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I didn't. What I said is that a proven five percent failure rate among adherents does not equal "a lot of people". Any non-adherents who blamed PrEP who indeed be spreading fear. Incidentally, even condom use has associated failure rates -- one rate for perfect use and another for typical use.

Nope, there will be many people who didn't take Truvada daily, as prescribed, and who became infected. Per the iPrEx study, the protective effect is in the mid nineties when a patient is having risky sex and actually has the drug in his blood. Medicine doesn't work when you don't take it, which is where the trouble begins. As for resistance, FDA prescribing guidelines call for quarterly HIV testing. Thus, a PrEP patient who seroconverted would be switched to an appropriate three-drug regimen within at most three months. It would be unprofessional and unethical for a doctor to renew a Truvada for PrEP prescription without making sure that the patient was still HIV-negative. Cost effectiveness on a societal level does depend on giving the drug to patients most at risk of getting HIV. Nevertheless, drug prices vary dramatically from country to country. In the US, obviously the world's highest-price drug market, drug patents last only 20 years, which means that there will be a cheap generic version of Truvada in less than a decade.

I'd encourage you to get online and call Gilead right away. Gilead offers three levels of assistance for Truvada for PrEP. If you don't have insurance, Gilead will pay the full price of the drug. (For people with insurance, no application is required for reimbursement of up to $200 a month, and you can apply formally if your out-of-pocket cost is higher than that.) If you want to apply for Medicaid, be sure that you understand the Medicaid program as implemented by your state. Is Truvada covered routinely by your state? Is there a copayment? An arbitrary cap on the number of prescriptions covered each year? Unfortunately, Gilead's assistance programs are not available to people on any kind of government health insurance, whether Medicare, Medicaid, or VA. As RawTop said, you will need to see a doctor's initially. See if there is a free or low-cost public or charity clinic near you. Several tests are required every three months, but they're not particularly expensive. A well-organized health system won't require you to see a doctor after the initial visit. For example, my test results are sent to my doctor electronically, and we exchange an e-mail message ahead of each renewal. Good luck!

Each person makes a choice about his own health whenever he has sex. Nothing that another person says or doesn't say can protect us. We should never assume that we know the other person's health status, nor that he himself knows it. People don't always get regular STD tests, don't always understand the results, and don't always have symptoms, and our health is constantly changing anyway. The BF's choice to use condoms is protection enough for the BF's health. As much as people say that they're concerned about the BF's health, all this talk of "immorality", of "rights" and of "character" -- when the BF is well-protected by his own choice to use condoms -- suggests a deeper judgment about a normal sexual desire. Most human beings, if we're honest with ourselves, desire barrier-free sex with multiple partners. In choosing to have sex, we need to be comfortable with the fact that many of our partners have acted or will act on this desire at some point.

I don't mind if a boyfriend/partner/husband "cheats" on me. In fact, I find it hot that he's expressing himself and having fun! People have such a variety of sexual needs that we cannot hope to satisfy all of them by ourselves. I cheated on my domestic partner/husband for most of the 9 years that we were together. It was purely physical, never emotional, and I started only after discussing my sexual desires with him and being told that wanting sex was "selfish". I often tried to set him up with guys he found attractive, but nothing ever happened. Loving someone is so much more than regulating who he can fuck.

I agree in a general or theoretical sense with the people who advocate telling the boyfriend first, but we should acknowledge the poster's sexual needs as being of the same importance -- and not better or worse than -- the boyfriend's needs. There shouldn't be any judgment, or question of character. Sex is sex. If he gets fucked bare by other guys and the boyfriend continues to fuck him safely, there is almost no HIV risk to the boyfriend. Using PrEP or having a circle of known and trustworthy neg or undetectable tops would reduce the HIV risk even more. As for other STDs, most are curable, all are treatable, and no matter how much one trusts a sexual partner there is always some risk from his past or from his outside activities. The only real issue is that an STD diagnosis could force an awkward conversation; at that point, there would be an ethical obligation to disclose the STD, though not necessarily the conduct. I've been reading a 50-year-old book about open marriage lately, and early proponents of that idea emphasized that privacy is healthy in a relationship.

Do it! You will satisfy your sexual needs and, when your boyfriend eventually catches you, you will either lead your relationship in a new direction or be free to find a boyfriend who understands you. Some things to be aware of: - Once you start, you won't be able to stop -- barebacking or cheating. The "rush" from both activities is very powerful. - You could get HIV. Use PrEP if you want to prevent that. - You could get other STDs and pass them to your boyfriend. If he continues to fuck you safely, that will minimize, but not eliminate, the risk. - Your boyfriend could leave you if he finds out that you are cheating. (On the other hand, if he really wants to be with you, he will start fucking you the way you want to get fucked -- bare -- and he will understand that your taking other guys' loads doesn't diminish your feelings for him.)

While it's true that drugs receive regulatory approval in the US on the basis of safety and efficacy, not cost, US insurers in cannot, in practice, pick-and-choose which FDA-approved drugs to cover. They can offer little or no coverage for all prescription drugs, charge more for brand-name drugs, or publish a formulary listing covered drugs for by medical condition. Otherwise, they have to write categorical exceptions into their insurance contracts. For example, all US insurance contracts exempt experimental (not-yet-approved) drugs, and virtually all exempt any drugs and services for gender reassignment. Categorical exceptions usually name a medical condition, not a drug or class of drugs. Historically, in the US context, where patients had to switch insurance plans frequently (due to job changes, family status changes, or lack of access to funds), strict economics favored discouraging use of preventive drugs or services, on the assumption that the cost of treating a disease would fall to some future insurer. This is why the US has, among developed countries, very low vaccination rates.

otebbtop, while the Hobby Lobby decision is worrisome, it was focused on the question of employer payment for, not even availability of coverage for, birth control methods that religious nuts believe are like abortion. The result is that closely-held corporations will not have to pay for such services but that insurers will continue to offer the coverage, spreading the cost to the rest of their insurance pool and/or relying on direct federal subsidies. PrEP is markedly different because, among other things, it can be used by straight and gay men and women, even though our focus is obviously on gay men. Out of curiosity, do you breed neg bottoms, and specifically, ones who aren't chasing? You could learn about PrEP ( www.prepfacts.org ) and let them know about it!

Do you bring up your use of PrEP with friends? How do they react? How often will a friend go on PrEP at your suggestion? Or not go on it? A friend of mine, living right in my neighborhood and only in his early twenties, told me last week that he had seroconverted. A year ago, when I started PrEP, I mentioned it to him twice, even letting him know where he could go to enroll in a free PrEP study. I feel so sad that he didn't heed that advice and has now seroconverted. (It goes without saying that I'd be happy for him if he had been chasing or had met a special guy to "father" his infection, but in this case, he definitely did not want to become Poz.) Another friend of mine started PrEP through his regular medical plan. He's about to exhaust his first month's supply and couldn't see his doctor for a renewal due to the holiday weekend, so I've been on his case to take it seriously. He's a bottom, so he has a substantial risk. Any thoughts about how to get guys in our social circles to be curious about/open to PrEP?

I'm a (gay) top, so physically it's the other way for me -- fucking straight, bi and gay guys in relationships is incredibly hot. I have no problem playing with guys who are cheating (nor with cheating or being cheated on). All of the parties are adults, old enough to know what they need. This is true even of the spouse: if sex isn't happening at home, it should be obvious that it's going to happen elsewhere. I don't buy the notion that there's some "healthy" gay relationship ideal from which playing with attached guys distracts us. Sometimes, incredible intimacy can develop in an affair. It just isn't analyzed, belabored, or taken for granted as it is in conventional relationships. And sometimes, in addition to the sexual chemistry and the excitement of sneaking of around, I welcome the limitations imposed by fucking an attached guy. Maybe I want to enjoy my space and freedom and leave the marrying, the parenting and the other societal obligations to him.

This is a hot story. As I was reading hit, this is the ending I was anticipating: He looked relieved. He then asked me back to his place. This was on a Friday, and didn't leave until Sunday night. He was so turned on and so guilty that he pozzed me that he asked me to marry him. We made it official at city hall the next week. That was the best test I ever had.

This story is hot, and very timely. I was at San Francisco City Clinic the other day for a regular check-up. I got one of the (rare) male practitioners. He's kind of cocky, but still endearing, right down to his voice and his style of dress. I would fuck him in a heartbeat. I've often wondered whether gay men who work in these places love or hate their jobs. They get to see and touch hundreds of asses and dicks every week. Still, some of these practitioners probably stand in judgment of their patients, and others must get bored of seeing guys' bodies. Maybe there are a few lucky ones who know how to tread a fine line between work and pleasure.

It's hot when we give in to biology and fuck first, ask questions later. As a top, I love it when a bottom in a bathhouse or a glory hole place offers his hole without asking about my status. When I was still willing to put on a condom, it was hot have condoms out in view, to watch the bottom wrestle with the decision to speak up or not, and then for him to give me tacit permission to go in bare. I adhere religiously to PrEP, so I know I'm not putting the guys I fuck at risk of getting HIV. Though I also get tested for other STDs every three months, I might fuck 5 to 10 guys in that space of time. Most of them will be new and/or anonymous partners, so there is a bit of risk there. I love Poz men and I take offense when "clean" is used in a Poz-phobic sense. If that's what's going on, it's always fair game for me to answer "yes, I'm clean", even if I'm breeding my third hole of the weekend. If it's someone sincere, I'll explain about PrEP and disclose my level of sexual activity. After sex, it's too late for the bottom to change anything, so I don't feel the need to get into a discussion. On one hand, I get off on watching the bottom's initial eagerness turn to apprehension. Biology is powerful enough to make us do things we think we shouldn't. On the other hand, I also wonder how anyone can second-guess a primal sexual encounter that we both needed and enjoyed.

I read in Sperm Wars that the shape of the penis evolved so that a man could remove semen deposited by the last man who fucked his woman, increasing his own chances of being the father. Whereas women evolved to have a heightened sexual response when with a new partner (i.e., when being unfaithful), men evolved to have a heightened sexual response after their female partners had been absent (i.e., potentially unfaithful). Without suggesting that gay male bottoms are necessarily exhibiting feminine behavior, I think it's safe to say that gay male tops are exhibiting masculine behavior. It doesn't surprise me that this sound occurs in a bottom, but only after he has taken a few bareback loads. It's a matter of biology that the final top wants to pump out his competitors' semen and be the one to successfully knock up the bottom.

Several thoughts: - Time of day matters. I've found that weekdays from after work to early evening are good. Sunday afternoon is also good. If you're limited to weekday daytime play, try Folsom Gulch in San Francisco at lunchtime. - If you want more contact, get a locker and wander, instead of getting a room. With apologies to Shakespeare, sex begets more sex. If you start something in public with one guy, others will want to join. (And speaking strictly for myself now, "Want to go back to my room?" is as big a turn off as "Got a condom?" I can have sex in a bed, behind closed doors, without leaving home!) - There isn't much point to pre-arranging meetings at a bathhouse (unless we're talking about an ongoing buddy, and the bathhouse serves as your regular meeting place). Just go, and take advantage of the benefits of the setting: relatively many men, chances to 'try before you buy', and nothing lost if you're incompatible with a particular guy, as there are always others at hand.

If I could count the number of times I've heard a guy raise this final, feeble objection even as he gets into position, his hole inches away from my bare dick... From my perspective, this is one of the biggest benefits of same-sex marriage! Thanks for starting this story. Your writing is honest, realistic, and hot.

And what exactly is the problem with your ex-BF's idea? ;-) A guy whom you have great sex with, who wants to stay faithful to you, and who understands that you like other dick is marriage material, as far as I'm concerned.

Yes, but mainly because I happen to get off on glory holes and anonymous sex as much as I get off on fucking a man I'm in love with in front of the proverbial fireplace. When the setting allows, I like to have a conversation to exchange information not about HIV per se, but about health. Is my Neg partner getting tested regularly? Is my Poz partner receiving regular medical care? I want Neg guys I fuck to know that I'm on PrEP, that it's effective because I use it daily, and that I am tested for HIV and other STDs every few months. I want Poz guys I fuck to know this last point, because I care about their health. I know that any kind of infection can be serious for them. No. This was part of my strategy before PrEP. Since starting, last July, I happen to have met a long-term non-progresser, another man whose HIV was under control without medications, and one guy who had some general health challenges and was switching HIV medications. When I'm having sex with a guy whom I know is Poz, my main concern is whether he is receiving regular medical care. No. Most of my sex partners happen to be Neg. No. Before I started PrEP, though, the combination of "he thinks he's Neg", "he doesn't test regularly", "he doesn't know what an HIV antibody test result means" and "he takes it raw" would give me pause (no pun intended). When we're talking about sex, which is primal and gives rise to some of the best physical sensations and emotional feelings that we will experience in our lives, it's unrealistic to have rigid rules. In the course of my HIV prevention volunteer work years ago, I heard a practitioner say something along these lines: "Focus on your expectations for the next encounter, the next week or the next month, not on permanent rules that will be hard to uphold." Whatever rules you set, don't get discouraged if you only come close to perfection. The world isn't likely to end if you miss a Truvada pill every few months, or find out that the incredibly hot Poz guy who came inside you one time wasn't on meds.

Excellent point, JizzDumpWI. On a related note, if you elect PEP and can contact your sex partner, the CDC points out that it is helpful to find out which HIV drugs he has used. This is because a range of different drug combinations can be chosen for PEP. PrEP is simple by comparison, with only one 2-drug combination thoroughly studied and approved so far -- Truvada -- and others currently under study.

I feel bad saying it because emotions are obviously involved, but this sounds hot! Sex outside the strictures of a relationship is liberating. Enjoy it, communicate, and be sure that both of you are managing your feelings. Maybe you'll be happier as fuckbuddies than you were as boyfriends, or maybe you'll get back together.

Your mentioning a "last minute effort to prevent HIV" suggests that you are confusing Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP). There is nothing "silly" about either one. PEP is what you ask for immediately in an occupational medicine clinic if you've had a "needle stick" incident at work, or in a public health clinic or hospital emergency room if you've had a sexual exposure that puts you at significant risk of getting HIV (this could be a sexual assault, consensual sex with an HIV-positive person, or a discovery that a sex partner was HIV-positive). Although PEP is the current standard of care in occupational and emergency medicine, doctors practicing outside urban settings might be unfamiliar with it. A similar approach, Infant Antiretroviral Prophylaxis (IAP), is used in babies born to HIV-positive mothers. PrEP involves taking the HIV drug Truvada when you are known to be HIV-negative. Occasional or "last minute" use does not prevent HIV infection, but daily use is very effective. A similar approach is used to prevent expectant HIV-positive mothers from passing HIV to their babies. Use of various HIV drugs for PEP has been recommended by the U.S. Centers for Disease Control and Prevention (CDC) for about a decade, Truvada for PrEP was approved by the U.S. Food and Drug Administration (FDA) in 2012, and both PEP and PrEP are recognized by international health organizations. In case you didn't know, there is a dedicated PrEP forum.

PrEP has near perfect effectiveness with daily adherence. Condoms can break; aren't always available when we have sex spontaneously; and are often not used in monogamous relationships, despite the risk that one's partner might be cheating, might not disclose his status, or might honestly not know his status. Truvada for PrEP prescribing guidelines call for regular testing for potential side effects. It should also be noted that men whose sexual activities put them at a truly high risk of getting HIV would, if they did become Positive, face a required 3-drug regimen for the rest of their lives, instead of an optional 2-drug one (Truvada), limited to their years of high-risk sexual activity. To the original poster, it could be that your doctor buddy feels guilty about barebacking. Having come out during the early 1990s and been brainwashed by fear-based safe sex messages, I remember saying something stupid the first time a guy asked me to cum in his mouth! He wanted it, I knew from my activities and test results that I wasn't putting him at risk, and oral sex is a relatively low-risk activity, but I still did the "right" thing and pulled out. (How irrational of me, and how embarrassing to recount the story 15 years later!) Whatever your buddy's explanation, and his current, true HIV status, PrEP is a great way for you to reduce your HIV risk and increase your peace of mind.

At least the message is honest. Bare is better. I'm fine promoting "safe sex" -- I did serious volunteer work in that field for years -- but not lying. If we limit ourselves to telling people that there are potential health benefits, they might choose to use condoms part of the time. If, on the other hand, we pretend that using condoms feels just as good, people will stop using them the moment they've had the epiphany of that first bareback fuck. Realizing that we lied to them, people will then tune out anything worthwhile we might have to say about sexual health. You're ignoring many levels of psychology. (Still, I trust that you are sincere, in the same way that I honestly believe that Nancy Reagan thought that preventing drug abuse was as simple as telling people to "say no". I don't see her as simple-minded or negligent, in the way that others do.) There could well be a difference in physical sensation for a bottom. Unless your butt is naturally hairless or you're using silicone-based lubricant, which someone new to gay sex wouldn't know about, which many people can't afford, and which few people carry with them, the condom will drag against the hair on your butt, in a way that the skin of a bare penis does not. It's not a pleasant sensation, especially in a part of the body with so many nerve endings. But psychologically speaking, - Your first gay sex act (or any gay sex act, for that matter) isn't always planned. You might not have a condom with you. - Having to stop and wait for your top to put on a condom is an unnatural interruption. Sexual excitement is spontaneous. Annoying wait aside, you might fear losing your nerve to try getting fucked, or your top might fear losing his erection. - Intimacy plays a big role. In relating to other people, do we feel better when we say or hear "no", or "yes"? Good God, why would they want to fight a prevention strategy shown to have near perfect effectiveness under proper adherence? It's not an either/or question, in any case. An effective and ethical HIV-prevention organization promotes all available strategies, including frequent testing, early and sustained HIV drug therapy (Treatment as Prevention/TaSP), PrEP, PEP, condoms, and harm reduction. PrEP is always prescribed in conjunction with frequent HIV testing, because the two drugs in Truvada are strong enough to prevent, but not to treat, an HIV infection. (Current treatment practice calls for starting a three-drug regimen soon after diagnosis.) For a prevention-minded organization, the built-in promotion of regular HIV testing is a beneficial side effect of launching a PrEP program. Regrettably, this is all true. We need to get past our Victorian sexual mores. This problem is serious throughout Canada, and also in most parts of the United States. Even in the San Francisco Bay Area, service access differs markedly from one city to the next. Try getting PrEP; or a qualitative PCR RNA HIV viral load test after a high-risk exposure; or HIV drug therapy immediately on diagnosis; in Oakland. Suburban public and private medical providers lack experience and current knowledge. Yes, PrEP has not yet received approval in Canada, and yes, non-poor, non-senior Canadians must pay out-of-pocket or rely on employer coverage for prescription drugs. Both of these problems can be solved. If we tackle the first problem, Canadians will already have an advantage because prescription drug prices are regulated in Canada. In the US -- hardly a model for health care access -- PrEP was approved by the FDA two years ago. Thus, private insurance plans for non-poor, non-senior Americans cover it on the same terms as other prescription drugs. PrEP is available to those who take the time to inquire. Insurance for the poor (Medicaid) is a federal-state partnership, so states have discretion, but it is known that some states do cover PrEP. The patent on Truvada will expire in a matter of years. Less-than-daily dosing, and alternative HIV drugs, are already being studied. This makes me sad, and it makes me ashamed on behalf of uninformed Neg guys. I have never treated Poz guys this way, and I often confront Neg guys who say stupid things like "Neg and clean only". They're not fun to play with. My thought experiments for them: - What if you fell in love with a Poz guy? Does your heart know his HIV status? Love is supposed to be deeper than that, right? - What if you were physically attracted to a Poz guy? Does your dick know his HIV status? Sexual attraction is supposed to be instinctive, right? You need to meet the right men. As a Neg guy on PrEP, I'm glad to be able to play freely with Poz guys. Poz guys get extra points from me, since in many cases -- and without romanticizing HIV at all -- a person's becoming Poz is evidence of an active, uninhibited, pleasurable sex life.

I'm on PrEP, with perfect adherence, so I don't ask anymore in 1-on-1 hookups. My status and my use of PrEP are disclosed in all of my profiles, and I'm happy to explain if asked. No one I've met lately on BBRTS has asked for or volunteered status information in conversation, though most profiles seem to be filled out. "Ask me" where there might be doubt is pretty rare. If someone says he loves to get fucked in the sling at a Cummunion party, or that his record for taking loads is 10 in one day, the meaning of "ask me" becomes pretty clear. On the apps for "good" boys, a few courageous men put "[+]" after their screen names. I don't blame those who don't, because as a Poz-friendly guy, I keep hearing stories from men who have been berated in those apps after disclosing. Hornet and Scruff are the only mainstream apps I know of that provide specific places for disclosure. (iBBRTS is a mobile Web site, not an app., and in any case, it targets barebackers.) Hornet's "Know Your Status" (KYS) feature, and that app.'s demographic, effectively shut out Poz men. I've never seen a Hornet profile with Poz in the KYS field. Scruff has openly Poz guys. Curiously, when I added "Positive men" to my "into" list, the random view in Scruff started showing only Poz men, ignoring any other groups in my "into" list. :| All in all, how we feel about safety seems to matter more than whether we are actually safe. As a top, I find that bottoms in bathhouses and glory hole places don't ask, and that bottoms in 1-on-1 situations ask after we've started fucking without a condom, or even after I've cum inside them. (I admit that "fuck first, ask later" is a huge turn on, and that this line of questioning is liable to make me pick up the pace and cum inside, knowing of course that I do not put anyone at risk.) Disclosure of status is a good thing, I think, but it's always been clumsy because few people understand the window period associated with HIV antibody tests. I'd swoon if a sex partner were knowledgeable enough to tell me that he'd just gotten a 4th-generation HIV antibody test (shorter window), or a qualitative PCR RNA viral load test (essentially no window). People's not knowing what to do with a disclosure is another problem. "I'm Poz and undetectable as of..." entails less risk than "Of course I'm Neg."