BootmanLA

Not saying you (or anyone else) should stick with a relationship if you (or he) doesn't want to. I'm just saying that a relationship can be built on things other than sex, and that it can be preferable to be partnered with no remaining sexual interest (and getting whatever sex one wants elsewhere) rather than being single. Maybe not in your case, and that's fine.

I think it depends on the length and depth of the relationship. Two years in? Yeah, I'd say call it quits, move on, and try to find something that fits better. Ten years in? It's not necessarily just intertwined financials. It's shared pets, shared experiences, shared traditions, not to mention deep affection that goes beyond sex. Just like married straight couples sometimes stay together even if sex has waned, gay couples can do that too. The point is that gay relationships, being already somewhat transgressive, don't have to stick with the same rules as other people's. The relationship can be based on, and include or exclude, any factors the participants wish. One thing to remember is that as we age, the number of potential relationship partners may well decline just as the number of potential sexual partners declines. If the pools of both are shrinking, the chances of finding someone who's a member of both pools can be a lot tougher. So ditching someone who's otherwise a great relationship partner in hopes of finding someone else who's both a great relationship partner AND a good sexual outlet may not be the best bet some people can make.

It seems to me that this thread has now gone far afield of its original purpose, discussing whether bare sex with a particular person was advisable. It's devolved into "here's the latest update on my personal life" replete with a blow-by-blow on sexual activity occurring. I respectfully suggest that this topic now belongs in one of the "My last orgasm" type forums - the decision in the original, health-related discussion has clearly been made and there's not really any further health connection to updates on what sort of underwear one wears to meet or whether someone might walk into a public rest room while activity is going on.

Interesting. I'm sure millions of people around the world will be surprised to learn that because they use condoms, they aren't actually having sex. Come to think of it: maybe you could sell that idea to fundamentalist churches - try to convince them that all their kids are still virgins as long as they've always used condoms because sex with condoms isn't sex.

It's true that the case was decided in 2012, but HIV understanding has advanced considerably since then, with U=U messaging becoming ubiquitous. It's not unreasonable to think that a future case, perhaps not even that far in the future, might hold otherwise. In fact, in that very case, the Supreme Court of Canada noted, immediately after acknowledging that undetectable+condom = no realistic possibility of infection, so it couldn't qualify as assault, that "This general proposition does not preclude the common law from adapting to future advances in treatment and to circumstances where risk factors other than those considered in this case are at play." It's especially important to note that the decision says "the common law" - that is, decisions made by judges, based on the facts of cases at hand, etc. Common law, unlike statutory law, doesn't require changes enacted by the legislature; it requires changes recognized by judges. And that means if, in a future case, a judge is convinced that the scientific evidence is that unprotected sex with someone who is undetectable does not present a realistic possibility of infection, he can so recognize, and unless overturned on appeal, that decision can enter the common law - covered under the "advances in treatment" rubric cited by the SCC.

Part of it may simply be legal issues. If the corporation acquiring his practice has shareholders, even if it's not publicly traded, there may have been restrictions on what could be said before the transaction occurred, so as not to interfere with the transaction, tip off competitors, etc. If it IS a publicly traded entity of some sort, the restrictions can be even harsher to avoid issues with the Securities and Exchange Commission. He told you his payroll was a strain - that goes a long way towards explaining why he chose this option. But in addition: health insurers are constantly putting the squeeze on providers, trying to get more work for less money, and thanks to COVID, lots of other expenses (like rent) are rising. Property insurance rates in Florida are undoubtedly continuing to escalate as they have for decades. All in all, it may just have reached the point where costs required action. As for the mix of work: here's the thing. Making up numbers to illustrate a point (and simplifying, ignoring things like contracted rates, mandated discounts, etc.), let's say he has 20 "slots" to see patients in a given day. An appointment for an ID issue merits a $300 reimbursement on average from insurers while a PCP appointment merits a $150 reimbursement. Let's say 15 out of 20 appointments during the day are for ID issues and can be billed as such; 5 of them are for other issues like those for which you would also see him. If the acquiring corporation has a total of 5 ID specialists after purchasing this practice, and each one was billing 25% of his hours to non-ID issues, they could dump one of the five, consolidate his caseload among the other four, and hire a GP for far less money than the ID doctor they're replacing while still generating the same overall billings. Or they could just not offer the PCP services at all, shifting those people elsewhere, and still letting one ID guy go because with the streamlined workload, they don't need five. As for the notification: yeah, form letters suck. But the problem is, he's likely got scores or hundreds of patients that all have to be notified. Assuming even 5 minutes per patient to explain things - and that's not very long, considering what he's got to explain - coupled with ID verification, leaving messages, calling people that weren't reached the first round, etc. etc. - you're talking weeks of time spent just to personally notify every patient. And honestly: I realize you've been with this guy a long time, but so have, most likely, a lot of other patients. They all deserve equal consideration, and sometimes, there just isn't the time in the day needed to allow for personal notification of a major change like this. It sucks - yes - but that's modern American medicine. This is what happens when you have competing health care finance entities (ie insurers) coupled with private providers, patients, and ostensibly unrelated parties (like employers) all with their hands in the pie.

You joined in May, 2016. You made one post in 2017. You made your second post in September of this year, and the post I'm quoting and replying to is only your third. You may have been a member for a long time, but you have not been an active member yet at all. Just creating an account here and doing nothing does absolutely zero to advance your privileges on the site - otherwise, spammers and the like could simply sign up and wait until the clock chimes enough, and then wreak havoc. You've had over six years to read the rules of the site and how to gain more privileges. If you haven't grasped it by now.....

Think what you want - your fevered imagination, I'm sure, can conjure up anything. Back here in reality, I stick by my response.

Why? If you are currently, or were formerly, battling cancer (why else would you have an oncologist), why would you want to add additional health challenges like an STI going undiagnosed and untreated?

I have not personally experienced this with my ID specialist (who is, like yours was, my PCP). That said, it is indeed a fact that the practice of medicine is changing rapidly. When I first needed a doctor after graduate school, I was fortunate that I had a relative-by-marriage (married to my cousin) who had recently become a doctor. He went into partnership with an older doctor, and a large chunk of my relatives on that side of the family came to be his patients in his practice. Other doctors joined, the original doctor retired, and there was a nice thriving little group of doctors. Then a large local hospital bought their practice (and many others), and they all became employees rather than business owners. There were, as in your case, financial decisions that went into that, some of which probably have to do with liability and malpractice. I'm sure there were also some savings by consolidating things like building maintenance, payroll services, claims processing, and the like under a central umbrella. One way those large groups control costs is by covering physicians for what they are specialists in, and no more. So, for instance, the malpractice liability rates may be lower for an ID specialist if he's not also diagnosing, treating, and writing prescriptions for a variety of other conditions. Another is by managing billing. ID specialists can bill for ID-related services at a higher rate than a GP, most likely, and by having him see only ID patient issues, all his work can be billed at a higher rate than if some of it had to be billed at GP rates. It may be that this larger corporation can consolidate all the ID work under, say, two ID specialists instead of three, and hire a cheaper GP to do the PCP work in another clinic or facility. In any event, it's indeed likely to be a strictly business decision and one that wasn't entered into lightly. I'm not suggesting your feelings on the subject are wrong in any way; I'm just saying that the office worker who tried to offer assistance transferring part of your caseload to other doctors was genuinely trying to make the transition as workable as possible for the patients in the office. Side note on my cousin-in-law's practice: I was without insurance for several years before the ACA as a self-employed person, so I didn't go to the doctor unless I was actually sick, and that usually happened after hours anyway so I'd just go to the Urgent Care and self-pay if needed. Once I was insured, I found that not having seen the doctor in over a year, my file was "closed" and his office managers weren't letting him take on new patients (which I would be, after that gap). My partner was seeing another doctor in that practice (he was insured at work), but that doctor decided to quit the practice and go into a "boutique" firm that offered what they called "concierge" medicine - they didn't take insurance, and you paid them a substantial fee every year, and in turn you got a certain number of MD visits a year, including wellness consultations, etc. Great if you have a lot of money to splurge on care with no insurance subsidizing it, but not for us; my partner had to switch to a different doctor in my cousin-in-law's practice. This kind of thing is only going to become more common as more and more care is consolidated.

I wonder, though (since I haven't traveled abroad enough to know) whether that's something culturally inherited in the US/western countries because of white attitudes towards black people? In other words, do Asians in Asia have the same issues with black men as Asians in the U.S.? And is it equally distributed across Asia? Or do, say, Japanese display this more (or less) than Indians, or Malaysians, or Vietnamese? As far as Latins from Central and South America go: given that the source of most of their black population (and those with significant black ancestry) is, like the U.S., from slavery, I can understand that the cultural dynamic might be similar. In some South American places, I know, the highest spots on the social order belong to the small number of people who are of almost entirely European descent, and as the percentage of native and/or black ancestry increases, one's social status not infrequently declines - especially in places which had huge slave populations, like Brazil. So I guess what I'm wondering is - would you find the same bias against blacks among, say, Spaniards in Spain as opposed to Americans of Latin American descent, or among Indians in Bombay compared with, say, Vietnamese descendants in California.

I don't see any chains pinning you to this site. More importantly: sites like this are a community, not just a free-for-all where anything goes. Societies and communities *always* have rules that have to be obeyed; it's what makes it possible for a bunch of people to interact with each other even when they may have disparate goals and ideas and beliefs. The nice thing about reputation points working as they do is that they aren't "brownie points" awarded by the site management for agreeing with them or whatever. They're the sum of positive and negative reactions given by others in the community. As such, if most people here like personal sexploit tales (like those found in the "Your last load" section (which has over 17,000 posts at this point), they can encourage more of the same by liking and upvoting those kinds of posts. And for those who appreciate good health care information, likewise, liking and upvoting posts in the Health and HIV forum that are useful and convey good information boosts people's willingness to participate. Ditto for the fiction section, the bugchasing section, the straight and bi section, the fetishes (hard core and soft core) sections, and more. There are only a handful of things you can't post about here; otherwise, it's pretty much wide open. Some things that fit, however, may be more (or less) popular than others, within this particular community. That's just how the world is.

That's kind of what I was getting at - to the extent there's a problem, to the extent that racial preference slides well into racism territory, it's almost exclusively a whites-excluding-others problem, and most of that is whites-excluding-blacks. It's just sad.

Absolutely true, and I certainly don't mean to suggest that racial preferences only go one way, or that everyone is happy to have sex with white guys while that's not the case with other races and ethnicities. Far from it. Still, I'd posit that there are a lot more (or a higher percentage of) white guys who either (a) actively reject some other races/ethnicities - hence the once-ubiquitous "no blacks" in personal ads- or (b) only go after people of those races/ethnicities as part of a fetish - wanting "BBC" or "tight Asian boy pussy" or whatever, than the number/percentage of non-white men who reject everyone other than their own race. At least in the United States, which has hundreds of years of that kind of conditioning to break through.

And right on schedule, the thread picks up with a bunch of guys adding to the "real bottoms always do X" and "tops can be expected to do Y no matter what". All bullshit pseudo-excuses to try to explain away that some people are so fucking selfish that they will choose to violate someone else's consent just to get a nut. Man there are a lot of shitty people in this world.

Not to argue that these guys are straight - I'm sure they're not - but straight guys aren't necessarily virgins to anal sex. Pegging is a thing. Granted, these "boys" are highly unlikely to have girlfriends who peg them. But it's not an impossibility for a guy to be straight, but accustomed to having things up his butt.

To be perfectly clear: the effects of stopping medication - if the stop is permanent - are pretty clear (you're almost certainly going to die, much sooner than you would otherwise). But stopping otherwise, the science is somewhat less clear. Back in the day of multi-pill, multi-times-a-day treatments, doctors used to sometimes suggest a "meds holiday" - the early HIV treatments were a lot more toxic to the rest of your body, and as a result, taking a break for a few months, every few years, made some sense - especially since the medication landscape was regularly changing and there were frequently newer medications to try. The breaks allowed the body's other organs, especially the liver and kidneys, to get some respite from filtering out the medications' residue. Nowadays the medications used are less toxic and are calibrated more carefully to be (when taken daily) as otherwise innocuous to your system as possible. And innovations in treatment by medicine seem to be coming a bit slower, with new drugs coming on the market less rapidly than in years past. As a result, there may not be as many other medications to try if you take a break from meds and then, upon resumption, your old medication doesn't seem to be as effective. That doesn't mean that if someone wants to stop taking meds for, say, 3-6 months, he's inevitably going to die fairly soon. Someone whose system was already severely compromised by HIV before beginning treatment, like @ErosWired, might find himself at death's door after 3 months off meds. That's because some of the damage done by HIV once it's fairly advanced may not be reversible; treatment can perhaps postpone the inevitable (ie death) indefinitely, but there's far less leeway for error. On the other hand, someone whose system was solid and who begins treatment immediately after infection is discovered might well be able to have occasional medication holidays without extensive long-term damage. We don't know, really, because there's not really an ethical way to study that.

As noted, there's effectively no difference between the two. Some of us have our own reasons for using one over the other, either always or in particular situations, but you can use either one and have the same impact, generally speaking. The site owner, RawTop, posted something on this in another thread back in 2021:

I respectfully disagree at least for some (though not all) such people. Some white guys doesn't want to have sex with a black guy because they're fixated on, say, thin, small-framed Asian guys, or beefy muscular Arab men, or whatever, They're not targeting black men because they have something against black men; they're targeting all non-[whatever] guys, including white, black, or whatever men who don't fit the profile of the kind of guy they find appealing. There's an element of racism involved - but for lack of a better way to phrase it, one race is being elevated above the rest to the exclusion of everyone else, including the person's OWN race. That's not quite the same kind of racism as excluding everyone who doesn't match oneself. In many ways, that kind of "I only like" racism is not really any different from guys who will only have sex with redheads, or guys over 6'2", or guys who are at least 250 lbs. But yes, there are also some white guys who don't want to have sex with a black guy, even if they'll have sex with another white guy (and maybe a Latino guy, an Asian man, an Arab man, an Inuit man, or a First Nations man). And yeah, that's racism of a much worse kind, because it's targeting one race or ethnicity (or sometimes, a few races or ethnicities) for exclusion.

I'd only add that what also can offend people is how one express to others what does and does not get one's dick hard. If one follows a handful of basic guidelines: --focus on what you do like, not on what you don't like; --avoid reducing the kind of people you DO like to stereotypes; --if you must rule out certain characteristics, do so with polite, non-offensive terms; then one's not likely to offend. Let's say that what you like is Latin men who are muscular and hairy. Instead of saying "No blacks, no Asians, no pasty white dudes", you could say "attracted primarily to fit and hairy men of northern Mediterranean heritage, especially Italians and Spaniards". Instead of saying "no smooth chests", say "body hair, especially chest hair, really is important for me." And if it's absolutely critical to be muscled and masculine, for god's sake don't say "no fats, no femmes"; you can say the same thing nicely by saying "fitness is important to me, and traditional masculinity is key". You can soften the blow of implicitly rejecting those who don't meet such limits by stressing - if it's true - that "this applies only to sexual interest; my friendships transcend any such boundaries." Just don't say that if 39 of 40 of your closest friends are all furry Latin gym rats.

I think, to be fair: a lot depends on who the people involved were. There's an enormous difference between, say, a 19 year old young man and a 17 year old young man having sex, and a 35-year old man having sex with a 13-year old, even if the 13-year old is horny, even if he's sexually capable, even if he's attracted to older men, even if he's the top, even if he doesn't think he's being traumatized. Just because someone says "I wasn't manipulated and I don't feel traumatized" doesn't mean that they were not, in fact, manipulated, and had they known that earlier, they might well have a different perspective on trauma. As long as humans develop and mature at varying rates, any limits placed in terms of age of consent laws are going to be somewhat arbitrary: some young people are mature enough and ready for sexual experimentation long before others are. And there's also always going to be some discretion involved as to which cases to pursue and which to let slide. For far too long, those decisions were based more on influence and misperceptions of power; the 19 year old junior-college boy who had consensual sex with his 16 year old girlfriend got felony jail time because mommy and daddy wanted to punish him for defiling their baby girl while the minister or coach or doctor who groomed dozens of kids and had sex with all of them never got charged because no one wanted to ruin the reputation of a good man who had done so much for the community. And for gay kids, historically, the situation was worse because they were all, almost to a person, closeted and frequently ashamed of feelings they didn't understand that society (and often their families) were vocally condemning. Those kids were ripe for grooming by adults to get them into sex with the only other gay people the kids knew: themselves. Thankfully, there's an ongoing shift in accountability for those who groom kids.

This is a bit more of a thinking out loud posting than answering the poll question type, but... I'd say that most people who claim on here "never condoms!" are honestly answering the question - they won't have sex unless it's bare. I also think a significant portion of those people have very little sex, or at least with very few people. I also note that a goodly number of those responding this way seem to be newer members - and my experience has been that new members tend to boast more "look at MEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE what a cheap whore I am!" posts, thinking this site is a competition for bragging rights or something. I think there are some portion of the "never condoms!" crowd that nonetheless will occasionally use one depending on the circumstances. They may not admit it, they may be internally grumbling the entire fuck, but they'll do it in order to get fucked. As I've seen in the responses here, there are a significant number of people who certainly prefer bareback, but who will use a condom if requested. As I posted in another thread elsewhere: you'd think that condoms were made of 40-grit sandpaper the way some people complain that they hurt hurt hurt hurt hurt - as though they weren't even more smooth-surfaced than the average cock. It's also hysterical to me how many people I've seen insist that they will never, ever, ever have a condom-covered cock inside them and yet they play with big dildos and butt plugs all the time. Me? I prefer bareback, absolutely. But I'm not going to turn down a good fuck from someone if he wants it covered.

To answer your last question first: you have multiple options for an in-person PrEP prescription. In the United States (which your profile says you're in), any doctor of medicine (M.D.) or doctor of osteopathic medication (D.O.) can prescribe any medication for which a prescription is required. Additionally, in many states, there are other medical professions which have prescriptive authority, including (in some states) nurse practitioners or Advanced Practice Registered Nurses, Physician Assistants, and sometimes others. In some cases they can prescribe with no oversight by a physician; in others they must get approval from a supervising physician before the prescription can be released to the patient. The requirement for STI testing beforehand is not, technically, a legal requirement but a guideline that the FDA, the pharmaceutical industry, and the doctors' organizations adhere to because it's very unwise for someone who is HIV+ (and may not know it) to begin taking PrEP. So you'll probably need to get bloodwork done; but the health care provider may be able to send the prescription in to a pharmacy to be filled without a second doctor's visit if your blood tests are clear. Unfortunately, in the United States, cumbersome insurance requirements sometimes make it difficult to see a doctor other than your PCP without a referral from that PCP. A urologist would be a good candidate for someone to consult regarding PrEP but other types of doctors could do so. My question for you is: Do you want to continue using a PCP who ignores your sexual health concerns? If you like the doctor otherwise, I would ask him to reconsider, telling him that your sexual practices put you at risk, and you want the peace of mind of being protected; if he refuses, ask him for a referral to a doctor who would be willing. If he won't give you a referral, I'd strongly consider changing doctors, period, because while you want him to use his expertise, you don't want his personal moral choices and opinions shaping your care (or lack thereof, in this case). There may also be government-funded or sponsored clinics in your area that focus on STIs. That includes prevention, not just treatment, and they'd probably be happy to keep you from needing treatment services by helping you locate preventative care. They may even be able to arrange eveything themselves.

The first two sentences are correct. The last - I am unaware of any studies that say closer to 24 hours before sex is better. In fact, given that a body starts filtering the drug as it circulates in your system, it's probably getting close to the non-therapeutic level as it approaches 24 hours. 2 hours is a minimum; based on available evidence, the level of protection in your system after two hours is generally sufficient, but it's also true that for some time after that, the level of medication in your system may continue to rise. But NOT, it should be noted, for the entire 24 hours. Well before the 24-hour mark, the drug level in your system will start to decline. In other words, it releases into your system faster than your system is able to clear it; and for that reason, I'd say split the difference with the focus on closer rather than farther away from the first planned sexual experience: say, ten to twelve hours before. That has the simplicity of allowing you to take the pills in the mid- to late-morning for a late evening play session. Additionally, you're likely to be up and awake by mid-day each day thereafter, even if you're up late having sex, and that means you can more readily stick to your schedule.

That was probably very much the case 5 or 8 years ago. But nowadays, with the widespread adoption of PrEP, a lot of guys who are negative and on PrEP no longer feel the need to ask about status.