45 loads in 7 days - is PrEP even a factor?

[wood]

That's true, but I've tried to use conservative numbers. For instance, I think it's unlikely that the risk reduction from a partner with undetectable viral load is more than a tenfold decrease.

The really big variable here is how susceptible your body is to infection. But it seems reasonable to me that whether you happen to be really good at fighting off HIV or drew the short end of the stick in that department genetically, the rate of risk reduction would be more-or-less the same across the board.

If you want to get technical, you can look in these studies for 95% confidence intervals to get some sense of how reliable the numbers probably are.

There is one thing I'd caution here, and that is the power of wishful thinking. If we want something to be true, we tend to discount evidence to the contrary and play up evidence that supports our position. As this is a barebacking site, I'd suggest that our own bias would be towards downplaying the risks that go along with that.

If you are serious about wanting to avoid HIV, for instance, then it makes sense to choose a number towards the top end of the range of estimated risks, as I have here. That gives you a good idea of an upper bound to the risk that you are engaging in. If it turns out to be lower, then great! But it's not wise to assume it's going to be lower. That represents wishful thinking.

I agree with the second part you are saying here, but as rawTOP was saying about the first part, garbage in garbage out. I fully understand trying to figure out a way to quantify risk, but its really not that easy. Statistics can be manipulated in anyway you like, and im sure you know that. One way you did was taking the 3% transmission risk for receptive sex, and working down from there. HIV is VERY different to each person. One person may get infected during their first unprotected sexual encounter even without ejaculation with a midly virulent partner, and another person and go for years taking loads from guys with high viral loads. PrEP throws another variable into the loop because we really only have one study on it so far. What we do know is that if taken properly it is very effective. We also know that in the study many did not take it effectively and many of the statistics in the final report were based on that.

That being said Im not trying to be naive about PrEP, and pretending its perfect, but I think it represents a step in the right direction.

[daddybreed]

this is a really interesting conversation - and a great discussion. It makes me wonder about the opposite end of the equation: HIV neg tops who fuck raw. The past month I've been horned out of my mind and fucking ass like crazy! Two weeks ago I went to CumUnion SF and fucked three different guys, all with multiple loads in their ass (one guy had 7 loads when I fucked him and blew my load in him; another guy had 11 loads when I bred him; not sure how many loads the 3rd guy had but saw him take a few while I was there). Came home and within 24 hours fucked 3 other guys raw, two were poz. Got me wondering what the likelihood of seroconverting from topping is.

[Pighole88]

Vrsguy, can't help but wonder if you fucked me there... I had 7 loads in me at one point...

[daddybreed]

I might have pighole88 - but I'd have to see a pic of you to know for sure ;-)

[Pighole88]

An update - I haven't been feeling super hot lately. Spent the weekend in bed last weekend with flu-like symptoms but no fever. I have an appointment with City Clinic in SF on Friday (I have to go for a PrEP screening anyway) and will be interested to see the results.

[wood]

An update - I haven't been feeling super hot lately. Spent the weekend in bed last weekend with flu-like symptoms but no fever. I have an appointment with City Clinic in SF on Friday (I have to go for a PrEP screening anyway) and will be interested to see the results.

That could really be anything, from food, to a cold. Flu-like symptoms encompass about every disease and sickness out there, lol.

[Guest JizzDumpWI]

I've been on PrEP for about 8 months now, and have taken it diligently every day. I would occasionally bareback, usually with friends, and any poz tops were always undetectable (so they said).

That said, in the last week I took 45 anonymous loads - a decision I'm not regretting because it's something I've always wanted to do. However, other risks aside (HSV, Hep C, Syph), What are your opinions on how much I can rely on PrEP at this point?

I was told that it was up to 98% effective in preventing transmission of HIV. UP TO 98%, which means there's a chance that it could be lower.

Has anyone else been on PrEP and still converted?

So that was middish August pighole88. Outcome?

My guess is there were no ill effects. PrEP is ignorant of load count. The effect should be boolean. Whether you have one load or a thousand... Understand that as long as you're dosing compliant; what will trip you up will be STI's. If none of those showed up, I would expect PrEP has remained effective.

Edited September 27, 2013 by JizzDumpWI

[ryanroman]

Thank you guys for starting this conversation. I've been thinking about going on PrEP myself. I'm 98% top and 2% bttm (every top bttms on a rare occasion). I bareback exclusively when topping (haven't used a condom in over 10 yrs). I go for HIV tests every 3 months (next one will be around Halloween) and am HIV- as of 7/30/2013. I'm no angel - I love to breed bttms. I've fucked a lot of POZ bttms over the yrs. I've been thinking about PrEP as a form of protection. I'd like to hear what you guys think.

[rawtuscany]

im exactly like .. no one swallom in my hole since 2008 ...

will be interesting to know how i spossible tyo have a shield..??

[wood]

Thank you guys for starting this conversation. I've been thinking about going on PrEP myself. I'm 98% top and 2% bttm (every top bttms on a rare occasion). I bareback exclusively when topping (haven't used a condom in over 10 yrs). I go for HIV tests every 3 months (next one will be around Halloween) and am HIV- as of 7/30/2013. I'm no angel - I love to breed bttms. I've fucked a lot of POZ bttms over the yrs. I've been thinking about PrEP as a form of protection. I'd like to hear what you guys think.

I would go on it ASAP.

My simple logic is that I would rather take something to prevent a problem than to treat a problem. HIV is a bitch, despite what some say in here, and if I can drastically decrease my odds of infection, then Im going to do so.

[wood]

Well obviously even with PrEP, you have an increased risk, but yeah the advantage of PrEP is that you still get a significant amount of protection from it even with exposure. Now obviously that is a lot of potential exposure, but if some of the guys were already on medication, that further lowers your risk. I doubt many were neg, but obviously there is no risk from them.

Lets look at it this way, your risk of contracting HIV from an infected source during receptive anal sex is .03-3% chance. Considering some were neg, some were undetectable, and you were on PrEP which significantly reduces your risk, Id venture that during your entire week long session you have about a 1-2% chance of converting, although I would more than likely bet you have some other STD now. That being said if you want to stay neg make sure you keep taking your meds at exactly the same time daily.

After reading about PrEP more, I have to say I somewhat disagree with what I wrote here before. IMO the risk is probably less, on the magnitude of less than .5%. The iPrEX study was quite broad and also included injection drug users some of which would have direct blood contact with HIV. Still no one in the study who always had the proper medication levels in their bloodstream converted during the test.

As long as you continued taking the medication consistently before and after the event, I would bet your are fine. that being said, I am also quite confident you probably picked up some other STI.

As I have stated before, PrEP is NOT a magic bullet. It is however remarkably effective against transmission, when taken properly.

I am no epidemiologist or virologist, but as a sheer guess the only way I could see infection taking place is if someone in the group is very drug resistant to the drugs in Truvada. I could see theoretically how that could result in transmission, however I have no idea if thats true or not.

[bluphnx]

Maybe I'd have enjoyed word problems in school more if they were more along the lines of "If half the football team fucks MascMountainMan in the shower after the game, and half the rest cum in his mouth, then how many loads did he take?"

LOL omg. Love it. Me too. Would have taken loads from 80% of my school's football team. And 100% of the soccer team.

[Pighole88]

Still neg, and still taking loads, so all is good in the hood.

My study concludes on April 1st and I will no longer have access to free PrEP. Talked to my doctor who wrote me a prescription but a 30 day supply will cost me $1000 dollars. Presumably because my insurance company thinks I'm neg. need to do more research but might need to start weighing my options here soon, as I certainly can't afford $1000 a month.

[daddybreed]

hey pighole88, I'm in the same boat - I tried to get PrEP from one clinic I go to for testing but they say they can't prescribe it (something about a mandate from the government funding they receive or CDC rules or some other bullshit). They are a really good, sex positive clinic so I was a bit surprised. I'm a lot like RyanWolf: I top 98% of the time and fuck a lot of poz bottoms and get fucked very rarely (I got fucked 4 times in 2014: 2 times raw & took loads, 2 times safe). I'd like to go on prep but like you, I can't afford $1000 a month for the rest of my life.

[rawTOP]

My study concludes on April 1st and I will no longer have access to free PrEP. Talked to my doctor who wrote me a prescription but a 30 day supply will cost me $1000 dollars. Presumably because my insurance company thinks I'm neg. need to do more research but might need to start weighing my options here soon, as I certainly can't afford $1000 a month.

Gilead will cover $200/month. $1000/month means the insurance company isn't paying for any of it. I'm a little surprised by that. Most insurance companies will cover it since they can't tell the difference between Truvada for a poz guy and Truvada as PrEP for a neg guy. Could the $1000 be a deductible that ends after the first month and then you have coverage?