Question about PrEP, effectiveness, etc.

[SteveAgain]

There were several boards I could ask this, but I thought I'd use this one because I'm sure Escorts would certainly have a lot of information about PrEP.

 

First, I'm not able to get it myself (lowsy insurance, discretion issues, etc). But as a Bottom, I have some questions about being topped by someone on PrEP.

 

If an HIV-neg top has been on PrEP for sufficient time, I understand that they cannot be infected by HIV and thus cannot pass it on. My question is: If a versatile top was exposed, how long does it take for the exposure to be eliminated from their system so they cannot pass it on? That is, could someone be exposed, and 1 hour later still have something in their system (not infecting themselves, but just as a carrier) pass it on? Or, am I not fully understanding how HIV, and PrEP, works?

 

Then, for someone that is HIV+, and is on ... PEP is it? ... that keeps HIV from progressing within themselves, right? But can they still pass it on?

[mike carey]

Not an escort and not an expert. But. To pass on any contagious disease you have to be infected with it, not just to have had contact with it. You become contagious when the virus is replicating in your system, and PrEP generally prevents that. I'm happy to be corrected, but the only way that you can be infected by someone who is on PrEP is if it fails, there is no short term infectious period before it kicks in and combats the virus. PEP is post exposure prophylaxis, a dose of the drugs when you think you may have been exposed to HIV. PEP does not refer to the HIV meds that positive people take. The normal meds that HIV+ people take usually have the effect of making their viral load undetectable, and essentially they are not infectious.

[+ BenjaminNicholas]

The normal meds that HIV+ people take usually have the effect of making their viral load undetectable, and essentially they are not infectious.

 

This. If someone is compliant with all of their meds, undetectable and regularly makes sure of that through blood work, the chance of passing on the virus is nearly zero.

 

https://www.buzzfeed.com/lanesainty/hiv-study-treatment-as-prevention?utm_term=.lfVDo1QlaM#.nyx9DxR0q2

[KennF]

I'm not sure how to answer it directly. I think you're not fully understanding how a virus, HIV, or PrEP work.

 

Let me try and break some of your question down.

 

In general... any virus strand, in order to infect a person, has to enter into that person, find a host cell and mass reproduce. When the infected cell overflows with virus, it breaks open and thousands of new virus strands are released. They repeat the process.

 

 

HIV- guy on PrEP fucking (topping):

It isn't that they can't be infected, it is that the possibility of being infected are extremely small. As a top, it is less likely that their dick has a break in the skin and that blood or bodily fluids can pass from an HIV+ person into his cock. The only really "exposed" area is inside the urethra. So, the bottom would have to have a tear inside their ass, bleed sufficiently for blood to find an open spot to enter into the top. Once inside the top, the HIV virus would have to deal with the Truvada chemicals that are blocking them from infecting the cells in the top.

 

HIV- guy on PrEP getting fucked (bottoming):

The same type of situation. Now the bottom has to have a tear in the skin or lining inside his ass. This is a little more likely since a cock is pushing in and out and rubbing/dragging along the lining. As lube breaks down, the rubbing becomes friction and the possibility of internal tears increase. Now, if the top is infected with HIV, his precum and sperm may contain some of the virus. And if the virus enters the tears, then HIV has entered into the bottom.

 

Once there, the virus strand will attempt to infect cells of the immune system, but Truvada's chemicals are present and interfering with that. Thus the bottom is at decreased chance of infection.

 

Passing it on after exposure:

It is EXTREMELY difficult to see how the HIV- guy on PrEP can "pass it on".

Neither PrEP or PEP actually remove any infected cell. They work by blocking the virus strands from entering into new cells.

 

So, for the person to be a 'carrier', they would have to pass the blood or bodily fluid with "loose" HIV virus strands from the original HIV+ person onto a new person. That new person would also need to have a break in their skin or anal lining.

 

In blunt terms, the HIV- top with exposure would have to fuck a new guy with a bloody dick or with his dick having an open cut. The HIV- bottom with exposure would have to continue have minor bleeding in his ass, bleed out the original viral strands and those strands would have to enter a break in the new top's cock.

 

For the exposed bottom to turn around a top another guy and pass along the original virus strands, well that is surreal. The virus would have to travel through the blood, being unable to pass into the lymphocytes, float freely and happen to be at the cock as it happens to be bleeding.

 

 

Hope that helps.

[SteveAgain]

Thanks, that is a HUGE help to my understanding of all this. So to recap:

 

An HIV- guy on PrEP topping me bareback ... sounds like zero chance I could become infected with HIV.

An HIV+ guy on appropriate meds topping me bareback ... not quite a zeero chance I could become infected with HIV.

 

Other diseases are still fair game - PrEP only is for HIV.

 

Right?

[+ José Soplanucas]

Thanks, that is a HUGE help to my understanding of all this. So to recap:

 

An HIV- guy on PrEP topping me bareback ... sounds like zero chance I could become infected with HIV.

An HIV+ guy on appropriate meds topping me bareback ... not quite a zeero chance I could become infected with HIV.

 

Other diseases are still fair game - PrEP only is for HIV.

 

Right?

 

Right, only HIV

[+ Eric Hassan]

There were several boards I could ask this, but I thought I'd use this one because I'm sure Escorts would certainly have a lot of information about PrEP.

 

First, I'm not able to get it myself (lowsy insurance, discretion issues, etc). But as a Bottom, I have some questions about being topped by someone on PrEP.

 

If an HIV-neg top has been on PrEP for sufficient time, I understand that they cannot be infected by HIV and thus cannot pass it on. My question is: If a versatile top was exposed, how long does it take for the exposure to be eliminated from their system so they cannot pass it on? That is, could someone be exposed, and 1 hour later still have something in their system (not infecting themselves, but just as a carrier) pass it on? Or, am I not fully understanding how HIV, and PrEP, works?

 

Then, for someone that is HIV+, and is on ... PEP is it? ... that keeps HIV from progressing within themselves, right? But can they still pass it on?

 

If you're on Facebook, I highly recommend joining the "PrEP Facts" page (https://www.facebook.com/groups/PrEPFacts/). My best friend started this group about 4-5 years ago, and it's been recognized by the WHO and other organizations as a resource about PrEP. Damon has been invited to speak at CROI and other HIV/ID conferences to discuss how to share information and connect consumers with appropriate care. There are tens of thousands of other people on the group, including many doctors and other healthcare professionals. Gilead knows about the group and supports Damon (not financially), but doesn't promote the group, which I think has something to do with Pharma laws. Anyway, check out the group - there are links to the research and conversations about all kind of sex/HIV/PrEP related topics. It's a great resource to find out the facts, ask questions, talk to other users, get information, etc.

[+ VictorPowers]

Prep works in conjunction with SAFE sexual practices. This does not mean it's a free pass and you won't contract HIV.

 

https://www.poz.com/article/HIV-risk-25382-5829

 

This article states you'd have a 1-70 chance if it's BB and you're the bottom. Prep in research studies has shown 90%+ effectiveness in reducing that risk. Although that makes your risk significantly lower, it is still a numbers game if you play raw. Your sexual choices are your own, but for me personally I take Prep daily and play safe 95% of the time.

[Cannon]

It's best used as a supplement to condoms, and not as a replacement for them.

[KennF]

In a broad sense, you are correct.

 

An HIV- guy on PrEP topping me bareback ... sounds like zero chance I could become infected with HIV.

Since they aren't infected, the only chance is that their cock has a 'stray' HIV strand on their cock from someone else, AND, that viral strand enters a tear inside you. That is more than a little surreal. Basic hygiene handles this. And, who wants someone else's ass residue on the cock fucking them?

 

An HIV+ guy on appropriate meds topping me bareback ... not quite a zeero chance I could become infected with HIV.

One of the usual meds an HIV+ person is on includes a entry inhibitor. It makes it very difficult for the virus strands to find new host cells. The person's viral load (the number of loose viral strands) becomes so low that it is referred to as 'undetectable'. With less loose virus strands, there is a lower chance that they can pass it along.

 

Just want to point out, you have no way of knowing whether the person topping you raw is HIV- or HIV+.

You only know what they tell you.

[rvwnsd]

Regardless your insurance, Gilead (the manufacturer of Truvada) has a program that will pay your copay, rendering it free of charge. In terms of discretion, you can get a prescription filled by a pharmacy that is not near your home or work. If your insurance requires that you use mail order you can have it shipped to any address.

[+ WmClarke]

Regardless your insurance, Gilead (the manufacturer of Truvada) has a program that will pay your copay, rendering it free of charge.

The Gilead copay maxes out at 3600/year, so 300/month. That seems to cover a lot of insurance copay amounts, but not all.

[LivingnLA]

An HIV- guy on PrEP topping me bareback ... sounds like zero chance I could become infected with HIV.

 

An HIV+ guy on appropriate meds topping me bareback ... not quite a zeero chance I could become infected with HIV.

 

Other diseases are still fair game - PrEP only is for HIV.

 

Right?

 

A few points of clarification:

• How long has the top been consistently on PrEP? It takes a solid 20 days of consistent medicating to reach optimal levels.
  
• There's a "window period" of typically up to 3 months but could be longer from when someone is infected with HIV until they show as HIV+ on testing. If someone is infected and then started PrEP after being infected, they may test as HIV- and test as such for 3 months or so but they'll actually be HIV+ and possibly able to infect others.
   
  
• PrEP isn't perfect. It's great at preventing HIV transmission during sex (90+%), but there's still a chance.
  
• PrEP-resistant HIV strains already exist, though they are very rare.
  
• Consistency is very important. The top needs to take PrEP every day on a set schedule.
  
• If you're in an orgy / group sex situation, it's possible for the top to pick up HIV from an infected bottom and deliver it to you. This is a very low probability, but it's greater than zero.
  

These points apply to both of your scenarios. It's possible for you to be infected with HIV in both situations when you engage in sex without condoms, but the probabilities are very low so long as the top has a very consistent PrEP routine.

 

Yes, some of what I mention is highly unlikely, but as I've said before, escorts--especially men who have sex with men--are a very high risk population. There are many edge cases within this group and since you said "zero chance," I felt it relevant to mention the possibilities even if they're incredibly small because they are not zero.

 

Lastly, yes, PrEP only addresses HIV. There are many other STDs and STIs that can be transmitted via unprotected anal sex. Many of them are becoming very resistant to treatment too, so please educate yourself, get the appropriate vaccines, and don't be shy about discussing these issues with a medical professional you trust and whoever is topping you.

[+ WmClarke]

A few points of clarification:

• How long has the top been consistently on PrEP? It takes a solid 30-45 days of consistent medicating to reach optimal levels.
  

That's not correct. Research shows it takes 20 days to reach max saturation levels in the body. That is assuming you take your pill every day.

[LivingnLA]

That's not correct. Research shows it takes 20 days to reach max saturation levels in the body. That is assuming you take your pill every day.

 

I was multitasking and made a mistake. Thanks for the correction!

[+ WmClarke]

I was multitasking and made a mistake. Thanks for the correction!

I was worried for a second--thought some new research had changed the number! Looked into up to be sure before I posted. lol

[LivingnLA]

I was worried for a second--thought some new research had changed the number! Looked into up to be sure before I posted. lol

 

Lol! That's what I get for talking to someone while writing a post here and listening to a voice mail.

[rvwnsd]

The Gilead copay maxes out at 3600/year, so 300/month. That seems to cover a lot of insurance copay amounts, but not all.

True. However, there are other programs such as the ones listed in this link. Others can be found with a little research.

[+ Eric Hassan]

That's not correct. Research shows it takes 20 days to reach max saturation levels in the body. That is assuming you take your pill every day.

 

Where are you seeing this 20 day number? Can you cite this research? As far as I know, and from what I have read, the typically accepted timeline is 7 days, not 20.

[+ BenjaminNicholas]

Where are you seeing this 20 day number? Can you cite this research? As far as I know, and from what I have read, the typically accepted timeline is 7 days, not 20.

 

From the CDC website...

 

https://www.cdc.gov/hiv/basics/prep.html

 

[KennF]

My understanding is that they're discussing different types of tissues taking different amounts of time to reach maximum efficiency. Back in 2014 there was some question about the transmission mechanism.

 

For rectal tissue, 7 days;

For blood tissue, 20 days

[+ WmClarke]

That's not correct. Research shows it takes 20 days to reach max saturation levels in the body. That is assuming you take your pill every day.

 

Where are you seeing this 20 day number? Can you cite this research? As far as I know, and from what I have read, the typically accepted timeline is 7 days, not 20.

I get it from a PrEP Facts group on Facebook. Where this gets cited a lot:

 

From the CDC website...

 

https://www.cdc.gov/hiv/basics/prep.html

 

Thank you BN for providing the source!

 

My understanding is that they're discussing different types of tissues taking different amounts of time to reach maximum efficiency. Back in 2014 there was some question about the transmission mechanism.

 

For rectal tissue, 7 days;

For blood tissue, 20 days

Yes. While some researchers think the 20 day number is conservative, no research has shown a better number except for receptive anal sex. I believe that's because this specific issue has not been researched further--so they stick with what research has shown previously.

[KennF]

I will also point out, that it begins to become effective within the first few days.

When we are talking about reaching the maximum efficacy, we are talking about the difference of a few percentage points.

 

And it provides NO protection if it isn't taken

[+ Eric Hassan]

From the CDC website...

 

https://www.cdc.gov/hiv/basics/prep.html

 

Thanks! I don't know how I missed that!

[SteveAgain]

Thanks for all the information guys! Very informative!

 

How's about a followup: if I as a bottom could get PrEP (difficult in my situation) and take it regularly, clearly I would be most protected than just the top being on it.

 

But suppose now my source terminated where I couldn't get more. So when would be the last day I could be exposed, but protected? Up to the last day of medication? Some day(s) before the last pill? Or a day or few after the last pill?