.

 

It's important to have the right doctor and a honest relationship with him or her. Any hint of negative judgmental attitude or slut shaming it's time to find someone else.

[killianjamesnyc]

If you're going to take a pill take Prep. PEP will destroy you for a month in a way prep never will.

[keithhardy]

Just curious, is PrEP being used more in Major cities over smaller places. I ask this because I travel a lot and work with people from all over the US, some have never heard of it and others have asked their Docs for it and their Docs have no idea what it is. One Doc even said, "why do you need Truvada, I didn't know you are HIV positive". I have found that it is not so easy for some to get, where in Philadelphia it seems as if everyone is on it.

[MikeyGMin]

I have no stats to back it up, but one would assume that major cities with lots of homos would be the early adopters and the most informed.

[killianjamesnyc]

Just curious, is PrEP being used more in Major cities over smaller places. I ask this because I travel a lot and work with people from all over the US, some have never heard of it and others have asked their Docs for it and their Docs have no idea what it is. One Doc even said, "why do you need Truvada, I didn't know you are HIV positive". I have found that it is not so easy for some to get, where in Philadelphia it seems as if everyone is on it.

 

The truly educated know that Truvada is broken down into two uses, as an antiretroviral for people who are HIV positive and as Prep for those who are HIV negative. If you tell me you're on Truvada im automatically assuming you're HIV positive, when you tell me you're on "Truvada used as prep" it means something totally different. Tons of People will tell you they're on Truvada and will hope you think it means prep, when in fact they aren't taking it that way. The med has just been THAT socially accepted that its super easy to hide behind without any further questions on it. Always ask "Why are you on Truvada?" Never ask "are you taking Truvada as prep?" The first will elicit a more honest response. Educate yourself y'all

[keithhardy]

The truly educated know that Truvada is broken down into two uses, as an antiretroviral for people who are HIV positive and as Prep for those who are HIV negative. If you tell me you're on Truvada im automatically assuming you're HIV positive, when you tell me you're on "Truvada used as prep" it means something totally different. Tons of People will tell you they're on Truvada and will hope you think it means prep, when in fact they aren't taking it that way. The med has just been THAT socially accepted that its super easy to hide behind without any further questions on it. Always ask "Why are you on Truvada?" Never ask "are you taking Truvada as prep?" The first will elicit a more honest response. Educate yourself y'all

I absolutely agree...in my post I should have mention the doc asked what is PrEP....and the Doc replied with the above. I mentioned earlier in the thread about Truvada and some of the concerns health care providers have with PrEP and developing resistance to it if not taken correctly.....and how many strains of HIV require Truvada for treatment. There are lots of people out there not educated on PrEP or HIV, its kinda scary.

[killianjamesnyc]

I absolutely agree...in my post I should have mention the doc asked what is PrEP....and the Doc replied with the above. I mentioned earlier in the thread about Truvada and some of the concerns health care providers have with PrEP and developing resistance to it if not taken correctly.....and how many strains of HIV require Truvada for treatment. There are lots of people out there not educated on PrEP or HIV, its kinda scary.

 

I hear you. So many guys out there want to preach and educate. I personally stay far away from it these days. I'm not a doctor and can't advocate passing along information I found on wikipedia or quoting some study or two I found on google. We need to focus on educating ourselves on an individual level and learn how to prevent succumbing to the ignorance of others when it comes to our health.

[ChrisWydeman]

Many people who work in sexual health shame people for seeking services be it testing or even inquiring about prep. There are risks to taking prep and ultimately it's up to you to make the decision for yourself if your risk warrants the medication.

 

People are going to have sex right? Why not provide all the resources we as a society can to help people stay healthy?

[+ Keith30309]

And no, you definitely should not do PEP every time after sex as a routine method for prophylaxis. PEP is not only truvada but a combination of medications and many -if not most people- experience a lot of strong side effects. They often describe their PEP month as a terrible, terrible month of diarrhoea, nausea, cramping and aches

 

If you're going to take a pill take Prep. PEP will destroy you for a month in a way prep never will.

 

What activity warrants seeking PEP treatment (which I guess is another way of asking about the ease of transmission)? Specifically, if briefly (5 seconds) penetrated without a condom by someone with a 1-month old negative screen (I know you have to consider his preceding 90 days as well) is there a significant risk of transmission?

Is there a resource to help evaluate the risk ?

 

Going thru hell and potentially wrecking my insurance isn't ideal but the possible alternative is worse.

[+ Billsboy4]

Guys, I've been an HIV test counselor for several decades and have seen HIV medications come and go (when I started doing this AZT was the drug of choice....and what a mistake that was.) It's only years later, after years of use, that the real toxicity of the drugs comes to light. All of the drugs in current use, have potential damage to one's major organs......what may be a desirable decision today, may be regrettable 10 years down the line. Safer sex is still the best decision in my view and has always worked for me. That's my two cents.