What are the symptoms?

[+ sniper]

Okay, then I am still not understanding how is it that you think that asking all gay men to put out only on the third date will make their sex less risky. The only way in which it is slightly safer is that they would be fucking a lot less, which in truth makes this a "keep it in your pants" kind of "suggestion".

 

I am wondering whether I am missing some other amazing ways in which this would make us all safer. Care to elucidate?

 

It has to do with the mathematics of chains of exposure. It often turns out that only slight changes in frequency can have massive effects on aggregate numbers when you are working with an exponential distribution. Say previously one person would spread X to, on average, 4 people in 2 years before entering treatment and no longer transmitting. And each of those people on average does the same. In ten "generations" you've now got 4^10= ~1 million cases. Then say you reduce that number to 3. 3^10 is less than 60,000. And that much lower overall number of infections makes the occasional "breach in protocol" a lot less risky.

[Juan Vancouver]

So I understood correctly the first time; you are suggesting that people fuck fewer times than they already do.

 

Don't you think that correct information coupled with adequate prophylaxis is a much more efficient strategy than having fewer fucks?

[LivingnLA]

So I understood correctly the first time; you are suggesting that people fuck fewer times than they already do.

 

Don't you think that correct information coupled with adequate prophylaxis is a much more efficient strategy than having fewer fucks?

 

What @sniper was talking about is pure mathematical reality. For me, I coupled that with the additional time to enable someone to actually assess if someone seems trustworthy and reliable for sexual activity.

 

I definitely hear where you're coming from, but humans are humans. They are not perfect. They forget or skip meds, including PrEP, for various reasons. They forget condoms. Etc.

 

I absolutely agree that every adult should be required to have comprehensive safer sex ed. But, that's highly unlikely to happen. And high-quality vaccines and safer sex prophylactics should be easily available to all sexually active citizens. In America, that too is unlikely to happen for many many years.

 

We have no easy good answers because human sexual behavior is frequently selfish, blind to long-term consequences, and rarely rational.

[Sebastien Sterling]

Well said. That one long sentence perfectly captures a large driver behind why so many STIs have much higher infection rates among black Americans. Just as American medical care has grossly mis-served women, it has also poorly served black Americans and especially those who engage in bi and gay sexual activity. Though, black America has some responsibility for many of those "cultural issues" that contribute to the speed bumps, roadblocks, and stop signs that contribute to making the delivery of high-quality STD/STI testing, treatment, and care so challenging.

 

This is why I mentioned to @Sebastien Sterling about the importance of good STI prevention practices because Atlanta has much higher than average rates of nearly every STI, largely because of the issue identified by [uSER=12528]@FTM_Twink[/uSER] in the above post.

 

I appreciate the concern, but I do always play safe.

[LivingnLA]

I appreciate the concern, but I do always play safe.

 

That's great! Just remember, nothing is 100% safe. All we can do is educate ourselves and play as safely as we're comfortable playing.

[LADoug1]

What @sniper was talking about is pure mathematical reality. For me, I coupled that with the additional time to enable someone to actually assess if someone seems trustworthy and reliable for sexual activity.

 

I definitely hear where you're coming from, but humans are humans. They are not perfect. They forget or skip meds, including PrEP, for various reasons. They forget condoms. Etc.

 

I absolutely agree that every adult should be required to have comprehensive safer sex ed. But, that's highly unlikely to happen. And high-quality vaccines and safer sex prophylactics should be easily available to all sexually active citizens. In America, that too is unlikely to happen for many many years.

 

We have no easy good answers because human sexual behavior is frequently selfish, blind to long-term consequences, and rarely rational.

 

Safer sex education isn't just for adults. It should be a high school requirement as well.

[+ sniper]

So I understood correctly the first time; you are suggesting that people fuck fewer times than they already do.

Fewer partners, not necessarily fewer fucks, strictly speaking.

Don't you think that correct information coupled with adequate prophylaxis is a much more efficient strategy than having fewer fucks?

PreP costs a very significant fraction of the cost of treatment for HIV in the first place. We'd be spending more on prevention than we currently do on treatment. I'm not sure that "efficient" is the word I'd use for that. And then there's the fact that the average person is pretty bad about adhering to pill regimens, as our abortion rate would attest. Everyone using protection is, it seems, as unrealistic as abstinence.

[Juan Vancouver]

Judging by your contributions it occurs to me that you are giving us your emotional opinion and are not very well informed when it comes to previous and current public strategies for sexual health tried in your country and all over the developed nations.

 

Fewer partners, not necessarily fewer fucks, strictly speaking.

 

Restraint as a means of reducing sexually transmittable infections has never worked and will never work. You can theorize till the cows come home and you can ask "all the gays" that they fuck less as much as you want, this has not and will not make any change in their behaviour. Many countries at different times have recommended restraint to absolutely no impact on transmission rates.

 

"You guys, fuck less!" doesn't work.

 

PreP costs a very significant fraction of the cost of treatment for HIV in the first place. We'd be spending more on prevention than we currently do on treatment.

 

Are there a few typos in these past two sentences? Somehow math doesn't add up. Care the elucidate me?

 

I'm not sure that "efficient" is the word I'd use for that. And then there's the fact that the average person is pretty bad about adhering to pill regimens, as our abortion rate would attest. Everyone using protection is, it seems, as unrealistic as abstinence.

 

By the way:

 

Prophylaxis doesn't mean PREP. If you are really interested in learning about the different ways in which different countries are tackling this serious issue, read. Don't listen to people's opinions. Your pastor, as well meaning as you may want to believe he is, is just trying to advance his own agenda which may or may not have a positive impact on this serious health crisis.

 

pro·phy·lax·is

ˌprōfəˈlaksəs/

noun

1. action taken to prevent disease, especially by specified means or against a specified disease.
   "the treatment and prophylaxis of angina pectoris"
   synonyms: preventive treatment, prevention, protection, precaution
   "our dental insurance covers twice-yearly prophylaxis"
    
    
    
   

[WolfRamNHard]

http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-hcp.htm

 

There have been limited studies of the bivalent and quadrivalent HPV vaccines used for patients who were already HPV+ for at least one type. Unsurprisingly, if the person already has one of the cancer causing strains, the vaccine will not prevent disease development of that strain but does appear to protect against the other strains. Scroll down in the above CDC link to the "HPV Vaccine Efficacy" section.

 

But, that doesn't increase your cancer risk. All it means, is that the vaccine is not able to protect you from disease development if you're already infected with one of the types it targets.

 

Further, for all of us cocksuckers out there, America is seeing a huge uptick (4 to 5-fold increase over the last decade) in throat/oral cancer and it appears all of it can be tied to HPV transmission via unprotected oral sex. So, if you love to suck cock, get the HPV vaccine too, but keep in mind that it cannot protect you if you've already been infected by one of the cancer-causing strains.

 

http://www.mountsinai.org/patient-care/service-areas/ent/areas-of-care/head-and-neck-cancer/oral-cancer/hpv/hpv-faq

 

I strongly agree that everyone should be vaccinated against HPV regardless of age. As a head and neck guy, I have seen firsthand the recent increase in incidence of oropharyngeal cancer among young gay men.

 

Speaking of HPV - when I was a surgical intern a long time ago at a certain inner city hospital, there was a gay male patient on the service who had the biggest anal condyloma that anybody there had ever seen. This thing was about the size of a grapefruit!!! I was young and naive at the time and very curious as to how anyone could just let something like that get so big before seeking treatment. He wasn't my patient per se, but one night on call when I was covering the entire service, I took advantage of a little downtime to tactfully converse with him and find out more. I was able to gather that he was so embarrassed about it that he couldn't bring himself to get it checked out, so he just let it keep growing and growing until it started interfering with his bodily functions, at which point he had no choice but to seek medical attention.

[LADoug1]

Judging by your contributions it occurs to me that you are giving us your emotional opinion and are not very well informed when it comes to previous and current public strategies for sexual health tried in your country and all over the developed nations.

 

 

 

Restraint as a means of reducing sexually transmittable infections has never worked and will never work. You can theorize till the cows come home and you can ask "all the gays" that they fuck less as much as you want, this has not and will not make any change in their behaviour. Many countries at different times have recommended restraint to absolutely no impact on transmission rates.

 

"You guys, fuck less!" doesn't work.

 

 

 

Are there a few typos in these past two sentences? Somehow math doesn't add up. Care the elucidate me?

 

 

 

By the way:

 

Prophylaxis doesn't mean PREP. If you are really interested in learning about the different ways in which different countries are tackling this serious issue, read. Don't listen to people's opinions. Your pastor, as well meaning as you may want to believe he is, is just trying to advance his own agenda which may or may not have a positive impact on this serious health crisis.

 

pro·phy·lax·is

ˌprōfəˈlaksəs/

noun

1. action taken to prevent disease, especially by specified means or against a specified disease.
   "the treatment and prophylaxis of angina pectoris"
   synonyms: preventive treatment, prevention, protection, precaution
   "our dental insurance covers twice-yearly prophylaxis"
    
    
   

Other than PReP and safe sex, to what prophylaxes (spelling?) are you referring?

[Rudynate]

Other than PReP and safe sex, to what prophylaxes (spelling?) are you referring?

 

Male circumcision.

[LivingnLA]

Other than PReP and safe sex, to what prophylaxes (spelling?) are you referring?

 

I'm only speculating, but I imagine @Juan Vancouver is using the comprehensive meaning of the word, prophylaxes. So, for example, mandatory and complete sex education would be part of a total societal prophylaxes regime to reduce the spread of STIs. Mandatory Hepatitis A&B, HPV, and meningitis vaccines in pre-teens with adult boosters would be a another societal commitment. Clearly and comprehensively communicate how risk increases exponentially for each additional sexual partner. Free condoms in all high risk communities. The list goes on and on.

 

Basically, prophylaxes is about behavioral, educational, medical, and societal activities that create a total preventative plan to reduce the chances of whatever we're trying to protect against.

[+ sniper]

When I was talking about the cost - Truvada is over $1500/month in the US. - and that's the number to use as even if your copay is lower, your insurance is picking up the rest and the money is being spent. That is ,much more than the average total per capita health care expenditure in the US, and it's a significant fraction of the cost of managing an HIV infection - over a lifetime it's more given that the typical HIV patient doesn't get infected their first time out of the box. Some people are recommending that all MSM go on Truvada and I'm saying that's simply not going to happen - it's cost-prohibitive. I'm not saying or expecting that people would stop having sex, but typical numbers of partners have increased dramatically in the last 20 years, while before treatment was available people slowed the rate of HIV infection, so the idea that behavior doesn't and can't change is simply not true.

[mike carey]

@sniper, I had reacted suspiciously to your comment that the cost of Truvada is greater than average health expenditure in the US, but you're right (I had focussed on the '$1500' part and not the 'per month' part). The latest figures I could find were $8713 pa (cf $3866 in Australia and $4429 in Canada). Two comments on the dynamics of pricing that may affect the take-up of the treatment (and the cost): now that health insurers in the US cannot stop covering expensive patients they are likely to consider the potential cost of AIDS treatment as well as the immediate cost of Truvada, and large insurers have a pricing advantage with drug companies. The production cost of a drug is almost zero, so if an insurer offers the drug company 1,000,000 sales at $150, the company makes ten times the amount they would from 10,000 sales at $1500.

[+ sniper]

Yes, perhaps that pricing could/should be altered with some heavy handed negotiation on the part of insurers, which could happen as the industry consolidates, but at the moment it isn't. Another year or two could see significant changes, as a lot of small health insurers are getting crushed under Obamacare because they don't have the expertise to take advantage of some of the incentives that the big boys do and the industry is likely going to be just a couple of big players in a few years.

[LivingnLA]

Consolidation won't help pricing, it will make it worse. But, that's borderline politics, so I won't discuss it further here. Suffice it to say, medical costs in America are going to get much worse as corporations continue to maximize profits.

[LADoug1]

When I was talking about the cost - Truvada is over $1500/month in the US. - and that's the number to use as even if your copay is lower, your insurance is picking up the rest and the money is being spent. That is ,much more than the average total per capita health care expenditure in the US, and it's a significant fraction of the cost of managing an HIV infection - over a lifetime it's more given that the typical HIV patient doesn't get infected their first time out of the box. Some people are recommending that all MSM go on Truvada and I'm saying that's simply not going to happen - it's cost-prohibitive. I'm not saying or expecting that people would stop having sex, but typical numbers of partners have increased dramatically in the last 20 years, while before treatment was available people slowed the rate of HIV infection, so the idea that behavior doesn't and can't change is simply not true.

When I considered Truvada I received a grant from the manufacturer to cover the cost. Grant was based on income.

[Rudynate]

Consolidation won't help pricing, it will make it worse. But, that's borderline politics, so I won't discuss it further here. Suffice it to say, medical costs in America are going to get much worse as corporations continue to maximize profits.

 

This is one of those occasions where bigger is better. My Truvada is covered through Kaiser, the largest private healthcare system in the US. If full retail for Truvada is $1500.00/month, you can be sure that Kaiser isn't paying the manufacturer anywhere near that. It costs me $35.00/month. Kaiser's position re: PrEP is full speed ahead. In their own studies of their patient population on PrEP, there hasn't been one seroconversion. You're assuming that PrEP will ever and always be Truvada, but the search is on for alternatives to Truvada. As a matter of fact there are low-cost PrEP protocols in trials employing agents that have already been FDA-approved and thus could be used off-label for PrEP.

[Wrestler]

Sorry I'm late to this convo. To address the original post--no one is more closeted than I am. Have had only oral sex and swallowed cum several times over the past year. And enjoyed it greatly. Yet, I was determined not to pass on any disease I might have had in ignorance.

 

I was nervous at first, but ended up pretty comfortable using an anonymous walk-in clinic for testing. What a blessing to be able to go to a place like that, as I would never discuss with my doc either. Hope that helps.

[Guy Fawkes]

Honey, I refuse to do the queen. It's just not fitten.

Queen Victoria would be really proud of you.

[LivingnLA]

This is one of those occasions where bigger is better. My Truvada is covered through Kaiser, the largest private healthcare system in the US. If full retail for Truvada is $1500.00/month, you can be sure that Kaiser isn't paying the manufacturer anywhere near that. It costs me $35.00/month. Kaiser's position re: PrEP is full speed ahead. In their own studies of their patient population on PrEP, there hasn't been one seroconversion. You're assuming that PrEP will ever and always be Truvada, but the search is on for alternatives to Truvada. As a matter of fact there are low-cost PrEP protocols in trials employing agents that have already been FDA-approved and thus could be used off-label for PrEP.

 

@Rudynate, yes and no. Kaiser is legally able to negotiate prices and they're large enough to have some influence. As drug companies consolidate and their lobbyists continue to outlaw drug-pricing negotiations, generics, extend patents, etc. prices will continue to climb.

[+ Eric Hassan]

And then there's the fact that the average person is pretty bad about adhering to pill regimens, as our abortion rate would attest. Everyone using protection is, it seems, as unrealistic as abstinence.

 

It's not a fact that the average person is "pretty bad about adhering to pill regimens." This is an extremely weak argument borne of fear, not fact, and is poorly thought out. It's like saying people can't be trusted to brush their teeth regularly. If it were true, medicine would look very different. I'm not saying that everyone is perfect about taking medications as prescribed, but that phenomenon is not all of a sudden new and related only to taking PrEP. I'm not sure on how you made the leap to the rate of abortion with relation to medication compliance.

 

It's time for us to be careful in how we speak. Citing feelings and calling them facts isn't effective and serves to spread fear and confusion. When it comes to "safer sex," we need to educate ourselves with facts. The days of safe = condoms only are long gone, and we need to catch up.

[Juan Vancouver]

It's time for us to be careful in how we speak. Citing feelings and calling them facts isn't effective and serves to spread fear and confusion. When it comes to "safer sex," we need to educate ourselves with facts. The days of safe = condoms only are long gone, and we need to catch up.

 

What the handsome dude just said!

[+ Eric Hassan]

Some people are recommending that all MSM go on Truvada and I'm saying that's simply not going to happen - it's cost-prohibitive. I'm not saying or expecting that people would stop having sex, but typical numbers of partners have increased dramatically in the last 20 years, while before treatment was available people slowed the rate of HIV infection, so the idea that behavior doesn't and can't change is simply not true.

 

Who are these people that recommend all MSM go on Truvada? Where are you getting this? The CDC and every single doctor I know is not making this recommendation.

 

It's cost-prohibitive? Where do you get that information? Why would you say that, after just saying that PrEP costs less than managing an HIV infection? And if it were cost-prohibitive, why would insurance companies pay for it?? I can't think of a single insurance company that would think "This costs way too much, but we'll pay for it anyway."

 

Before treatment was available, the rate of HIV did not slow. Maybe you are too young to remember the early days of this epidemic or don't have the knowledge, but before treatment was available, the rates of HIV transmission were growing exponentially.

[+ Eric Hassan]

This is one of those occasions where bigger is better. My Truvada is covered through Kaiser, the largest private healthcare system in the US. If full retail for Truvada is $1500.00/month, you can be sure that Kaiser isn't paying the manufacturer anywhere near that. It costs me $35.00/month. Kaiser's position re: PrEP is full speed ahead. In their own studies of their patient population on PrEP, there hasn't been one seroconversion. You're assuming that PrEP will ever and always be Truvada, but the search is on for alternatives to Truvada. As a matter of fact there are low-cost PrEP protocols in trials employing agents that have already been FDA-approved and thus could be used off-label for PrEP.

 

Don't forget - Gilead offers a co-pay assistance card. There is no cost to the consumer to receive the card or the benefits, all you need to do is go to their website and sign up for the card. It only covers the medications that Gilead makes for PrEP or treatment of HIV. It covers up to (I think) $300/month in co-pays.