Poz1956

I think I'm with Baggerr on this one. The first sentence of your post says it all. Use it when you see the ID doc. That situation is one of the indications for which the CDC says PrEP is appropriate. Over the course of the time you're on PrEP you'd need to be consistent with you lie at every 3 month appointment. It will be a lot easier to just tell the truth. From the sounds of it the ID doc probably has a some experience with PrEP. He's also probably had lots of conversations with both Poz guys and people wanting to go on PrEP that include the exact same words as your first sentence. He may give you the condom lecture, but you can take it. It's not like you haven't heard all that before. But don't take any BS from him. Dr. Demetre Daskalakis, the Assistant Health Commissioner, heading New York city's Bureau of HIV/AIDS Prevention and Control said it was time to start identifying a practitioner's refusal to prescribe PrEP when medically indicated as "malpractice." If you need to whip out that line, do it. If he tries to slut shame you, call him on that too. Ask if he'd rather be treating you as a Poz patient for the rest of your life, of if he'd rather help you prevent that situation. There are lots of stories from guys who let a doctor delay their access to PrEP, and became Poz within the next year. If he tries the "Test now and we'll repeat it in three weeks" before he'd write the prescription, tell him to order a viral load test to rule out an acute infection. But you might be pleasantly surprised. He may just say "let's get these blood tests done" then write you the script.

I was having the same kind of problems with ED. The meds were iffy - worked sometimes, and other times didn't. One of my antiretrovirals makes ED mes metabolize quicker. I'd kind of written my dick off, and was bemoaning my lost sex life. That's one of the reasons I started considering BB. I thought the added sensation might coax some life back into the old tool. I tried the daily low dose of Cialis, and was very happy with the results. The price isn't too bad either - About $129 a month at Costco here in Canada.

Gilead has a program for uninsured people who earn under $50K a year. (Hint - Lie and say you've got a Poz boyfriend.) But that doesn't pay the before you start, and routine tests you need to be on PrEP.

Slow release injectable ARV are being considered for Poz guys. Specifically the ones that are having problems with adherence. For example think of homeless street youth. They're more concerned about their next meal, and a roof over their head for the night than taking their meds. For PrEP, it's kind of a unknown quantity. Will a guy remember to book/attend his appointment in three months, especially if he only has to think about HIV once every three months? And what happens if he skips/misses that appointment. The injectable PrEP level will drop. If it drops low enough, and gets exposed to HIV, that could lead to drug resistance. Of course that's the same arguments AHF makes about Truvada for PrEP. We're beginning to see an interesting trend for guys currently taking PrEP. Before PrEP many were poorly adherent to other medications they were prescribed. But their focus on staying negative by taking Truvada every day, is leading to them taking all their other meds every day too. Yet one more chink in the Weinsteinian arguments.

All HIV tests have a window period. That's the time between an infection, and a possible Poz result. Tests that look for antibodies have a longer window period. Some people who catch HIV start producing antibodies later than average. Around 90+% of people with HIV will test Poz by six weeks after exposure. More than 99% will test Poz by three months. Here are the window periods most of the tests in use. Pooled NAT RNA test = 10-14 days (Only available at specific clinics in some large cities) Fourth generation Antibody / P24 Antigen test = 3 weeks (Vial of blood drawn ans sent to a lab) Third generation Antibody test = 4 week (Vial of blood drawn ans sent to a lab) Rapid Antibody tests = 5 weeks (Tiny drop of blood from a finger prick - Test time ranges from >1 to 20 minutes Western Blot test (usually used to confirm a Poz result) = 6 weeks Oral fluid Antibody test = 6 weeks While I can see where for a first time encounter the OraQuick test is attractive, it's also the assay with the longest window period. A lab test is much better than an OraQuick. You interview process might need to include how long since his last sexual activity. Between the test, and too much interview it might kill the buzz, and you might end up with no nookie. For your second question, ALL gay men should get routine testing a minimum twice a year. If they're very active four times a year. Lab test are better than home tests. The tests should include all the other STIs too. (Blood test for HIV, Syphilis, Hep A,B & C -- First Void urine sample for Gonorrhea & Chlamydia -- Throat and Ass swab for Gonorrhea & Chlamydia) If you're not vaccinated against Hep A & B get it done now! Hep B is 50-100 more transmissible than HIV, but nobody asks about it. Here's an HIV 101 fact that I'm sure you don't know. A person who acquired HIV very recently (within the last 2-3 weeks) is at their most infectious. As you can see from the window periods I listed, depending on which test is used, that newly Poz guy could still test Neg, but have a very high chance of transmitting the virus. He'll have a viral load that could be as high ans 10,000,000 viral copies per ML of blood. Some estimates are that about 54% of new cases of HIV are caused guys in the acute phase of infection (first three months). Another 30+% are from guys who have transitioned to the chronic phase of infection with viral loads in the 30,000 to 120,000 range, but they don't know it because they haven't been tested recently. Only about 20% of guys are getting tested per annum. Your safest bet would be to hook up with a guy on PrEP. He's on an HIV prevention pill, and gets screened for HIV and other STIs every three months. (Or you could go on PrEP. You don't say if you're a married Bi guy. That might be hard to explain to the wife.) I'd be willing to bet that like most Neg guys, you think that playing with a Poz guys has a transmission risk of between 50% and 100% per encounter. Since our standard campaigns have never discussed this, people have an extremely infatuated sense of risk. From a Poz guy in the chronic phase of infection, the "High Risk" described by our prevention campaigns starts a 1.4% per exposure to a bottom and go down from there. What we know about HIV has changed tremendously over the last few years. Quite literally there is a complete paradigm shift happening. Some of the things our standard prevention campaigns have always taught, turn out to be wrong. Due to the window periods, high viral loads, and low testing rates mentioned above, the standard advice to "Always ask status" (serosorting to Neg guys, and rejecting anyone who tells you they are Poz) can actually INCREASE your chances of catching the bug. You're probably going to think I'm crazy, because the next bit runs contrary to everything you've been taught for the last 20+ years. The science is sound on this, and I can provide dozens of links to back it up. A Poz guy who is on treatment, and has had an undetectable viral load for more than six months, is only bettered on the safety meter by a guy on PrEP. It's ironic that us undetectable Poz guys, who Neg guys fear the most and immediately reject, are turning out the be the ones least likely to infect them. They call the concept Treatment as Prevention (TasP). The concept of TasP is simple: Get as many people tested as possible. Start the ones who test Poz on treatment as soon as they ready to commit to the daily medication. Treatment lowers their viral load. A low viral load means they are less infectious. When their viral load reaches undetectable, they are for all intents and purposes, not able to pass on the virus. You will start to see education campaigns featuring this idea within the next couple of years. I'm a little too tired to write too much more at the moment, but I'll leave you with homework of reading the document I'll link to below. In September, the Australian based HIV service organization ACON issued a position statement titled "What is Safe Sex?" (They choose to use the word Safe rather than the more widely accepted Safer) ACON's area of responsibility is Sidney, and the rest of New South Wales. In it they put Condomless sex with a guy whose viral load is Undetectable, Comdomless sex with a guy on PrEP, and sex with Rubbers all on an equal footing. They are ALL safer sex. www.acon.org.au/sites/default/files/What-is-Safe-Sex-Position-2014.pdf

The fact that some on here think Gonorrhea and Chlamydiae CAN be detected by a blood test is quite scary. It shows how poor the education and understanding around sexual health is in our community. Only around 20% getting tested for HIV annually, Most check for other STIs even less often than they go for an HIV test. There are an awful lot of people with asymptomatic G & C running around out there. Every gay man should be vaccinated for Hep A & B. Neg guys should check for Hep C annually.

The graphic that was supposed to show in the above post didn't work. Since the allowable editing time is WAY TOO SHORT for my big assed posts, I couldn't correct the error. Here a link to the original infographic on the CDC's website. US CDC Treatment Cascade InfoGraphic - November 2014

There has been exactly ONE person cured of HIV. And I'm not even sure if they consider his case a functional cure, or sterilizing cure. The most likely future scenario is a fictional cure. The virus would be totally suppressed, and there would be no need for a daily drug regime. But there would still be viral DNA spliced into some cell hiding somewhere in my body. Sure I'd jump at that cure. But sadly I'd still be considered Poz, and still face all the shitty stigma. I've never thought about PrEP even being applicable in that situation. I very much doubt we will ever get to a sterilizing cure, where all trances of the virus are totally eliminated. If it was developed, I'd leap on it in a second, and go on PrEP to keep me free of the bug. But I expect society would still consider me "dirty" because I had been Poz in the past. Similar to the situation survivors of Ebola now face. But at least I could say I was Neg, and have no qualms or guilt about it. Would there be people who would stay Poz. Sure! Look at each step of the Treatment Cascade. Those that get lost to the system now, would probably fall off each step of the "Cure Cascade." Like the 16+% who are Poz but don't know it. In the US you have that particularly egregious 46% drop between diagnosed and retained in care. So that totals to 62%. And just like the anti-Vax and anti-PrEP crowd, there would be science denialists, conspiracy theorists, and the "I'm not going to put that 'poison' in my body" group. But I suspect that the majority of those currently retained in care would leap at the chance to get rid of our unwanted hitchhikers. Standard provisos about access and affordability would apply.

I saw this over on the PrEP Facebook group, and thought it might be relevant here. (Slightly edited to remove reference to other posts, clarify point, and add a link)

I'm going to confirm what Bear said. The caution is about how some medications change how other drugs are metabolized. The Ritonavir effect slows metabolization, and would lead to much higher doses of the ED drug in the blood. I think you'll also find Grapefruit Juice on the list of No-No's with ED drugs. Grapefruit Juice plays with liver enzymes. I think it's the same one as Ritonavir. There is a specially designed drug called Cobicistat in the one pill once a day ARV Stribild that ties up the same liver enzyme, without the side effects fo Ritonavir. On the other end of the scale, the NNRTI etravirine (Intelence) increases the rate at which ED drugs are metabolized. (ie It takes the drug out of the system faster.)

There is more than one antiretroviral being studied as a slow release injectable. One is in monkey trials and is showing very good results. But sometimes drugs that work well in an animal model aren't as efficacious in human. There's a long way to go with that drug. A different antiretroviral is currently in Phase II human trials. Phase II trials try to determine what dosage to use, and and how different doses are tolerated. The current trial is trying to determine blood levels of the ARV over time. It has already discovered that people with a high BMI have lower quantities of the ARV in the blood. Participants have not yet reached the first three month blood tests. Phase III trials are where researchers determine IF the drug is effective. We are at least ten years away from injectable PrEP. It's important research, and hold great promise. Just don't expect it to reach the market soon.

At least in the part of Canada I live in, they consider anal PAP smears a worthwhile test to run on Poz guys. Since we also have a socialized medical system, the test must have value to the patient's health, or they wouldn't be doing it. In the US, the CDC has recommended anal PAP smears for gay men for several years.

I heard a piece on phase II trials of a Hepatitis C vaccine, using a non-traditional approach, that may bypass the roadblocks, Of course Phase II means we know it doesn't kill you, but we don't know if it works yet. If it does work, a vaccine is probably still a decade away. Longer if it doesn't. An MP3 of the show is only available for download from the BBC, for the next 27 days, so grab it fast. The Hep C story is the first segment of the show. BBC World Service - The Science Hour

Catching HIV via cum in the eye is extremely unlikely. It is theoretically possible - in the same way it is theoretically possible to get hit by a meteor. It would take an extreme series of misfortunes to catch HIV that way. I think the only people who have caught HIV via the eye are healthcare workers who got a significant about of high viral load blood in their eye. HIV transmission via cum on pimples is impossible. The fact that you even mentioned it shows you don't have a good grasp on transmission risk. To be honest, you're having an extreme stress reaction to a very low risk event. Since it will put your mind at ease, get tested. Go someplace that that does a real blood test (ie draw a tube of blood from your arm). What you want is a fourth generation Antibody / P24 Antigen test. Specifically ask if they use and antibody/antigen test. The window period for that is about three weeks. HIV blood tests that only look for antibodies, can register a positive result at 4-5 weeks. Oral fluid antibody tests (like Oraquick) have a minimum six week window period. (The Window Period is the time between infection, and when a test can register an HIV Positive result. The majority of people, if they were going to test Poz, would do so in the above time frames. It is very rare that someone doesn't show up until the three month range. Even rarer the six month. Depending on their level of risk, all gay men should get tested 2-4 times a year. I blame the level of fear you're experiencing on our standard HIV "education" campaigns. They really don't give much information except "Be afraid" and "Always use a condom." It contains no reference point of normal risks you face in everyday life, or the distance between High and Low risk. I'd be willing to bet, that like most young gay men, your perception is that having condomless sex with a Poz guy carries between 50% and 100% chance per exposure of becoming infected. What our safer sex campaigns call High Risk, is 1.4% for receptive anal sex. Topping is well below that Oral sex is so low that we can't even put a number on it. Most of the people who claim to have caught HIV via oral sex, admit to having taken other risks when interviewed six month to a year later. Check with your local heath department. Some will give the Hepatitis A & B vaccinations for free. Almost everyone who swears off sex doesn't succeed at that goal. You probably will play again within the next year. I think it's better to be realistic, and acknowledge that you will have sex again. Take charge of your own sexual health, by at least learning a bit more about HIV transmission that you currently do. What we know about HIV has changed tremendously over the last few years. Even the ways we define Safer Sex are changing. In September, the Australian based HIV service organization ACON recently issued a position statement titled "What is Safe Sex?" (They choose to use the word Safe rather than the more widely accepted Safer) ACON's area of responsibility is Sidney, and the rest of New South Wales. If you are interested give it a read. I'm sure it will be an eye opening experience for you. That paper is a gimps into the future of HIV prevention. http://www.acon.org.au/sites/default/files/What-is-Safe-Sex-Position-2014.pdf

If you look at hook-up sties & apps vers guys are mostly looking for other vers guys. They will play with tops and bottoms, but their preference is other vers guys. And when a very sexually active vers guy is newly infected, he's at his most infectious. It can get down to an 1 in 5 chance of passing it on with a viral load in the 10,000,000 range.

One of the dirty little secrets, never talked about in HIV prevention, is that most of this epidemic is caused by Vers guys. They are most vulnerable when the bottom, and most likely to spread it when they top. That 1 in 71 chance of catching it while bottoming, magically becomes 1 in 71 chance of passing it on when they top. The risk even much higher during the acute phase of infection, shortly after they catch the bug. Not to totally cast aspersions on vers guys. I am one, and flip fuck nights are great. At least I think they are -- it's been soooooo long since I had one of those. For the most part PrEP is just personal protection -- A chemical condom and really nothing more. Pretty important for bottoms, especially for cum dumps. From a public heath perspective, a PrEP campaign targeted at Vers guys might be an idea, since they're driving the epidemic. PrEPing them would create a choke point for HIV's spread. But in truth, just getting a larger portion of very sexually active guys following just the PrEP testing schedule of very four months would make the biggest dent in the number of new cases. From the recently released Kaiser Family Foundation survey, only 19% were tested in the last 6 months, and another 11% between six months and a year. 36% have not been tested in over a year, and 30% have never been tested. We know self reported testing is higher than actual testing, just like self reported condom use. A study presented at AIDS 2014 showed that where 50% of gay men reported they tested yearly, records of tests performed at STI (GUM) clinics (and through GPs) calculated that only 20% had actually been tested.

I just about choked when he, whose name should not be spoken, claimed that 50% of new infections are from people who know they're Poz. Studies show it's at most 10%, and those are all guys not on treatment. Almost all the new infections are from guys who think they're "Clean!"

Pitt1988: There is more to your friend's story than he's telling you. People don't go from undetectable to treatment failure in a few months without some other factor(s) causing the issue. Problems with adherence would be my chief suspect. Reinfection seems unlikely. Exposure to the same guy he caught the bug from would do nothing. Exposure to other people could only happen if he wasn't taking the ARVs. Even then, it's usually only one or a few viron that make it past all the bodies defences to set up shop. His own strain would overwhelm the new invaders. High blood pressure is really only associated with the protease inhibitor class of drug. Most first line regimes these days do not include the PI class because of their higher side effect profiles, so I doubt your friend was started on those. If he caught a multi-drug resistant strain, the doctor might have needed to resort to the PI class, but it seems unlikely. I know I always freak a bit when I have a nose bleed or a cut. I'm sure as a Neg guy that probably freaked you out too. If it's becoming a chronic problem, your friend should see an Ear, Nose, & Throat specialist. Vitamin K (and I really do mean vitamin K - NOT the recreational drug ketamine) can help with lessening nose bleeds. I don't mean to cast aspersions on your friend, but is he possibly snorting something? That might explain the high blood pressure, nose bleeds, and ARV adherence issues. Did he spill some poppers up his nose? Just casting around for ideas here. The question about Truvada and lipodystrophy comes up often in the PrEP Facts Facebook group. We've got more than then years of experience with Poz guys taking Truvada without that issue. With the studies we've got about five years with Neg guys on PrEP, and no reports of it. It's one of those Scary stories the anit-PrEP folks like to spread. Bottomhole: With the horror stories of the past, it's hard not to worry about side effects. Bearbandit and I have been on the meds for about 25 years. We were eye witnesses to those bad times. Some of the early drugs, especially at the massive overdoses they used back then, did cause lipodystrophy. It's just not something we see on the current generation ARVs. I've talked to many people just starting therapy and they have experienced no side effects, or some mild gut trouble for the first few weeks. When you mentally and emotionally ready to commit to taking the meds every day, I urge you to start them. If you need to chat about making the decision, and what to expect, both Steve and I will make ourselves available. Paraphrasing FDR, you have nothing to fear, but fear itself. (Yea, I know I'm volunteer you Bear, but I know you would do it without asking.)

Of course. Yes! We also grow antlers, and have green mould in our armpits. If you look closely you'll see we're starting to grow a tail too! There are no common visible signs that someone has HIV. If it were that easy then there'd be no need for antibody tests. Epidemiologist could walk into the bars and pick out the people who need to be on antiretrovirals. All the "Clean U B 2" serosorting freaks would stay negative. We would have stopped this epidemic in it's tracks before 1990. I hate to put it this way, but you're 46. Have you been living under a rock for the last 30 years? Living as a hetro, and just coming out? Been under the influence of evangelical Christians or some other very conservative religion? If your level of HIV knowledge is really that low, PM me. I'll be happy to set up some kind of chat (text, voice, or video) and teach you HIV 101. Hell with my level of knowledge, I could take you right up to your master's thesis.

I think the school of thought is changing now. Hell ACON in Australia just put out a position statement with a redefinition of safer sex. An undetectable viral load, PrEP, and Condoms are all on the same footing - all safer. It will be interesting over the next couple of years to see if PEP manuals get updated, and downgrade their recommendations if the exposure was from an undetectable Poz person. My guess is the Aussies will be the first. Their PEP guidelines are the most advanced I've read. They take into account viral load and circumcision. Their current guidelines don't recommend for receptive vaginal intercourse with an undetectable Pozzie. They also contain a footnote on receptive anal from and undetectable that reads "It is likely that risk is reduced if source viral load is undetectable, however there are currently no data to support this." With the preliminary Partner data, it seems likely they'll downgrade it to "not recommended" with their next revision. The thought about checking the med history of the Poz guy, is older knowledge, back from the days they thought we were infectious as hell. How the world has changed!

If you ask the average Neg guy what the chances of catching HIV from condomless sex with a Poz guy, he'll answer with a number somewhere between 50% and 100%. The OP seems to be in that camp. The actual risk is 1.4%. So yes a pretty good chance that you didn't catch the bug, but PEP is still a good idea. Please report back and let us know if you got on PEP.

The risk from an needle stick is lower than bottoming. Unless she actually injected blood, the chances are fairly low. I have to wonder if the needle shown in the story was a plant. Wouldn't the police have looked for it? Is the area where this happened a high prevalence drug area? What are the chances it's a discarded needle as opposed to the attack needle. I guess we don't know IF he went on PEP. I would sure hope that's the case. If it wasn't recommended to him, the guy should sue for malpractice. I wonder if the woman is just mentally unbalanced, and not actually Poz. And oh yea, Great! Just what us Pozzies need. One more wacko that paits us all as sociopaths, mad at the world for catching HIV, and trying to get even by infecting as many people as possible.

If you could get on PrEP, then you'd all be taking ARVs and in that sense be part of the same club. (I know you already said you can't) Please also consider the feelings of your husband. The thought of having passed the bug on to you could be divesting to him. For most Poz guys, their biggest fear is transmitting it to someone else.

Hey Wood, What metrics do you track? I've seen Jake Sobo's, but I suspect you're monitoring a lot more

I've begun to consider PrEP as nothing more than a chemical condom. It's a personal choice, for personal protection. There really is no difference between someone insisting they will use condoms 100% of the time, and being on PrEP. Yes I know, a pro-PrEP person will mention averting potential onward transmissions had he not been on PrEP, and become Poz. Some anti-PrEP dude will bring up other STIs. Both of those are public health angles to support their own position. But after all the arguing is done, it's just a chemical condom. Maybe we need that on a T-Sirt. PrEP It's Just A Chemical Condom