Unprotected sex

[Lankypeters]

Anecdotal evidence suggests to me that more and more guys --- working guys, their hires, non-working guys (gays) -- are having unprotected sex, relying on anti-viral drugs (PreP, Truvada) to keep them healthy. I've heard of "fuck parties" at which condoms are not used.

 

Is this wise? Is there still not a risk of gonorrhea, hepatitis, amoebas or even some new, as yet unidentified -- and deadly -- virus being circulated?

 

I can't help but recall what someone told me about a famous theater director who regularly held orgies in his loft in the late '70s and early '80s. A friend said, "No one who went to one of them is alive today."

 

I'm not being judgmental, I hope. I'm just curious -- and perhaps not all that well informed.

 

So I'm interested in information and comment on this issue.

[Tigger]

You definitely aren't wrong especially now with that Truvada resistant strain out there. The only mitigating factor is that HIV isn't automatically a death sentence as it used to be. On the other hand people are still dying of it today. This happened in 2013 less than three years ago.

 

 

 

 

 

But I'm going to bet that gay people as a whole are going to blindly do what feels good for them in the same way that we refused to see the necessity of closing the bathhouses in the 1980's or the need to switch over to condoms to begin with.

 

There are two problems as I see it. Number one is the Prep resistant strain that is already out there. We are going to have to hope it's one of those strains that isn't easy to catch from a biological standpoint. The other being either current other unknown strains that are resistant or that will become resistant under pressure from Prep.

[caliguy]

If people want to do that it's their choice. At least they're proactively doing something that statistically is better then just condoms alone.

 

It would be interesting to hear the statistics on the other std's on PreP users too. Most PreP'ies stay with others on PreP. They're getting checked out more frequently too. My guess is it would be low.

[caliguy]

You definitely aren't wrong especially now with that Truvada resistant strain out there. The only mitigating factor is that HIV isn't automatically a death sentence as it used to be. On the other hand people are still dying of it today. This happened in 2013 less than three years ago.

 

 

 

 

 

But I'm going to bet that gay people as a whole are going to blindly do what feels good for them in the same way that we refused to see the necessity of closing the bathhouses in the 1980's or the need to switch over to condoms to begin with.

 

There are two problems as I see it. Number one is the Prep resistant strain that is already out there. We are going to have to hope it's one of those strains that isn't easy to catch from a biological standpoint. The other being either current other unknown strains that are resistant or that will become resistant under pressure from Prep.

So far one person. Statistically speaking that's not much to worry about.

[+ quoththeraven]

That was going to be my point. There's one case of Truvada-resistant AIDS. That's not a brush fire.

 

PrEP has even more of a track record now beyond the clinical trials.

 

I have other medical issues going on, usually have side effects from drugs, and my risk factors aren't (imo) high enough for it to be worth it for me to be on PrEP. But my main problem with it is it that it's really only good for oneself or if a live-in lover uses it because then you can monitor usage.

 

It's not that I think the escorts who comment here who say they are on PrEP are lying. It's that what they do is not something I have personal knowledge of or control over. So to rely on them is for me to rely blindly. I prefer to rely on what I have some control over.

 

The thing is, some STDs can be transmitted even if condoms are used. Herpes, HPV, and syphilis, and possibly gonorrhea.

 

It behooves everyone to learn which STDs are still a risk even if condoms are used for everything or are risks if condoms are not used for oral.

 

/gets off soapbox

[+ WmClarke]

So far one person. Statistically speaking that's not much to worry about.

There have actually been three known cases to date.

 

Note that one of them was a man who used both PrEP and condoms.

[+ WmClarke]

/gets off soapbox

 

/borrows soapbox

 

Get tested regularly, everyone.

 

/gets off soapbox

[+ quoththeraven]

/borrows soapbox

 

Get tested regularly, everyone.

 

/gets off soapbox

 

That too. Maybe I thought it went without saying, but it probably doesn't.

[caliguy]

There have actually been three known cases to date.

 

Note that one of them was a man who used both PrEP and condoms.

Technically the first case (anthony) PreP wasn't taken correctly. The second one Michael is almost too hard to believe. Wow. Both Condom and PreP and still got it. The last one Joe we've all heard about.

[+ azdr0710]

where's Draker when we need him.....

[caliguy]

where's Draker when we need him.....

Ha. We'd be getting two pages worth of lecturing with everything you ever wanted to know about prevention and then some.

[+ quoththeraven]

where's Draker when we need him.....

 

Same as my reaction to ABBA: NOOOOO!!!

[+ nycman]

There have actually been three known cases to date.

 

Note that one of them was a man who used both PrEP and condoms.

 

I'm not buying the guy who said he used condoms and PreP.

 

In the article he says he used condoms "unless it was with a regular partner who was up-front about his status"

 

He does the math a thinks he knows the guy who infected him. And he says “I’m upset he lied".

 

Taken together it sounds to me like the guy told him he was negative and they skipped the condom use.

 

Maybe not but, in the end, I think the odds are more likely that there's more to the story, or he got his math wrong,

or that he just plain "forgot" about an event than that he contracted HIV while taking Truvada and using condoms.

[+ quoththeraven]

Ha. We'd be getting two pages worth of lecturing with everything you ever wanted to know about prevention and then some.

 

Also, some of the information might be useful, but some will be bullshit.

[whipped guy]

Also, some of the information might be useful, but some will be bullshit.

And would be presented in a manner that would pretend to be caring and thoughtful, but actually would smack of condescension and would not fool many but possibly some others here.

[+ WmClarke]

I'm not buying the guy who said he used condoms and PreP.

 

In the article he says he used condoms "unless it was with a regular partner who was up-front about his status"

 

He does the math a thinks he knows the guy who infected him. And he says “I’m upset he lied".

 

Taken together it sounds to me like the guy told him he was negative and they skipped the condom use.

 

Maybe not but, in the end, I think the odds are more likely that there's more to the story, or he got his math wrong,

or that he just plain "forgot" about an event than that he contracted HIV while taking Truvada and using condoms.

You are probably correct.

 

Any protection strategy must be adhered to in order to be effective--whether it's condoms or PrEP. Or both.

[+ quoththeraven]

You are probably correct.

 

Any protection strategy must be adhered to in order to be effective--whether it's condoms or PrEP. Or both.

 

My guess is that the inquiry ended after "I'm HIV-." Even if the person was a close and trusted friend, that's still a recipe for disaster because a not insignificant number of conversions have occurred when one party assumed things like (a) a monogamous relationship, (b) consistent use of condoms or other protective measures with other people, or © that the person had been tested recently enough to know (and even that's not foolproof because of the incubation/gap period).

 

This is why I say you can only protect yourself by deciding what level of risk you are willing to run and taking steps to protect yourself against those risks you don't want to assume. No one else can do that for you, not even a trusted escort or friend.

[ChrisWydeman]

You definitely aren't wrong especially now with that Truvada resistant strain out there. The only mitigating factor is that HIV isn't automatically a death sentence as it used to be. On the other hand people are still dying of it today. This happened in 2013 less than three years ago.

 

 

 

 

 

 

the Prep resistant strain that is already out there

Truvada came out in 2004 to treat HIV as part of a cocktail. There have been resistant strains long before it was used as prep and yet that never stopped it from getting FDA approval as prep 4 years ago. If the FDA and doctors across the country felt it was worth a seal of approval in 2012 so perhaps it is

[ChrisWydeman]

Many of you don't like that people are replacing condoms with prep right? There are many people that don't like IV drug users. Does that mean that we shouldn't provide IV drug users with clean needles because you have a problem with there behavior? Providing clean needles is harm reduction. What is harm reduction you ask?

 

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.

 

The same rule applies to unprotected sex, people are going to do what ever they want regardless of your approval so why not provide them with a way to reduce the harm to themselves?

 

STI's are inevitable and they aren't a big deal.

[Tigger]

Many of you don't like that people are replacing condoms with prep right? There are many people that don't like IV drug users. Does that mean that we shouldn't provide IV drug users with clean needles because you have a problem with there behavior? Providing clean needles is harm reduction. What is harm reduction you ask?

 

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.

 

The same rule applies to unprotected sex, people are going to do what ever they want regardless of your approval so why not provide them with a way to reduce the harm to themselves?

 

STI's are inevitable and they aren't a big deal.

 

The problem is what it always was. It was difficult enough to get people to start using condoms in the first place. Now with Prep people think they have a get out of jail free card. Or not being on Prep they think they can trust other people when they say they are on it. You can finesse however you want. The danger may he small now. But inevitably unless we find other treatments or an actual cure, the danger will grow. I'm not blameless myself. I'm on Prep. And while I still normally like to play safe I have to admit to having had several instances of not being safe. Even with Prep that makes me nervous.

[ChrisWydeman]

The problem is what it always was. It was difficult enough to get people to start using condoms in the first place. Now with Prep people think they have a get out of jail free card. Or not being on Prep they think they can trust other people when they say they are on it. You can finesse however you want. The danger may he small now. But inevitably unless we find other treatments or an actual cure, the danger will grow. I'm not blameless myself. I'm on Prep. And while I still normally like to play safe I have to

 

I don't think the risks have escaped people though that seems to be a common sentiment on the forum

[Tigger]

I don't think the risks have escaped people though that seems to be a common sentiment on the forum

 

People resisted the need for wearing condoms and the need to close the bath houses too.

[+ saminseattle]

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.

 

The same rule applies to unprotected sex, people are going to do what ever they want regardless of your approval so why not provide them with a way to reduce the harm to themselves?

 

With respect, I think this really discounts the impact that social attitudes and pressure can have on individuals’ behavior. Sure, some people will do “x” even if they are told they shouldn’t do it, but other people will attempt to conform to the preferred “norm” of social behavior and avoid “x” more than they otherwise would if they are told it is “bad” or dangerous.

 

Drugs are a good example here. Of course, some people still use heroin even though it is illegal and can sometimes result in overdose/death. But if it was made legal and Narcan was widely available, reducing the risk of death from overdose, it is not implausible to think that more people would use heroin more often. People may not go around calculating the pros and cons like perfectly rational economic actors, but at some level they still respond to incentives. For example, when the negative consequences of alcohol consumption were increased through prohibition, per capita consumption went down. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470475/ On the other hand, there were also countervailing side effects like the surge in organized crime that led to the eventual abandonment of the project.

 

Am I saying that Narcan should be withheld and people allowed to die in order to “send a message” to other heroin users that they need to quit? Or that the development of AIDS treatment drugs was actually a bad thing because it led to more unsafe sex? Of course not. I basically agree with you that when people engage in risky/”unhealthy” behaviors, public policy should focus on mitigating the harms rather than moralistically judging people. But I do think that a side effect of this policy will be some increase in the risky behavior, and we shouldn’t deceive ourselves about that.

[Tigger]

With respect, I think this really discounts the impact that social attitudes and pressure can have on individuals’ behavior. Sure, some people will do “x” even if they are told they shouldn’t do it, but other people will attempt to conform to the preferred “norm” of social behavior and avoid “x” more than they otherwise would if they are told it is “bad” or dangerous.

 

Drugs are a good example here. Of course, some people still use heroin even though it is illegal and can sometimes result in overdose/death. But if it was made legal and Narcan was widely available, reducing the risk of death from overdose, it is not implausible to think that more people would use heroin more often. People may not go around calculating the pros and cons like perfectly rational economic actors, but at some level they still respond to incentives. For example, when the negative consequences of alcohol consumption were increased through prohibition, per capita consumer went down. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470475/ On the other hand, there were also countervailing side effects like the surge in organized crime that led to the eventual abandonment of the project.

 

Am I saying that Narcan should be withheld and people allowed to die in order to “send a message” to other heroin users that they need to quit? Or that the development of AIDS treatment drugs was actually a bad thing because it led to more unsafe sex? Of course not. I basically agree with you that when people engage in risky/”unhealthy” behaviors, public policy should focus on mitigating the harms rather than moralistically judging people. But I do think that a side effect of this policy will be some increase in the risky behavior, and we shouldn’t deceive ourselves about that.

 

Wasn't there just an article out about how all the new bareback porn was encouraging people to go bareback more often?

[+ WmClarke]

Even if someone knows the risks (which is not always the case), other factors such as hormones, drugs, alcohol, peer pressure, self-esteem, trust, and lord knows whatever else is in the mix can trump logic and reason.

 

I learned many years ago in school that the best predictor of behavior change was intent to change behavior--and in the same breath the professor noted that intent is not a very good predictor of change in behavior.

 

It's just human nature.