BootmanLA

The point is, @Close2MyBro, the article YOU cited does not say what you claimed it did. The study YOU cited finds a correlation between having Covid-19 and erectile dysfunction, NOT between vaccination and ED. You misstated the findings of the study completely. As for the second study, it's (apparently) true that they looked at people who had received one of the mRNA vaccines. However, mRNA vaccines account for 97% of the doses administered in the United States, so it's highly likely this study covers the circumstances under which most men might find themselves affected, IF the vaccines caused ED. And that second study found NO correlation between ED and Covid vaccines. I'm not sure what you have against the vaccines - and frankly I don't care - but don't misstate what the evidence shows, and don't obfuscate the findings by saying they only studied the type of vaccine that covers 97% of the doses administered in this country.

I agree, and I've actually thought about some changes like this that would make sense, but it's getting them done - and that's not a knock on the moderators. It's not something I'd want to take on, time-wise, and can't imagine most people here would, either.

If you are having unprotected sex (particularly receptive anal sex) more than two times a week, the 2-1-1 schedule does not make sense except at the very beginning. At that frequency, you should be on a daily dosage without skipping at all. The problem is that with daily PrEP, you gradually build up a level of protection in your system over the week so that you can take potentially HIV+ loads regularly and still be protected. With 2-1-1 and jumping right into sex, you never go through that period where your system isn't actively fighting off an infection. So if you're starting from 2-1-1, and want to keep having sex before the full 4-pill regimen is complete, I would double up the first several doses at a minimum - so your schedule would be more like 2-2-2-2-1-1-1-1-1-1-1-1 etc. That way, you stand a chance of getting your PrEP blood level up high fast enough to negate anything that might come along in that first week. That said, two points: first, it's only relevant if the load is HIV+ and at a detectable level, so if you luck out and your partners are all negative or undetectable, 2-1-1 followed by daily would be fine. The problem is you can't be certain that those loads are in fact negative or undetectable. Second, holes do not "need" to continue "hoovering up baby batter". I get that the appeal is strong, but please - let's stop pretending this is an actual "need". If you found yourself on a deserted island, or in an isolation ward in a hospital, or hell, even just camping in a remote area, your hole would survive just fine without "baby batter". Just admit you don't want to do without.

The only way to do that is to report the topic and suggest where it might better belong. If the moderator(s) agree, they have the tools to move it. Unfortunately, this entire folder ("Making the Decision to Bareback") is pretty much a non-health area now. There was a time, before PrEP, when discussing the reasons to bareback or not meant it was inherently a health discussion, because there was no way to bareback and still remain relatively protected. So in that sense, this group of topics once was a health issue. Now it's not, and as is evidenced by the tenor of recent topics - "I Bareback ONLY, No regrets ever", "What turned you into a bare pig?", "Bottom should accept poz loads?", for examples - this section is quickly becoming another "Look at meeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee how trashy can i beeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee?" part of the forum. And that's fine - but those aren't health discussions. Unfortunately, the moderators have their hands full with other things, but what the entire "Health" section needs is a major pruning - moving large numbers of threads to other areas, locking certain topics, and then more aggressive day-to-day management of making sure posts here have to do with health issues. That said, while I can diagnose the problem, I can't fix it.

Costs, of course, vary depending on the drug and where you get it. But for comparison's sake, using full retail pricing (exclusive of any insurance coverage, but taking into account the pharmacy's own discounting for its bulk purchases), Descovy (the most recently approved oral PrEP medication) runs from $2,178 to $2,450 for a month's supply. Truvada, which has been out longer, is somewhat cheaper in general. By contrast, full retail on a one-month supply of Biktarvy (which I'm on) runs from $3,828 at Albertson's to $4,522 at CVS. Genvoya, which I was on before Biktarvy, runs from $4,006 at Walmart to $5,230 at CVS. Of course, essentially no one pays those prices. Major insurers negotiate steep discounts on those drugs, assess you a copay, and pay the balance to the manufacturer. So, for instance, Blue Cross may pay Gilead only $1,500 for that Biktarvy prescription and my copay might be $250, meaning that Gilead is discounting the medication by $2,000 a month or more. And in turn, Gilead offers copay assistance programs, where they waive the copay portion of the tab for those who make less than a certain amount. And to be honest, they don't check that very closely - you don't have to submit a copy of your tax return or anything to qualify for that. In fact, my pharmacy handles that internally so I've never actually filled out anything. Of course, one still has to have insurance. As a self-employed person, I foot the bill for that myself, and it's not cheap. I don't qualify for an ACA subsidy because I make too much money - and I recognize I'm fortunate in that respect! - but I still shell out nearly $1,400 a month to cover just me, personally. And that's with a $4,300 deductible, $9,100 out-of-pocket maximum, and where they only pay a 60/40 split on in-network covered expenses above the deductible until the out of pocket max. Prescription drugs have a separate $500 deductible, but that is met the first month of the year. So any way you slice it, HIV isn't cheap.

Your post is ambiguous, because it's unclear what you mean by "it". If you mean "I just got approved for PrEP, but I want to take PrEP, too", then there is no problem. Get on it. If you mean "I just got approved for PrEP, but I want to get HIV, too", then your post belongs in the Bug Chasing forum on this site, not the health section. Basically, if this latter construction is what you mean, then the advice you get will be based on where you post. Here in the health section, the point is to encourage the use of PrEP to avoid getting HIV, and there are very extensive discussions of the problems you can face as an HIV+ man. Basically, you're signing yourself up for a lifetime of expensive health care, which practically no one can afford without some sort of health insurance (be it an employer plan, an individual plan, or a government-financed one. You'll be at heightened risk for all sorts of complications for the rest of your life (because HIV medications not infrequently take a toll on other parts of your body). Despite a vastly better educated populace than we had in, say, 1985, substantial numbers of potential partners (romantic or sexual) will reject you because of your HIV status. If you have dreams of world travel, there are places where you won't be admitted if you truthfully answer questions about your HIV status, and if you lie and they figure it out because you're carrying HIV medication in your luggage, some of those places will arrest you for trying to enter their country illegally. (Thankfully, this is becoming rare, but it's not unknown even today). This isn't to say you must get on PrEP. It's a personal decision. But as I've said many times here, there will always be idiots in the Bug Chasing forums talking about "brotherhood" and deep spiritual meanings behind sharing DNA and all kinds of other bullshit. That "brotherhood" isn't going to be taking care of you when you get your first serious opportunistic infection. They're not going to pay your insurance bill to keep your treatment going when you change jobs and have a gap in coverage, or when you lose your job and you can't get coverage because you don't live in a state with expanded Medicaid (and COBRA coverage is far too expensive). "Brotherhood" in the poz community seems (to me) to be mostly a bunch of jack-offs online indulging in the fantasy that you're all connected because of your shared HIV experience, and it manifests itself mostly in people showing off biohazard tattoos. And look - I get it; the erotic appeal is much like the appeal inherent in things like vampire legends, the seduction of someone into permanently changing something key about himself, a change that wreaks a fundamental reconstruction of the body' But at the end of the day, all it really means is that you now have an incurable disease, one that for the overwhelming majority of people will eventually kill them if they stop treatment (and by eventually I mean far younger than would otherwise be the case). Thanks to science, it's possible to ward off that death sentence to the point that most people with HIV on treatment will die of something else before they reach that point. But the key there is treatment, something that's expensive and can't be stopped if you want it to remain effective.

Actually, the bill in Florida, and the bill introduced in Congress, are exactly "Don't say gay" bills - at least insofar as in the places they apply, such as schools. They pose as standards about "appropriateness" - a bunch of bullshit about how we shouldn't "sexualize" children and topics of "sexual orientation" shouldn't be discussed in schools below a certain grade. But they don't mean ALL sexual orientations - they mean LGBT ones. Because I guarantee you, no second grade teacher is ever going to get in trouble for mentioning that she has a husband, and no boy's PE coach will ever get in trouble for mentioning that he's got a girlfriend. A heterosexually married female teacher will never get in trouble for acknowledging to her students that she's expecting a child. What this is aimed at is not letting LGBT teachers acknowledge having a same-sex partner - an acknowledgement that presents no problem if the partner is the opposite sex, because small-minded bigots want to control what their children think about such issues. If they're presented with a positive role model in a school setting, their iron-clad religious grip on the child's thought process may loosen. And THAT boils down to "don't say gay" - just don't mention it, or else you're likely to lose your job.

I'm not objecting to you making an update. I'm saying that the whole topic could easily be moved by a moderator to a more appropriate area, given that this really isn't a health discussion any longer. (But I will note: all the discussion of what panties you're wearing, how deeply he entered you on his first thrust, all of that - that's irrelevant to the actual HEALTH question you raised initially, which had to do with whether you should agree to take a load from a poz guy. Those are points best raised in a section of the site devoted to describing one's sexual exploits.) One of the real issues on this site is organization. Even when a post initially fits a topic - as yours did, when it was introduced - time, intervening events, and the nature of the discussion can render it inappropriate for a particular part of the site. And while it's not the case here, there's a serious problem with new members joining and then their first, second, or third post is a personal ad ("Looking for guys to do X or Y or Z") in the midst of the health forum, the porn video forum, the fiction forums, or whatever. Even worse are the ones who decide to post a tale - true or not - of some sexploit, full of details like a porn story but with a line or two at the beginning just to nudge it into another area. There are lots of places on this site where one can post true and fictional sex tales. Nowhere on this site is this issue a bigger problem than the health forum - not because there are more "misplaced" posts here (although those are frequent), but because people who are looking for accurate, up-to-date health-related information have to sort through so much else. I have no problem with posts encouraging people to chase HIV, for instance, as long as those are in the Bugchasing area. This area is set aside for discussing the health consequences of our actions - sexual and sometimes otherwise - and the issues involved in making those health-related decisions.

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.