bearbandit

There's a little logic behind it, in that if you've had lipodystrophy, and recover (very slowly!) without using fillers, such as Nu-Fill, you can end up with veins that appear more prominent than average. Phlebotomist at the HIV clinic refers to me as having oil wells for veins...

Think about it: either your on meds stronger than PrEP which would knock out any strain of HIV, or if you're not on meds, the "local" strain would overwhelm the "invading" strain. I'm given to believe that the chances of getting a second strain and it surviving to co-exist with the strain already present are such that it happens once a year on the entire planet...

I can understand the feeling of being left out: just as you can't really grasp the gut-wrencher that is HIV, their memories of being HIV- inevitably fade. I can understand the urge to line up alongside each other and face it together. When I was one of a triad in the late nineties, it was my husband who was the negative one. All three together or just me and my husband: keep it safe. Just me and our boyfriend: what's a condom? As tallbtm says you're an excellent candidate for PrEP if it's available where you are. No problems if you're in the US, other than the usual ones your byzantine health system throws up, more difficult elsewhere. If you're in UK the PROUD study hopes to recruit 2,500 gay men early next year, providing they get the funding. Other countries, you may be able to get it prescribed "off-label" as with two HIV+ partners you're at high risk. Kudos to your husband for wanting to protect you by waiting till he's gone six months undetectable. Six months isn't so long. I know of guys who've seroconverted and damn near died within five years. I know of people who had seroconversion illness so badly that they were hospitalised for months. Say you go ahead and get pozzed; therapeutic (as opposed to preventative) HIV treatment isn't necessarily a picnic. What if you end up being the one who has difficulty getting a regime that you can tolerate? How much anxiety will that put on your husband and boyfriend? Some people are lucky and can get away with a single combination pill a day - what if, like me, it turns out you can't tolerate the drugs in the combination? I'll be honest here and say that I fell out of the side-effect tree and hit every branch on the way down: few people go through the crap I've been through with ARVs. Are you prepared to gamble your future? HIV just ain't worth it. My husband got it at work, giving first aid to someone who'd hit an artery instead of a vein when shooting up. We thought nothing of it at the time, but five years later after a needlestick injury at work, policy then dictated he be tested for HIV and Hep B/C. The HIV test came back with a CD4 count low enough to show that he's had it for some time. I guess what you're feeling right now is similar to what I felt then: I just wanted to somehow get it out of his body. If I hadn't already got it, I would have wanted to get it. You've already got a husband and boyfriend with HIV: that's enough to worry about without you joining them.

Don't do it. Even if the Truvada is going spare, there's more to it than swallowing a pill every day. If you are unlucky enough to get HIV in one of your Truvada-less periods, it is not an adequate treatment for HIV and it possible that resistance could build up. Truvada for HIV treatment requires at least one other drug beside it (preferably these days an integrase inhibitor). That's why guys on PrEP have to have an HIV antibody test every three months. Secondly you need to have your liver and kidneys monitored on a quarterly basis. Embitricitabine (FTC) isn't too bad on the side effect front, but tenofovir (the other ingredient) can be vicious and fast. Two years ago I smashed my bike, moved house to a very ill-advised location for someone with no personal transport, believed a small pot of yogurt and a litre of fruit juice was an adequate diet, lost a lot of bone mass (a one way street), and when I did go into hospital I was within a week or so of dying and the police were there to ensure I did go to hospital. All because tenofovir had damaged my kidneys so much that I was pissing away minerals and vitamins essential for life. Yes you can buy generic truvada online (Tenvir-EM - google it) for about $100 per month, but the important thing is you need a range of blood tests at least quarterly to check that truvada isn't doing internal damage. Don't get me wrong: truvada is the next step on from condoms and I do all I can to promote it within the UK (where also it won't be available till 2017/8). The PROUD study is hoping to recruit another 2,500 gay men to the study early next year - if you can produce a UK address and can afford the travel costs, that may be your best bet...

PrEP in the USA was authorised in late June/early July 2012 - I remember that particularly because I was in hospital at the time and had just read the news before the ward round and gave my doctor the third degree about her ideas on the subject. That will have been preceded by several years of testing (we're hoping that it will be available in the UK by 2017 since they insist on testing nation by nation). When truvada was first licensed as PrEP, its availability was almost a state secret in the USA.

A difficult question, not least because of the unfortunate truth that some men lie. In the USA you'd be an ideal candidate for PrEP, and I'm sure I've read of Canadian doctors prescribing truvada for off-label use as PrEP. But as you can say you can't afford the $800 per month... Really, it all hinges on how much do you trust this guy. I have HIV and I know that my viral load is low enough that I'm below the level at which I could pass it on. In fact it's a worst nightmare situation for me: my partner (also poz) was having a routine operation and the surgeon slipped resulting in one of the nurses getting sprayed with my partner's blood. I wrote Pozdaddy (it's in the Backroom Fiction section under chasing/giving) as an exercise to see if I could write and eroticise gifting. Any request to see the printouts of his blood results is going to look crass - personally I'd take offence if someone asked me that. It generally takes a viral load of 1000 to be capable of passing HIV on, though last time I used that statistic someone here commented that there has been recorded a transmission from someone with a VL of 386. The European PrEP studies are all using 200 as their undetectable marker, whereas the figure varies from 70 down to 20 in the UK depending on which hospital you use. The risk to you is much less if you're fucking him than the other way round. Is it low enough for you? Fucking after fisting may carry an extra risk because of micro-abrasions in his ass. Ultimately, it all comes down to the degree of risk you're prepared for. I used to use my motorbike as an illustration: although great fun, it's a risky form of transport. After putting tens of thousands of miles on various bikes, I had a minor accident, barely scuffing my leathers, but breaking my ankle badly enough that two years later I still need a stick to walk out of doors. To me the risk was worth it, even though I know I'll never ride again. If he truly is undetectable, then he's one of the safest fucks in town: TasP, Treatment as Protection, is the natural counterpart to PrEP. When I see my doctor I'm automatically asked about sex I've had since I was last there: nothing to gain from lying. I presume his HIV clinic has the same approach to STIs as they can complicate things with HIV. After all that, if I were HIV-, I'd go ahead and fuck him, and if someone were making me the offer I'd be reaching for the lube...

You have my sympathy... I had anal herpes for six months. The good news is that if you listen to your body, you'll learn the warning signs of an impending attack (for me it was the nerve pain down the back of my thighs). As soon as you get a warning that it's trying to resurface, hit the antivirals and continue with them until a good week after the last symptom goes down, just in case. The first bout is usually the worst with subsequent bouts having less and less intensity. My first attack was over twenty years ago and I honestly don't know when the last one was, probably when my CD4 count started moving upwards in 2000. You're only infectious when you've got an active attack going (and, frankly you probably wouldn't feel much like sex anyway at this point), so be sure to watch out for your signs of an impending attack. That's when you stay off Grindr etc and get on with something else instead. As well as HIV I've got diabetes which can cause genital thrush: "Sorry, not just yet: I've thrush playing up. Should be okay in a week or two". You'll be substituting herpes for thrush... Always better to brazen in out, in my opinion. If you're not having an attack of herpes, you can't pass it on; if he's scared off by knowing the the virus is locked in and inactive, was he worth fucking? As I say on one of my profiles "If you're not comfortable with my HIV, we probably won't get on." Okay, it's painful, but it goes away. At which point it might as well not be there. (I wish, how I wish!) It means a few adjustments to your sex life, but nothing so drastic as you fear. And you're not saying anything I haven't heard other guys with herpes say. A couple of tips: it is said that there's an amino acid in mung beans (the little green ones used for bean sprouts) that herpes doesn't like, and cross chocolate off your list of treats: it contains an amino acid that herpes thrives on. Good luck...

Saying "clean", as you rightly point is pretty much an insult to PwHIV. As part of pre-sex negotiation using more accurate, less loaded terms, is what guys should be going for. "Dirty load" and such come more under the heading of sex talk. How many guys who referring to their asshole as their cunt really believe that they have a functioning vagina? How many guys who get off on race play would actually use the word "nigger" in their every day speeech? It's a question of knowing what sort of language is appropriate when...

PEP and PrEP are different things. PrEP, pre-exposure prophylaxis, is a daily dose of truvada (itself composed of two drugs emtricitabine and tenofovir) which is, in the USA, prescribed to guys who are HIV- to prevent them getting HIV. You need to have quarterly blood tests to check on the health of your kidneys and liver and that you are still HIV-. PEP (post exposure prophylaxis) which is taken for a month after a possible exposure to HIV. If it isn't started within 72 hours, it's pretty useless as the virus is, by then, too embedded in the system. Basically it's a three drug combination the same as someone who has HIV might take. At present truvada (two drugs in one, remember) backed up with raltegravir is a popular choice among doctors. It's essential to take PEP exactly as prescribed to maintain drug levels in the system: you can't afford them to slip in case you really did pick up HIV. If one of the drugs prescribed is raltegravir, that one is formulated to be taken every 12 hours, so you have to make sure it's 12 hours, not eleven or thirteen hours between doses. Think of it as "the morning after pill"...

From the time of exposure you've got 72 hours to get PEP: after that time limit any HIV infection is going to be too well established for PEP to work

A friend of mine who worked in British porn got HIV on-set. But PrEP is still being tested in the UK...

I've no doubt that it'll happen at some point - straight women have been using the pill for fifty years, sometimes forget it, and the planet has one more citizen. Guys with HIV are told to maintain at least 95% adherence, which works out at it being safe to miss a dose a month if you're on a once a day regimen. It's the same with PrEP: saving money by taking it only four times a week results in reduced protection. The drug is designed to be taken daily - easiest thing to do is to take it with a specific meal (taking it with food reduces any GI side effects). Although you use the term PrEP failure, it's actually adherence failure. PrEP failure implies that the drug wasn't working whereas the failure is on the part of the guy taking it to take it properly, as instructed.

PrEP is one pill a day (truvada, which is made up of tenofovir and FTC, so it's a double drug). PEP is only effective if started within seventy-two hours of possible exposure, ie before HIV has a chance to establish itself. It's a standard combination as taken by PwHIV, using truvada as the backbone to which is added another drug. Raltegravir is becoming more and more popular as the third drug, despite the fact that it's a twice a day drug, the reason being that it's got a deeper penetration into places where HIV hangs out. There are signs that the integrase inhibitors (of which raltegravir is one) are going to be as revolutionary as the protease inhibitors were in the late nineties onwards.

I can't find anything since this time last year at which point tenofovir alafenamide fumarate was in phase 3 trial. All the signs in the UK were that the new version would be available pretty much as stocks of the old formulation ran out. Disappointing news...

Standard treatment for KS used to be radio and chemotherapy. Now it's ARVs; could be a sign that your current combination isn't working as well, in which case a change of drugs would be indicated, possibly with a little radiotherapy to help things along a bit if it's somewhere noticeable or on the sole of your foot.

Taking truvada with a meal/snack of about 500 calories helps with many of the gastric effects you may encounter as it slows the absorption of the drug. Remember too that side effects aren't compulsory: even the commonest only hit about 10% of guys (though given their rounding down on patient information leaflets, I'd say 19.5%)

Every now and then there surfaces a study that says that a small percentage of guys have caught HIV through cocksucking. Personally, I don't think the statistics are accurate because, would you believe it, men tell lies. Somehow it's "less gay" to suck a dick that it is to take it up the ass, which is more likely the real story. The wonders of not being able to afford to tell the truth! Generally speaking you'd need sufficient damage in your mouth (recent extraction, gum disease such as gingivitis, or very poor oral hygiene - all things that would put guys off from even kissing you) for there to be any risk.

Perfectly possible (I once knew a woman who lost her virginity, got pregnant and got syphilis in the same five minutes) - all it needs is for you to fuck, suck, get fucked by or sucked by the "right" guy(s) in one night.

Depends on your metabolism. I've found that the side effects of therapeutic ARV goes after about three weeks, but as we seem to be seeing HIV- and HIV+ guys process the drug differently. If you've gone a month, those extra few days to be certain aren't going to kill you...

Keep it that way, Cocksucker. I've got friends who spent weeks in hospital while they seroconverted (and that joke "why does the patient in room 17 like pizza so much" "It's all I can get under the door..." still holds true in some places). Medication... I've never met a side effect I didn't hate. I have serious neuropathy in my feet and halfway up to my knees, as well as in my hands. At least the pain medication (codeine for the most part) stops the antiretrovirals from shitting myself in public. I'm an HIV activist and travel a lot, but find that I can only travel every other weekend, as I need the other weekend to recover from the travelling (and it's not as though Britain is a big island). The choice comes down to sex party or HIV meeting... There's no way to predict the course of HIV disease: you might end up being well for twenty or more years, as have some friends, you might get sick almost immediately, as have other friends. Toss a coin. Me, I was doing fine until two and a half years ago. I'm one of the longest term survivors in the UK. I'd built myself up with weights and did thousands of miles on the bike I thought I'd never be able to ride again. One of my drugs bit me in the ass: a £2000 bike trashed, and the discovery that I had the bone structure of, perhaps, a seventy year old. Oh, diabetes too... with all its attendant problems. I can't get a hardon without viagra, so I'm gradually sliding back into being bottom (which isn't who I am, but the pretty much the only way to get sex, unless he's into strict obedience). Some guys talk about the freedom of being poz: what sort of freedom is it when you need a doctor visit every quarter? Or, if you top, wondering if you seeded someone when you didn't mean to? Of when the police are banging at your door because one of your tricks (who needn't have been at any risk) went running to the law?

I'd go for the 30 days - after all, it's how long PEP is prescribed for. Take a poz load just before you stop and, frankly, we don't know what your chances are as PEP involves at least one other drug. And what happens if you get lucky on holiday? Personally I wouldn't stop at all: studies into the residual protective effects of PrEP would be unethical and immoral, so all we've got to go on is anecdotal evidence. It's only one little bottle in your luggage. I can tell you, though, that in the quarter I skipped taking my ARVs (sheer pill fatigue: I take something like 25 a day) for a week, my viral load went from 0 to 156 and I lost 200 CD4 cells. I'm saying this in the full knowledge that guys on PrEP seem to process truvada differently from those of us with the virus, but frankly, mate, in your position I wouldn't be taking any chances.

How big he needs to be depends on your body size and internal geography. I got fucked last year by a guy with at least ten inches (even soft taking his entire dick in my mouth set off my gag reflex). From previously playing with an anal probe and having a colonoscopy a couple of years ago, I'd guess my second sphincter is about eight or nine inches in. What? You thought I was going to sit on a ruler?!

Hepatitis B (didn't even enjoy getting it: it was a courtesy fuck - I mean, what else do you do when last night's trade's partner turns up?), followed by a number of imperfect, overdosed first generation ARVs. Newly diagnosed guys take note: the same sort of damage will not happen to you if you opt for meds. There are alternative drugs available if it proves that you can't tolerate drug X, and doctors are keen to minimise the effects of ARVs on the body as damage to internal organs makes it harder to come up with an alternative prescription and their job is to heal not damage. We took the imperfect drugs because they were better than nothing: the same drugs that damaged my pancreas to diabetic levels also kept me alive till something better came along. I know guys who are into their third or fourth combination before their first year as a PwHIV is up because they couldn't find a good match. That said, side effects are unusual these days...

I meant Kidney damage - many apologies! I've lived with liver damage for so long that it's automatic to say liver damage, even when it's not. Sorry, guys!

I wouldn't say that PEP is a workable option because PrEP uses drugs with the lowest side effect profile possible, while maintaining a barrier against HIV. Even so, of the two drugs in truvada, one of them can cause serious liver damage in people with HIV (people without HIV seem to have a better chance against these side effect, possibly because of better initial health when starting them). PEP involves a fairly intense period (usually four weeks) of therapy in which the virus is hit every which way because when people go for PEP it's already had time to establish itself - three days after exposure it's worthless. One of the biggest jobs I have at myHIV is persuading people who've just started HIV therapy (which, essentially, is what PEP is) to stick it out over at least the first month before they ask change combinations. While most of us with HIV get used to the side effects, and indeed end up not having any side effects as our bodies adapt, the fact remains that the drugs used for PEP can make you bloody sick. Experienced as I am with ARVs (the health trainer at the charity I volunteer for calls me a drug whore since I've had most of them at one time or another) I've never yet met a combination that doesn't have at least some start-up side effects. Most are slight, but for PEP they bring out the big guns. You don't want to put yourself in line of fire, believe me!