bearbandit

These two sites have recently (this week) gone up from the UK, where we're arguing to have PrEP available pretty much on demand, within our health system rather than having to get private prescriptions. Be aware that the information on legality is specific to the UK. http://i-base.info/qa/10743 http://i-base.info/qa/10734 PrEP is a protocol, a method of doing things, to prevent transmission of/infection with HIV. I say that because people frequently think that PrEP is a drug. The drug used for protection against HIV is truvada, which in turn is composed of two drugs: tenofovir and emtricitabine. Although tenofovir has, in the laboratory, been seen to have some action against hepatitis B, it isn't used to treat hepatitis B. Otherwise the two drugs comprising truvada are ONLY active against HIV. If you're using truvada to protect yourself from HIV, it's important to understand that you're still open to a wide range of sexually transmitted infections (STIs). With truvada protecting you, you don't have to worry about HIV, and you can be vaccinated against hepatitis A and hepatitis B. There is a vaccination available for some strains of the virus that causes genital warts (which can lead to cancer) but that's often only available to teenage girls. Even taking truvada you are still at risk from other STIs, so it's important (and indeed is part of the PrEP protocol) to have a full STI checkup at least every three months: many of the STIs don't necessarily have any symptoms. While this all sounds very daunting, it's how we lived in the seventies: having your three-monthly checkup was often treated as a social event, with friends going together to the STI clinic, and guys picking each other up there. An STI check should consist of blood tests for hepatitis and syphilis (and if you're taking truvada, HIV - just to make sure it's working), a quick visual exam if you think it's necessary, the taking of swabs from inside your ass and the back of your throat (in the UK there's a move to get you to take these swabs yourself - they're easy enough to do, just get the nurse to show you the first time so you know what the swabs should feel like) and finally a piss sample. Be honest about what you get up to sexually: they're there to help you not to judge you. Most STI checkups are over very quickly (about five minutes for the physical stuff and a bit more time talking to a doctor).

To misquote Morticia Addams "don't beat yourself up - that's our job"... Focus on the ten months you've managed without, not on the recent lapse(s if you prefer to consider it as more than a single lapse). You know how to do it and you've simply discovered a new trigger point. Setting the calendar back to day 1 is going to be the most painful part of it. The rest you know how to do and you've learned more about what to avoid...

The pain of the actual act of piercing is there, but it's nothing compared to having your tits pierced. I'm told I cried out as the needle went through, but if I did it was more out of surprise. While my partner at the time bled profusely (we had them a day apart - he wasn't amused by my asking if this meant an end to all those years of PMT), I had minimal bleeding and jerked off in the bath less than 24 hours later. The position of the vein in your cock are what leads to a successful PA: my partner bled so badly because he had a vein too close to where the piercer needed to go, while mine ended up a little too shallow for my liking - I no longer wear it, but that's because of other reasons. You'll discover for yourself how dilute your piss needs to be: it varies from person to person. Although I had an easy first few days, mine healed comparatively slowly. Once I was ready to go I had no problems with condoms or going raw, progressing eventually to a 4mm gauge ring which is about as large as suits my dick (as I side note I wear my original ring and my partner's as tit-rings). Personally I've always been more concerned about the damage a PA can do to teeth rather than inside the ass. Try wearing a reasonably tight fitting jock in bed to help save yourself from rolling over the wrong way. Beware of hard water: limescale can collect on your PA and can hurt if it takes you by surprise: learn to take it out yourself and if you're in a hard water area, steep it overnight in white vinegar before rinsing it well. The reason I don't wear mine any more is that I have kidney problems which prevent me absorbing vitamins and minerals, so my piss is pretty much dilute calcium carbonate: I can take a new ring to needing the limescale cleaning within a week... Thanks for asking in public: it's a safe bet that a large number of people with less nerve than you have benefitted from the advice offered here.

With anything that goes into the urethra for long enough that you need to piss over it, the hardness (calcium content) of your tapwater has to be a consideration. If your local tapwater is hard, then you'll slowly accumulate limescale on your PA because the body excretes excess calcium via the kidneys. The jewelry needs to be removed to be properly cleaned (best method I've found is an overnight soak in malt vinegar followed by thorough rinsing). If left to accumulate, the limescale will hinder the free movement of the PA and possibly cut wherever it encounters flesh, leaving you open to infection, though it should be noted here that your own piss is sterile to you, and while it is enough of an antiseptic that you don't need any extra help while the PA is healing, urethral infections can an do happen whether you have a PA or not.

While it's true that truvada (the only drug currently licensed for use as PrEP) can cause damage, you have to look at it in perspective. The symptoms kazore describes aren't consistent with any side effect I've heard about from truvada: however there are a number of different medical conditions that could be the cause of these symptoms, so to kazore I'd say check things out with your doctor. Side effects from truvada are several orders of magnitude greater in people who are using it for treatment rather than prevention (ie people who have HIV). The general rule is that side effects, if they are going to happen, will most likely happen in the first few weeks. However, there is a problem with truvada in that long term use can result in toxicity which is precisely why the protocols for PrEP include liver and kidney function testing every three to six months. If you're on PrEP and not getting these tests at least twice a year, your doctor is an idiot and is playing with your life. Find another doctor. The kind of toxicity we're talking about here is a gradual process and needs an exceptionally bad prescribing doctor not to notice them. I was unfortunate enough to have such a doctor: after seven or eight years of therapeutic truvada I had enough kidney damage that it almost proved fatal. However, the damage done to me was, because of my HIV infection, much greater than would be seen in someone using truvada as PrEP, and for that reason, as well as the rarity of the effects I still unhesitatingly recommend truvada both for treatment and prevention, with the sole proviso that the appropriate blood tests are done at least twice a year. The damage I experienced from the drug is reckoned to affect 1 person in 100,000 per year. Stack that up against the danger of every day activities like travelling on/in a motor vehicle, crossing the road, changing a light-bulb and, without wishing to trivialise anyone's bad experience of truvada (least of all my own), we each do far riskier things each and every day as a matter of course.

Why not ask your questions publicly? No need for embarrassment: everyone has to start somewhere and one person's obvious mystifies another. In other words, the only stupid question is the one you didn't ask. And it's pretty much guaranteed that you'll find other guys have been wondering about exactly the same thing, so you'd be doing them a favour...

Good going, mate - I was just wondering how you were getting on the other day (I confess, it was my setting off for hospital for a liver scan that brought you to mind since we kinda quit together)... Me, still teetotal, and liver enzymes in normal range

I'm with BiAggieGuy on this one. As an example, I'm one of the 8% of people of north European origin with the gene HLA5701, which is strongly associated with the often fatal abacavir sensitivity syndrome. The paper reads as a "mopping up" job, seeking to explain the extremely rare incidents where truvada as PrEP has failed. I would imagine that by the time an answer has been found here and, if necessary genetic testing is introduced for PrEP, truvada will be yesterday's drug as far as PrEP is concerned, and something else (most likely, in my opinion, cabotegravir) will have long succeeded it.

I'd say as soon as possible: that way if he turns out to be a schmuck you don't have so much invested in him emotionally. Basically I'm thinking "protect yourself from getting hurt"... I won't deny it takes a lot to come out as poz, but I will emphasise that it gets easier. Assuming he's neg is probably a good approach. As to the "how where and when" of it, I'd say next time you see him, either at your place (home territory advantage) or a quiet bar you know, have a beer or two, not enough to get drunk, just enough to relax, and drop it into the conversation as just another interesting fact about you, about as important as your eye colour or the fact that you can't stand <insert name of junk food>. Make an oblique reference to when you had seroconversion illness or when you tested, and let him pick up on it. If he doesn't, try a reference to last time you saw your HIV doctor or how useful your HIV support group is. What I'm saying is don't just come out with it, put it into a personal context, which would make it easier for him to understand. And bear in mind there's a probability he might say "ah, you too..." If he reacts badly, there's one less asshole in your life to worry about, and if he reacts well, great! I always promised myself that I was giving up dating outside my HIV status, but I've ended up seeing a negative guy and more than anything else, he's curious about it. He asks an honest question, I give him an honest answer... Best of luck to you, mate!

A sexual health clinic in London has taken the unprecedented step of prescribing truvada as PrEP without waiting for it to be approved by the government's own drug approval body, NICE, which basically evaluates each drug as it becomes available and determines if the increase in quality of life the drug offers justifies its market price. The first article that I'm aware of is here: http://www.beyondpositive.org/2015/08/04/opinion-will-privately-prescribing-prep-do-more-harm-than-good/ Although I've written for this magazine, it's some time since I've sent them any work. However, I'd note that, for once, I agree with the author of the piece and feel that the worries he raises in the piece are all too real. <edit> Just found the clinic's website: http://getprep.uk/

Sounds good hairyone... one caveat is not to end up like a pair of friends of mine where the tongue piercing and PA got entangled: took them about 30 minutes to separate! Way to kill off the fun of cocksucking!

Right... in that case I wouldn't worry about - less harmful to you than my occasional bar of chocolate is when I'm running in "under-caloria" mode ;-)

If you're using the "as and when" protocol of Ipergay (two tabs up to 24 hours before a risk event then one tablet for the next two days), well, they haven't seen any seroconversions yet, but I personally remain wary of less than seven days a week dosing with tenofovir/emtricitabine. All combination pills that use tenofovir/emtricitabine use it at the same dosage as truvada, so in essence you're just taking truvada and a bit extra. All that would worry me is that in atripla, for example, a double dose of efavirenz would knock most people sideways. The only ARV to watch out for is abacavir, which according to wikipedia ( https://en.wikipedia.org/wiki/Fixed-dose_combination_%28antiretroviral%29 ) is only used in combinations that don't contain truvada. Abacavir carries the risk of a very nasty hypersensitivity syndrome (associated with the presence of the gene HLA*5701) I'd try, if at all possible to get hold of real truvada - and don't forget all the blood-testing that fits with the PrEP protocol...

In every trial document I've read the few who did seroconvert have had their seroconversions explained by (a) either they started the trial already seroconverting or acquired the virus with a day or two of taking their first trial truvada or ( they were sloppy in their adherence and acquired HIV in a period of not taking the drug. In the PROUD trial I know from one of the organisers that they had several guys become "lost to followup", at least two of whom seroconverted in their absence from the trial: at least two of the guys were absent for such a time that they didn't have truvada for most of the time they were missing. Resistance to emtricitabine and to tenofovir are two of the rarer resistances out there: a PwHIV in danger of developing both is far more likely to develop Fanconi's syndrome, which I did, which at 1 in 100,000 is way more likely than becoming resistant to both drugs in truvada. Tenofovir resistance would be more important as far as PrEP goes as emtricitabine is there basically to mop up what tenofovir missed. The other thing to consider is what drugs are in the pipeline both for treatment and for PrEP. The integrase inhibitor cabotegravir (these days when you go for PEP you're most likely to get a couple of nukes and an integrase inhibitor) is showing a lot of promise and looks likely to be developed as an injectable drug: frankly I don't really see the point for treatment as the "supporting cast" would still be in pill form, but for PrEP, it would be fuckin' magic: one injection four times a year and that's it. Adherence problem solved. And don't forget that Treatment as Protection (TasP) works too: in the PARTNER study, where the only safety net is an undetectable viral load (set at 200 despite moves forward in virology since the trial was established) the only seroconversions they've seen are invariably explicable by the fact that the negative partner played away from home. One conclusion already being brought from the PARTNER trial is that in a monogamous relationship as long as the poz person has a clinically undetectable load, the risk to the neg partner is as near to zero as possible. Finally, as indicated above, other drugs for PrEP are in the pipeline: don't fall into the trap of thinking PrEP=truvada, because while that might be so today, it probably won't tomorrow. Truvada is simply the first drug to have proven it can do the job.

One consolation for you here is that resistance to tenofovir (which is the main workhorse in truvada) is pretty rare: PwHIV who have to stop it almost always have to do so because of its effects n the kidneys or bone density - even while it was trying to kill me tenofovir was on top of my viral load and CD4 count. Resistance to emtricitabine is just as rare, so the chance of someone becoming resistant to both is extremely low...

Stribild is tenofovir, emtricitabine (the components of truvada), elvitegravir, and cobicistat. Truvada has an unusually long half life in the body and cobicistat is there as a booster, blocking the enzymes that the drugs need to me metabolised, so that they stay in the blood stream longer. The worrying one in this combination is elvitagravir with a half-life just under 13 hours. Also, as an integrase inhibitor, it's the most effective out of the working drugs in the combination. As fillmyholeftl says, missing once a month would be acceptable here, more than that is courting trouble. As poptronic says, the friend needs too fit taking stribild into his daily routine, keeping the bottle next to the toothbrush, or on the pillow, else setting a reminder on his phone. A "reward" system, whereby the pill has to be taken in order to have a drink or a meal in the evening can work as bribery. Above all, your friend does not want to become resistant to the drugs in stribild: the more resistances you acquire, the more difficult medication becomes. A combination f side effects and resistances have led to my taking instead of one pill a day, somewhere nearer thirty...

A tactic used by some is to ensure that they don't have HIV or any other STI and then present at an A&E department claiming to need PEP, which most of the time will include truvada as two of the three drugs used. They then take the truvada as PrEP, leaving the third drug alone. Of course they have to use a series of different hospitals to avoid awkward questions and the potential illegality of what they're doing. Plus they have to repeat the HIV and STI tests every three months, as well as arrange for liver and kidney function tests (when truvada fucks up it isn't pleasant - I'm disabled largely as a result of truvada making a mess of me). I say that to stress the importance of getting the tests done, and am informed by a nurse friend that a GUM department would likely do the tests with few questions. Other guys have bought truvada from sites selling generic truvada under the name tenvir-EM. Either way it's vital that these guys follow the USA's protocols for PrEP... Part of the problem with getting repeated prescriptions for PEP is that a good clinic is going to ask questions, possibly even decline to treat without one of these guys seeing a shrink first to clarify why they're putting themselves at risk so frequently. And simply on an economic level, the third drug prescribed is being wasted. Although it's illegal to pass on prescription drugs to someone else in the UK, I know for a fact that there is a group that takes left-over meds and sends them to countries where the law is less strict so they do get used. I guess we can only hope that NICE see sense and see that investing in PrEP at about £8k a year will show a massive saving over the cost of a lifetime's treatment of a PwHIV which is currently reckoned at about £300k (assuming no illnesses other than HIV itself). The Terrence Higgins Trust are campaigning to get PrEP available in the UK, so there is some hope... (edited because of bloody autocorrect)

The way I read the original (and it seems to concur with the IPERGAY study is 2 pills in the 24 hours prior to taking a risk and then two pills, 24 hours apart after the risk. So, two pill up to 24 hours before the risk event, one immediately afterwards and then one pill 24 hours later. With my over-cautious mind, I feel ambivalent about PrEP on demand and feel that the dosing is insufficient... better to my mind to go with the first option and then you're ready to go without any planning

LKMike, all the tea will do is help flush your kidneys out, which is good. It also has the extra benefit, if you're into piss, of being a mild diuretic. I took a lot of kidney damage in a 1 in 100,000 chance reaction to tenofovir (one ingredient of truvada), which my ex-doctor should have spotted at least six months before I was hospitalised for it, and I like my tea very strong and in large quantities. The 1 in 100,000 figure comes from tenofovir's use in people with HIV, not from its use in HIV- people who show considerably less side-effect problems than PwHIV. Kidney damage and bone problems from the tenofovir in truvada take a lot longer to develop than the interval between the blood tests that are part of the PrEP protocol.

as long as I was giving him what he needed Sorry but red flags go up at that line: he's asking for you to give everything he wants on demand and should you fail to give him the metaphorical goods, he'll do as he damn well pleases. You don't give ultimatums in successful relationships. You're not responsible for his well-being or mental health and it sounds like he's trying to use you to affirm himself. Personally I'd be saying "thanks, but no thanks"...

To me honesty is the deal-breaker. Either the CL incident might happen by accident or you might have mistaken someone else for him on A4A, but both is stretching things a little too far. Personally I don't have a problem with a guy I'm seeing fucking around (in fact right now, in another window, the guy I'm seeing is talking about his planned threeway this evening), but I do if he lies about it. If what's happened is a deal-breaker for you, then either get out of the relationship, or get him to be honest about fucking around and learn to accept it. The latter is the hardest route, and given the way that he's already lied about it, probably the least likely to work. I'd say you should try and assess what you want from a relationship, how wide the boundaries are (in that there are always grey areas), and what you can't tolerate in a relationship. Then use that as a framework to build on when you meet someone (else, probably) you're interested in. Talking about things can only be positive, as long as you stick to honesty...

5'6" bear with a hairy back... Step right this way, head of the queue, do not pass go, etc etc As NLbear says, just be honest about yourself and say clearly what you're looking for. Most people are shy to one degree or another: the trick is to act like you're not. Once you can do that, you'll find the shyness drops away. Have fun!

UK here... the law here says you have to return unused prescription drugs to a pharmacy for them to be destroyed: even unopened bottles and blister packs go into the furnace, which to my mind is a criminal waste of money. However, I'm aware of a project that collects unused anti-retrovirals and sends them out to countries where they can be used. I've no doubt that the people running this project will be able to help out should it turn out to be necessary.

Works for me, though! To me it seems like too few guys do. Differences in taste lead to more availability of the men we're after - we all win!

I'm with the guys saying "don't shave" My personal opinion is a shaved skull is sexy as hell, but anything else should be left to grow... One suggestion from the days when I was foolish enough to try body shaving is that you can relieve some of the irritation from the hair re-growing by using hair conditioner on it: it soften the hair somewhat and that decreases the itching (though I should really just let you itch as punishment!)