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So that others who read this in the future won't worry unnecessarily... In the United States, there is no requirement to obtain disability or life insurance when taking out a home mortgage on normal, commercial terms. Commercial lenders cannot make you buy those add-on products. PMI in the United States is a specialized insurance product that is most certainly not disability or life insurance. Pricing is based on your creditworthiness, and has nothing to with your health. PMI doesn't even cover you, as the borrower! It covers your mortgage lender, paying the lender if your home is foreclosed and sold at auction, and the auction price doesn't doesn't cover the remaining debt. In the US, HIV-Positive people may face discrimination in some facets of life, but access to credit is not one of them. HIV is a disability under the ADA, which makes job discrimination illegal. Nevertheless, in a country where almost all private employment is at-will (you can be fired at any time, and no reason need be given), discrimination is very hard to prove. Employers don't know initially that you have HIV. Rather, your risk comes from being gay, living in a conservative state, and living in a suburban or rural area. Housing discrimination is a possibility, but here again, your risk comes from being gay and living in a backward area. Whereas a small employer with an internally-administered, self-insured health plan could infer your HIV status from your health insurance claims, and whereas you might tell an employer of any size when you request a disability leave or a workplace accommodation, a landlord really has no way to know.

Poz1956, thanks for educating readers about differences in drug benefits and drug approvals in the United States and Canada. I grew up in Canada and have lived my adult life in the US. It still amazes me that there is so little understanding of the outside world here. Drug coverage for the non-poor, non-senior population is a big gap in Canada's system of socialized medicine. It's a relief to know that some provinces are now assisting patients with some HIV drug costs. And yes, it is a shame that daily Truvada for PrEP, which has been proven to be highly effective, has not (yet) received approval in Canada. I do want to clarify the insurance status of Truvada for PrEP in the US. Private US health insurers cover PrEP not for economic reasons, but because they are bound to cover it on the same terms as other FDA-approved prescription drugs unless they modify their contracts to exclude this category of care. (For example, experimental drugs are not covered, because they lack FDA approval, and fertility treatments are not covered, because virtually all US health plans have contract language excluding that category.) Where US insurers have discretion about which medical services to cover, at what levels, with how much promotion to members, and with how many barriers to access (pre-approval, extensive claims documentation, etc.), the main economic question is: how long will the patient remain insured with us? Since insurance for most Americans is still tied to employment, patients can be expected to switch insurers every few years. Though investing in preventive care lowers individual lifetime costs and total population costs, it doesn't benefit one's current medical insurer. This is why, for example, US health insurers don't do much to promote vaccinations, and why we have low vaccination rates for a developed country. Kaiser is just about the only private US medical insurer where preventive care incentives operate naturally. Insurer, medical practice group and hospital operator are one in the same, and market share is large enough that patients can remain in the system across most changes of employment. Not surprisingly, Kaiser's PrEP program is well-organized. The long-term, national economic case for PrEP is strong, and it will become even stronger when the Truvada patent expires, when/if less-than-daily dosing is approved, and when/if other drugs are approved for PrEP. From a policy perspective, let's hope that long-term societal interests prevail over fragmented short-term interests.

I voted no. Why not use PrEP and enjoy the same sexual freedom with much less risk, assuming that you will take your medication daily? Someone suggested that you buy life insurance before becoming positive, as it will be a requirement for taking out a mortgage if you want to buy a home. That is not true. Mortgage lenders care about your assets, debts, income and job, not your health record. Mortgages need not be life-insured. If you later have a spouse and/or children whom you want to protect, many employers offer term life insurance that costs pennies a day. There is no health evaluation if you enroll when you start a new job. "Term" means that you're only covered for a certain period of time -- while you work for the employer, in this case. Once you retire, presumably your home will be paid off and you'll also have savings to pass on to your heirs, making life insurance less necessary at that stage.

Very well said, bearbandit. I'm amazed to see the increased interest in PrEP over the past year. Now, people are even mentioning it in hookup profiles! The testing regularity alone is of tremendous value to the community.

Essence7, please ask a doctor or clinic with a gay male client base about fourth-generation HIV antibody tests, which, though still antibody tests, have shorter window periods than the older versions in common use. Your doctor or lab technician will be surprised that you asked. To be clear, you may also request a qualitative PCR RNA viral load test, which detects HIV, not antibodies, reducing the window period to a matter of days. Public health clinics with a progressive philosophy and a high-enough patient volume reduce the cost of this test by dividing and pooling blood samples from multiple patients. Only if the pool is positive are the individual samples that were set aside actually tested. Pooling samples in this way lengthens the window by a matter of days (few copies of HIV in a large pooled sample are harder to detect), but the effect is small. I'm on PrEP, and a top, though I made the decision to bareback even before starting PrEP. I would not give up the pleasure or the connection made possible by bareback sex. If I were very worried about HIV or other STDs, I would have a frank discussion with my sexual partner(s). Instead of looking at printed test results -- easy to fake and likely to be HIV antibody test results only, in any case -- I would propose going to a clinic together for PCR viral load tests. In a situation where you know your sexual partner and have time to plan ahead, the time (and possible expense) will let you enjoy an incredible sexual experience, that will hopefully foster trust, reduce fear, and lead to many more experiences.

It's time to separate assumptions and judgments from policy, let alone medical science. In Canada, prescription drugs are not covered by the provincial health insurance plans that make up the country's "socialized medicine" system. Just as in the US, there is public drug coverage for the poor and for senior citizens. Others pay for prescriptions out of pocket, receive supplementary drug coverage from work, or purchase such coverage. Coverage for PrEP in Canada is a moot point, as PrEP remains an off-label use there. In the US, Truvada for PrEP is FDA-approved, and private insurers must cover it under the same terms as other FDA-approved prescription drugs. If you meet the prescribing guidelines, you'll pay what you would pay under your plan for other brand-name prescriptions. The main public health plan of concern in the US is Medicaid, which covers the poor. As Medicaid is a federal/state partnership, coverage varies by state. This is more a function of budget than of the safety and efficacy results upon which any drug's FDA approval rests. For example, in California, Medi-Cal patients are limited to an arbitrary number of prescriptions each year. Interestingly, according to prepfacts.org , New York and Florida do cover PrEP for Medicaid participants. Now, from policy to science... If you argue that government shouldn't pay for an effective HIV prevention regime (between 95 and 99% effective for patients who adhere daily, to wit, better than actual effectiveness rates for condoms), then you are arguing that government shouldn't pay for HIV treatment, either. After all, except for blood transfusion recipients and needlestick victims, people got HIV through "slutty behavior", right? I find that label insulting. Sex is a human behavior. By the same logic, lung cancer victims should be left to die if they were smokers, as should sports accident victims, to say nothing of heart attack patients who were overweight. Individual behavior has nothing to do with medical science. In the US, when there is a scientifically proven treatment, we treat people, regardless of what might have contributed to their medical problems. Returning to the "slutty behavior" assumption, PrEP even has applications that don't have any hint of that. For example, it significantly reduces transmission risk in sero-discordant couples, and it can protect anyone from the undisclosed sexual activities of a boyfriend, partner or husband. In a few years, when Gilead's patent on Truvada expires, when less-than-daily dosing has been studied, and when other HIV drugs have been studied for PrEP purposes, it will be much cheaper to prevent HIV via PrEP than to treat the additional infections that would result from denying access. I'm not worried about a few years of high costs in the meantime.

Excellent advice from bearbandit! If yours is more than a general question and you do decide to get tested, ask for a qualitative PCR viral load test (the best option, as it tests for the presence of HIV -- immediate -- rather than the presence of antibodies to HIV -- delayed by weeks or months after infection). Failing that, request a "4th-generation" antibody test, the most sensitive of the antibody tests. My bet is that these diagnostics are much easier to get in socially-committed continental European countries like yours (what of the UK, bearbandit?) than in our fragmented U.S. healthcare "system".

Without wanting to debate the merits of Obamacare at all, I do want to clear up two errors. First, Truvada for PrEP received FDA approval in 2012. It is NOT an experimental treatment. Most medical plans have categorical exclusions for experimental treatments, but PrEP no longer falls into the experimental category. Google "prep fda approval" to find the FDA press release. Second, U.S. insurers are ALREADY covering PrEP. We've read accounts of this here on the forums, and I know it from personal experience, too. I went through the qualifying process with my insurer -- Kaiser, California's largest -- and was offered PrEP at my usual $25/30 day prescription co-payment and $10/encounter lab test fee. Kaiser has formal guidelines for PrEP, which I have read, gone over with my primary care doctor, and gone over with the pharmacist who administers the PrEP program at Kaiser San Francisco. What worries me about these online conversations is that speculation that PrEP isn't covered is deterring people from asking. Once they've read their health plan documents, checked the formulary (if applicable to the plan), and found a doctor who is willing to look up current FDA guidelines, most HIV-neg guys with better-than-catastrophic health insurance will find that PrEP is available and covered. If you encounter an uninformed doctor, it may simply be necessary to seek care in a large, diverse city like San Francisco or New York.

The San Bernardino public health official you spoke with is incompetent. The ACA plans being offered in California were drawn up months ago. Full plan terms have been posted on Covered California, our state's insurance exchange Web site, since October. It is simply a question of reading the documents for each company's plan -- and calling the insurer if a plan includes a drug formulary (a list of specific drugs). Why so many people speculate about coverage instead of reading the documents, I don't understand. Barring a categorical exclusion written into a health plan, Truvada for PrEP, as an FDA-approved drug use, must be covered under the same terms that a plan uses for other prescription drugs (and in this case, for lab tests, a necessary part of the PrEP regimen). Medicaid/Medi-Cal for very-low-income patients is a different matter, but there especially, there will be a regulation, manual or circular describing exactly what is covered. One sad fact emerges: gay men in suburban and rural areas get bad medical advice and inferior care because their doctors lack experience treating large numbers of gay patients. I live in the East Bay -- 20 minutes away from San Francisco's City Clinic and Department of Public Health, pioneers in HIV prevention, testing and treatment -- and you should hear the terrible advice my uninsured friend got when he sought care on our side of the Bay after he had sero-converted. In medical matters, it pays to live in -- or receive care in -- a place where there is a concentration of gay men. Your life may depend on it!

Took a load from a buddy who has been cheating on his BF with me for 3 years. We'd had a long break after he got caught, so it was nice to reconnect. (I posted a detailed account in the "last cheating episode" thread of the "Cheating" group, for others who are into that.)

PrEP suffers from its novelty, from a misquoted effectiveness statistic,* and from the fact that what little experience a doctor outside a major metropolitan area (or with a non-diverse practice) might have in prescribing HIV medications necessarily involves treatment rather than prevention. It might be helpful to bring a printout of the press release announcing the FDA approval of Truvada for PrEP last year (Google "fda approval prep"). This has links to prescribing guidelines. Separately, you should read the evidence of coverage for your health insurance plan. What are the deductibles and copayments/coinsurance rates for brand-name prescriptions? For lab tests? Does the policy contain a blanket exclusion, for something like sexual health? (As PrEP is now FDA-approved, the near-universal exclusion of "experimental" treatments no longer applies.) Is there a prescription drug formulary (a specific list if covered drugs)? If so, you'll have to go online or call to find out whether Truvada is listed. Provided that you meet the prescribing guidelines, PrEP will be covered on exactly the same terms as other drugs. It's wise to know the prescribing guidelines yourself. A conscientious doctor will order a qualitative PCR HIV viral load test to provide timely confirmation that you are HIV-negative. (The two drugs in Truvada are strong enough for prevention, but three drugs are typically prescribed for treatment, so PrEP is never started if there is a risk that you are positive.) The doctor will also order a kidney test. A liver test and some assessment of bone health should also be done. Once your results come back, you will receive your first prescription. The HIV and kidney tests should be repeated every few months, before renewals are approved. Kidney and bone side effects are relatively rare, but are very serious when they do occur. * Some authorities failed to read a key research report in detail, and are quoting an average efficacy rate. Efficacy for patients who adhered to the drug regimen was above 90%. It stands to reason that drugs only work if we take them.

Congratulations! There is no turning back, once you've experienced sex the way it was meant to feel. I don't fuck with a condom anymore; most guys don't ask, and those who do ask just seem to want me to make the decision to breed them. Incidentally, it's always a good idea to be aware of yours and your sex partners' health. Regular HIV and STD testing, and open discussion between guys who are fucking, can't hurt. If you are worried about HIV, it's worth inquiring about PrEP.

Gave two loads to a young Asian guy at Midtowne Spa in LA. It was of course dead when I arrived at 3:00 Thursday morning, but by chance we saw each other in the dark play area. I started sucking him, and then found a lubed hole when I started fingering him. Amusingly, there are posters everywhere announcing that barebacking is against the rules -- the most intrusive such campaign I've seen at a bathhouse. Although this guy wanted it bare, he quickly pulled off when I said I was about to cum. I don't know if he realized my dick was dripping with cum when I slid it back in. The second time there was no doubt about his intentions: he moaned loudly and tightened his ass muscles as I came in him. He then blew a big load down my throat. It was especially hot because he turned aggressive at the end, holding my head and choking me with his dick. Turnabout is fair play. :-)

I gave loads to two guys South of Market in San Francisco on Saturday night. I hadn't been to the notorious Folsom Gulch or City Entertainment (now stupidly renamed "PopSex") adult video arcades in years. After a slow start at the Gulch, I was alternating between blowing and getting blown through a glory hole. The hole was pretty large, so our hands were wandering. I could tell that he had a great body. When I happened to finger his ass a bit while sucking his dick, I noticed that he was already lubed. When it was my turn to put my dick through the glory hole again, I used my hand to motion him to stand up and turn around. He understood what I needed. Within seconds I was sinking into his warm, wet hole. Within a few minutes, I'd filled it with sperm. After I'd cum, I bent back down to suck him off, but I had plans and had to leave a few minutes later. I apologized through the hole and we let our hands wander a bit more over each other's bodies. Interesting connections can develop through a hole! Later, I went to the former City Entertainment, across the street. It is better lit and less sleazy, but those features usually mean less sex. To my surprise, no sooner had I entered a booth than another gentleman was inviting me to slide my dick through the glory hole. I received some of the best head I've ever had -- he was very talented. Torn between wanting to reward him with a mouthful of cum and wanting to breed again, I left the booth before cumming. In the next booth, getting my dick sucked through the glory hole quickly turned into fucking through the hole, and then an invitation to join the other guy in his booth. He gave me exactly what I needed as I bent him over, held him down, fucked his wet hole and bred it. I asked him how many loads he'd already taken and he said I was the first. I said I felt honored. If you're ever frustrated about being mistreated for being gay, remember some of the advantages we enjoy. No straight man I know can fuck -- bareback, no less -- more or less on demand. Most straight guys would give anything for the privilege.

This morning with a 23yo fuckbuddy I hadn't seen in a few months. We met at his place while his family was away. He has "snake bites" (two lower lip piercings), a bonus given that he's already an awesome kisser. I fucked him bare and shot a huge load in his ass. I had to be fast because he was a little sore from getting fucked the day before. Then we flipped. He asked me where I wanted him to cum, and I said, "Inside. Is there any other place?" I could feel his dick pulsing. We both agreed that we need to see each other more often.

I wanted to echo the suggestions of communicating with your sex partners and starting PrEP. I would broaden the conversation from HIV status to awareness and health. Statistically speaking, fucking an HIV-positive guy who is undetectable could be safer than fucking someone who claims to be negative but is unsure or might be lying. PrEP has received some traction in the international HIV prevention community, but I'm not sure which countries other than the U.S. have approved it. If it hasn't yet been approved in Australia, you could ask a competent doctor to prescribe Truvada for an "off-label" use. Canadian patients are starting to do that, for example. I would add not fucking guys who already have loads inside. You can find out by saying that it's a turn-on. (This backfires for me, because it really is. When a guy says yes, I can't resist slipping in!) Using lots of lube, not fucking too roughly, stopping if you feel the slightest abrasion on the head of your dick or on your foreskin, and cumming quickly instead of engaging in a marathon fuck session, can all reduce your risk. Relationships confer a false sense of security. Disclosing sexual escapades becomes even harder when emotions are involved. If you do get into a relationship, it's a good idea to have a no-fault disclosure policy. Being told that your boyfriend has been fucking around can break your heart, but it might also save your life.

Having endured a 9-year relationship that compromised my sex life as well as my self-esteem, and being a loving person who seeks a degree of intimacy (eye contact, kissing, touch, conversation) even in one-time encounters, I think I share your dilemma. Virtually all cultural influences suggest that love is "better", that it is a "necessary" element of human happiness, and that there's something "bad" about casual sex. On the other hand, high rates of infidelity (and divorce, heretofore a straight people's concern) reveal that many established relationships don't provide hoped-for levels of emotional or sexual satisfaction. Given the structure of our society, it's definitely true that love increases personal economic stability and confers social status (witness the battle for gay marriage). Since you get bored after single sexual encounters, is there some way to enrich those encounters? I realized, for example, that saying or hearing "I love you" during sex turns me on physically. Now, I make "I love you" an element of role play, in exactly the opposite sense of bb1991's suggested use of role play, I'm ashamed to admit! But maybe it's not role play at all, because bareback sex is an intimate act. On the relationship side, how do you feel about open relationships? Perhaps you could leave sex entirely out of the bargain, and have an emotional/domestic companion while continuing to enjoy sexual encounters all over the world.

MascMountainMan, as hollywoodslut pointed out, there are big problems with the article you linked to. First and foremost, the overall results of the iPrEx study (64 infections among 1,248 placebo users versus 36 HIV infections among 1,251 Truvada users, for a 44% reduction) reflect less-than-perfect adherence. http://www.niaid.nih.gov/news/QA/Pages/iPrExQA.aspx Truvada was highly effective for people who took it regularly. "[A]t least one of the study-drug components was detected in 3 of 34 subjects with HIV infection (9%)..." In other words, almost all of the people who became infected were not taking Truvada! Among participants who had detectable levels of Truvada's components in their blood, there was "a relative reduction in HIV risk of 92%." http://www.nejm.org/doi/full/10.1056/NEJMoa1011205#t=articleResults The authors of the article you linked are flat-out wrong about Truvada's "relatively low efficacy." Other online commentators retracted similar statements when they read the iPrEX results in detail and remembered that no drug works if you don't take it. I can't speak for other people, but I take my medicine religiously, because it could save my life. I wouldn't want my access to this drug to be compromised because other patients do not, or for whatever reason are not able to, comply with the drug regimen. Whether PrEP goes to high-risk patients and whether they take it regularly will determine its actual societal benefit. It's far too early to speculate about who will have access to PrEP, who will choose it, and who will use it regularly. The number of PrEP patients in the U.S. today is probably just in the hundreds. Even though clinical trials are finished, the practical use of Truvada for PrEP in the field is still being studied (see especially the DEMO Project in San Francisco). On the cost side, drug prices decline over time and with greater usage, as do the costs of diagnostic tests (like the rapid HIV test, used in all up-to-date healthcare facilities and particularly important for PrEP patients). The authors of the article have some nerve to complain about the cost of frequent HIV testing ("...does not even include the cost of the necessary monitoring for infection...it was suggested that such monitoring be done monthly to prevent the emergence of resistant virus by detecting infection early"). Getting more men to test more often will, in and of itself, reduce unintentional transmission of HIV. Even when we do know real-world adherence rates, and when the cost of the drug settles at a normal, post-patent level, the concept of dollars per year per infection prevented will remain abstract. If I'm talking about my own life, or the life of someone I care about, any price is worth it.

One way to think of it is that Truvada for PrEP is a 2-drug regimen and that you'd be on it by choice. If you became positive, on the other hand, you'd be prescribed a 3-drug regimen (at least), and you wouldn't be on it by choice. As TigerMilner said, why not try PrEP, assuming that you have access to medical insurance, to an assistance program from the manufacturer, or to one of the studies currently underway?

This has all you need to know about individual (not employer/group) health insurance in California going forward: http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf Through December 31, 2013, U.S. health insurers still do have the right to deny individual coverage on the basis of a medical review. After that, new Obamacare plans take effect; there is no medical review and no pre-existing condition exclusion. "Covered California" is the name of the health insurance exchange through which those plans will be sold in California. U.S. employer/group plans do not feature a medical review but may, for the time being, exclude pre-existing conditions. If you need coverage for the rest of 2013, it would be worth checking whether either of the schools where you teach has a medical plan that you could join. Some employers do provide coverage, with varying degrees of cost-sharing, to casual and part-time employees. You could also check with a professional "guild"; these organizations sometimes sponsor group health insurance plans. Finally, it doesn't hurt to check whether you qualify you for Medi-Cal, whether under today's income limit or the more generous one that will take effect in 2014 as part of California's participation in Obamacare. Regarding medical reviews and pre-existing condition exclusions in the pre-2014 landscape, it is very important to read the fine print. Although the Obamacare legislation has limited health insurance rescission for several years now, an insurer can still rescind coverage if a person intentionally misrepresented a material fact when applying. Seeking diagnosis of a medical condition (in other words, getting tested) can trigger a pre-existing condition exclusion. It would be entirely possible for an insurer to request that you release test results from the county health department -- or certify that no such results exist -- as part of a review. As you know, HIV is reportable in California. Testing in an "anonymous" rather than "confidential" center is advisable. The OraQuick rapid home test is also licensed for sale in any pharmacy. Paying cash at an old-fashioned pharmacy without closed-circuit TV would absolutely prevent tracing.

I'm curious what country you're in and where you read that. There is no legal basis for that in the US, since Truvada for PrEP gained FDA approval last October. Only plans with drug formularies and plans with some sort of categorical exclusion can refuse to cover Truvada for PrEP when a patient meets the prescribing criteria. An insurer can revise a medical plan to add an exclusion, but these are usually annual, calendar-year contracts, so a change in June is unlikely. Various people have posted on the forums that their plans are covering Truvada for PrEP.

I understand the stable relationship sentiment -- shared health interests and relatively more sex with a known person might be risk reduction strategies -- but I agree that it's tenuous. An HIV prevention psychologist whom I dated years ago loved to joke that breaking up gay relationships would be a great preventive. He felt boyfriends were likely to bareback with each other, unlikely to know about each other's outside pursuits. (Just to show that we're all human: He let me start fucking him bare early in our relationship, and cumming inside soon after, and he mentioned swallowing twelve loads in one night at a sex club! How could I not want to date a guy like that?) Setting aside the possibility that people who tell each other they're monogamous may not be, I find it disturbing that monogamy is often considered moral, and that any idea of morality might be a factor in access to medical care. The same can be said of a negative man's insisting on condom use, which lots of people outside (and inside) the gay community elevate to the level of a moral choice. In deciding eligibilty for PrEP, actual sexual behavior, not expected behavior, is what matters.

For now, Truvada is the only FDA-approved drug for PrEP, so if a US doctor ordered Isentress to protect an HIV-negative patient, that would be an off-label use, and also much less likely to be covered by insurance. The references I've found say that Isentress, used alone, showed promise in a very small sample of convenience of women, and in a small-scale animal study. I didn't see any randomized, double-blind trials like the ones conducted with Truvada, but a doctor or medical researcher would of course have access to better search tools. Interestingly, Isentress has a shorter half-life than Truvada, so it was given twice a day instead of once a day. Greetings to you in Pittsburgh, by the way! I spent several years there and loved the town and the people. Your avatar makes me want to go back. ;-) Bearbandit, while the US was ahead in terms of decriminalization of homosexuality (except for 13 holdout states, whose loosely-enforced prohibitions were finally struck down by the federal Supreme Court in 2003), our sex education programs are worse than what you describe in the UK. Some states and localities teach abstinence, and deliberately avoid mentioning practical ways to avoid pregnancy or sexually-transmitted diseases. Some of those states teach creationism, to give you an idea of the lack of scientific awareness. Everywhere in the country, parents have an absolute right to excuse their children from sex education. Have you seen the new documentary about Turing, who was a victim of England's law against homosexuality? Maybe we should all move to the Continent for good medical care and up-to-date sexual mores!

Bearbandit, wow, I'm surprised that early HIV treatment isn't accepted by the public in the UK, especially in light of the World Health Organization guidelines and the yet broader International Antiviral Society ones. Immediate treatment is the standard of care in the public health system in San Francisco. Paradoxically for the U.S., this means that people who cannot afford private health insurance but who do qualify for a local or state/federal program may have more options than people with the most restrictive private insurance plans. (Neighboring counties have less well-developed public health offerings, especially for sexual health, so the standard of care differs. There would of course be marked differences in other urban areas and other states, too.) It really upsets me when public acceptance -- usually serious bias, under the guise of moral righteousness -- limits access to effective medical treatment.

Bearbandit, no pity intended, just an acknowledgement on a person-to-person level. I hadn't noticed that you were in the UK. Forgive my US-centric position. I'm curious how the drug approval system works in the UK, and whether Truvada for PrEP would be an officially-recognized use or an "off-label" use. Either way, there is definitely a need to specify a standard of care: initial and ongoing tests, patient education for adherence, etc. I looked up my geographic neighbor Canada last night, and found that PrEP is not yet an approved use of Truvada there. Doctors who prescribe a drug for an off-label use have a pretty strong professional obligation to do their homework. Here are the special instructions for PrEP in the US: http://www.truvadapreprems.com/