Unprotected sex

[ChrisWydeman]

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.

Actually your dead wrong. Look up portugals drug war and what they did and the effect it had

[whipped guy]

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.

 

Well at one time or another we all have good intentions, and sincerely hope to alter our normal behavioral patterns for the better. That's why the gym is always so crowded in January. However, even with the best of intentions many never follow though so as to attain their often noble goals. That's why the gym is less crowded by February and usually half empty by March.

 

Add sexual gratification into the equation and all semblance of reality, logic, and reason gets tossed into the wind.

 

As someone who had a job where I was potentially exposed to HIV for the better part of forty years this discussion is not something that I take lightly. When I think back how my profession was not observing unversal precautions during the same timeframe when the first persons were becoming infected with HIV is quite a disturbing thought. Of course that was a different time and a different place and the medical profession was not even aware of the existence of HIV. As such we have come a long way since then, but at the same time I see a regression back to that time in the early 1980's where ignorance ruled the day. The sad part is that we are no longer ignorant of the ramifications, but still many are willing to look the other way.

 

One thing that I learned from my professors related not to human behavior and intent, but rather to the behavior and intent of a virus. Incredibly any given virus was often much smarter than any drug that was designed to prevent or combat it. Given that fact I would never solely rely on a drug for prevention. One must have the mindset that preventing HIV is a never ending battle and therefore the most effective armamentarium must be utilized. Be in denial if you wish, but I think what has proven to be most effective is already known...

 

Okay I'm off the soapbox.

 

[+ saminseattle]

Actually your dead wrong. Look up portugals drug war and what they did and the effect it had

 

Well, I did skim a couple of articles about Portugal’s experience with drug decriminalization, and I did not see anything to suggest I was “dead wrong.” Apparently, the Cato Institute did a study in 2009 suggesting that the policy did not increase drug usage rates, but other sources pointed out how difficult it is to get good statistics on drug consumption. In any event, they also “invested heavily in widespread prevention and education efforts, as well as building rehabilitation programs,” so it seems that they were increasing carrots as well as decreasing sticks, which makes it hard to know the impact of each individual aspect of the program. For the record, I don’t disagree at all with the suggestion that the “war on drugs” does more harm than good. My point is only that as a general matter, people respond to incentives and disincentives at least to some degree.

 

To bring this back to the original issue, it suggests that yes, theoretically, if you decrease the risks of condomless sex, you’re probably going to get more of it. Still, on the whole, it’s hard for me not to think of PREP as a very positive development. Maybe there will be more STIs as a result, but there will probably be less AIDS. And for those of us who are quite risk averse, it’s great to have the option of PREP plus condoms.

[+ Snbrd]

I'm relatively new to this site. This subject invokes logic and emotion. The tone of the dialogue is uplifting. There is a lot of shouting at one another taking place in politics, sports radio and other places. How refreshing it is to note the tone of this thread.

[rvwnsd]

Let's pretend for a moment that HIV never surfaced. Would everyone who is on the condoms-only bandwagon still insist on their use 100% of the time?

 

Before you answer that, keep in mind other STIs were prevalent before HIV. Clearly, condoms were not widely used to prevent their spread.

[Tigger]

Let's pretend for a moment that HIV never surfaced. Would everyone who is on the condoms-only bandwagon still insist on their use 100% of the time?

 

Before you answer that, keep in mind other STIs were prevalent before HIV. Clearly, condoms were not widely used to prevent their spread.

I don't think that's a fair question. In modern times from the 1950's on gonorrhea and syphilis could be cured and with basically the worst diseases out there being herpes and hpv.

[+ Lance_Navarro]

Let's pretend for a moment that HIV never surfaced. Would everyone who is on the condoms-only bandwagon still insist on their use 100% of the time?

 

Before you answer that, keep in mind other STIs were prevalent before HIV. Clearly, condoms were not widely used to prevent their spread.

 

I think that's a great point. There is a reason why VERY few gay men used condoms prior to AIDS, it FEELS BETTER and is much more intimate, and for most it was worth the risk of other minor and easily treatable infections, especially ones that are just as easily spread orally.

[+ quoththeraven]

I'm relatively new to this site. This subject invokes logic and emotion. The tone of the dialogue is uplifting. There is a lot of shouting at one another taking place in politics, sports radio and other places. How refreshing it is to note the tone of this thread.

 

You wouldn't have thought so as recently as a year and a half ago.

[rvwnsd]

I don't think that's a fair question. In modern times from the 1950's on gonorrhea and syphilis could be cured and with basically the worst diseases out there being herpes and hpv.

 

It is an absolutely fair question. Every time PrEP is mentioned we have to listen to how PrEP does not prevent other types of STIs, which is a very true statement. However, had gay men worn condoms to prevent other types of STIs prior to the dawn of HIV, there would not have been an HIV epidemic in the first place. The fact is, they didn't wear condoms and, as a result, HIV was spread and an HIV epidemic occurred.

 

I recognize this concept is a hard pill to swallow. I also recognize it is hard to reconcile the idolization of the people we lost to HIV/AIDS (which most of them acquired by not using condoms) with the demonization directed toward people who use PrEP instead of condoms. That's why demonization is such a dangerous activity. It can, and often does, come back and hit very close to home.

[LADoug1]

I feel like we are downplaying the possible long term negative effects of STIs especially HPV.

[Juan Vancouver]

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.

 

Your argument is flawed in every way. If social shaming and social pressure had any impact at all on individual behaviour we would see a lot more people keeping their piehole shut. Sadly, morbid obesity is growing (Specially in your country) at an alarming rate.

 

People are harshly aware of the dangers of being overweight, let alone morbidly obese, there are endless and uncontested documented studies on how being fat will kill you, there's a host of studies of how obesity hinders your emotional wellbeing, your social interactions, your ability to take care of yourself, etc.

 

Being morbidly obese will kill you. No questions asked. We know this, but people keep pushing terrible food into their mouths.

 

Being on Truvada and engaging in condomless sex will not kill you. Might give you a couple treatable infections here and there, but that's it.

 

On the other hand, being on Truvada will hugely help in stopping the transmission of this terrible virus.

 

I understand that most of the men here lost all their gay friends and saw death in amounts I cannot even imagine. I understand your guys might still emotionally equate condomless sex with losing everyone around you. Emotions are not rational. You feel the way you feel even if this has nothing to do with facts. I respect your fear and your desire to demonize this situation. However, considering the facts, having condomless sex now is not the russian roulette it was before, as a matter of fact, having condomless sex on Truvada is incredibly safer (and more fiscally responsible ) than stuffing your face with pie.

 

Still, you have every right to decry people taking risks. You go out in the streets? Drive a car? Eat selfish? Fall in love? Eat pie? All these activities, (As a matter of fact everything in life) carries a risk. Being an adult precisely means to be aware of the risks in which I incur, and consciously decide which ones I can stomach and which ones I can't

 

Being an adult, also means learning to respect other people's choices. Specially when the choices are really not that extreme in reality.

 

For me getting STI's here and there would be a real bummer. It would impact my income greatly and would not be worth the advantage of having bareback sex. Personally, I prefer to continue using condoms.

 

I know for some other people this risk assessment goes the other way. It is my absolute pleasure to defend their right.

 

Don't want to contract any STI's? Don't have sex.

[+ saminseattle]

Your argument is flawed in every way. If social shaming and social pressure had any impact at all on individual behaviour we would see a lot more people keeping their piehole shut. Sadly, morbid obesity is growing (Specially in your country) at an alarming rate.

 

People are harshly aware of the dangers of being overweight, let alone morbidly obese, there are endless and uncontested documented studies on how being fat will kill you, there's a host of studies of how obesity hinders your emotional wellbeing, your social interactions, your ability to take care of yourself, etc.

 

It’s an interesting theory that none of this has any impact at all on people’s behavior. My own theory is that obesity rates would be even greater if people weren’t concerned about the downsides of being overweight. Of course, there are many variables—from increasing suburbanization and more sedentary lifestyles to mass production of cheap high fructose corn syrup—so it’s not like this is a controlled laboratory experiment where you can really get a definitive answer on why people do what they do. So maybe we can just agree to disagree about this rather theoretical issue.

 

What I absolutely agree with you about is that a life with zero risks is pretty much impossible and probably not worth living anyway, and as adults, it’s up to each of us to decide how much risk we’re willing to accept when it comes to our own body and health, hopefully based on the best available information.

 

I feel like we are downplaying the possible long term negative effects of STIs especially HPV.

 

As a reminder to people, there is now a vaccine for 9 strains of HPV, including several that are known to cause cancer. It’s not officially approved for those over 26, but that just means you have to pay for it yourself. Personally, being a relatively risk averse person, I think it’s worth the ~$700 price tag.

[WolfRamNHard]

Normally I would stay clear of such a discussion, but against my better judgment I'll jump in (and probably regret it later). Several random thoughts/opinions come to mind --

 

-- The invention of PrEP is a good thing for humanity in the same way that penicillin was a good thing when it was first discovered (by the way, penicillin is still the first line drug of choice against syphilis, even in this day and age). Thus the moral judgments and finger-wagging to which PrEP users are often subjected these days seem unfair, even counterproductive.

 

-- Infections have always existed and will continue to do so, for such is the nature of biological evolution. We get rid of small pox, and something else pops up in its stead. STIs in general and HIV in particular provoke so many more emotions and judgments than say, Influenza or Varicella (chickenpox), even though both these examples (flu and chickenpox) are killers as well. I believe the difference in attitudes is because of *SEX*. In post-Victorian Western societies, anything associated with sex is either not talked about or is something to be embarrassed about. In addition, as others have mentioned above, the recent history of the AIDS epidemic in the gay community has left long-lasting tragic scars that elicit strong emotions.

 

-- There has been a recent uptick in cases of oropharyngeal squamous cell carcinoma caused by HPV, especially in young gay men (this is felt to be transmitted through oral sex). While it appears that this particular sub-type of cancer is somewhat different, has a better prognosis and is more amenable to treatment than the usual sub-type of oropharyngeal cancer that occurs in older smokers, it's still something that needs to be addressed. To me, this is of just as much concern as HIV from a policy perspective.

 

-- I strongly believe that the FDA guidelines for the use of HPV vaccine really should be revised. Everyone really should be vaccinated against HPV regardless of age, especially gay men. The counterargument that "everyone past a certain age already has it" is silly. Almost all elderly individuals have had chickenpox, yet the Varicella vaccine is still recommended in elderly patients. So why not vaccinate all sexually active adults against HPV, regardless of age?

 

I could go on and on but probably best to stop here.

[LADoug1]

Information and availability of PReP is more limited in certain populations i.e. low income and people of color. This makes me think we should continue to urge the use of condoms and not downplay the risks of not using them.

[+ Eric Hassan]

There have actually been three known cases to date.

 

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

 

Can you please provide citations??

[+ WmClarke]

There have actually been three known cases to date.

 

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

Can you please provide citations??

 

The article in the link in my message which you quoted is my citation.

 

The highlighted words ("three known cases") are the link to an article on poz.com

[+ Eric Hassan]

The article in the link in my message which you quoted is my citation.

 

The highlighted words ("three known cases") are the link to an article on poz.com

 

Great! I'm sorry I didn't catch that. Thank you

[+ WmClarke]

Great! I'm sorry I didn't catch that. Thank you

No problem. I will try to highlight the link better next time.