Great Article on PrEP in OUT.

[wood]

Its pretty good, and says almost exactly what my thoughts are on PrEP, its fairly similar in concept to female birth control.

Like the article says at this point i would really like to see if PrEP could be developed to be a once every two day/once a week, or once a month or longer medication. I think at that point we would see widespread usage of it, and IMO a sharp decline in new HIV infections.

http://www.out.com/news-opinion/2013/09/09/hiv-prevention-new-condom-truvada-pill-prep?page=0,0

[bearbandit]

Damn good article - my only quibble being that they play down the side effect possibilities (no, I'm not going to launch into another "how tenofovir nearly killed me" rant). They do stress the need for consistent adherence to the regime - I manage this with my antivirals by tying my antivirals to the diabetes medication: if I miss my gliclazide I feel like crap. For other people the event thy tie their PrEP might be the ten o'clock news, the dog's evening walk, whatever. The important thing is to take it regularly, and to be aware that most of tenofovir's problems surface after about three year's of use.

And I'm sorry, Slut, if a medication gets down to once a week us poz guys get first dibs ;-)

[Guest GoodExercise]

If PrEP is the new condom, I don't like condoms.

[wood]

If PrEP is the new condom, I don't like condoms.

yeahh okay... so you are saying you dont like PrEP, if so why?

[wood]

Damn good article - my only quibble being that they play down the side effect possibilities (no, I'm not going to launch into another "how tenofovir nearly killed me" rant). They do stress the need for consistent adherence to the regime - I manage this with my antivirals by tying my antivirals to the diabetes medication: if I miss my gliclazide I feel like crap. For other people the event thy tie their PrEP might be the ten o'clock news, the dog's evening walk, whatever. The important thing is to take it regularly, and to be aware that most of tenofovir's problems surface after about three year's of use.

And I'm sorry, Slut, if a medication gets down to once a week us poz guys get first dibs ;-)

I'm with you 100% on how much they need to stress adherence. As I posted in my other thread I take mine religeously because i want the full protection if i am going to take it. But Yes, I would really like to see something where both HIV poz patients and patients on PrEP, could take their regime every other day at least, I theory I think is fairly doable with current technology, IE slow dissolving coatings, etc. The idea of once a week is a bit more far fetched because PrEP works on the basis of having a consistent level in the bloodstream.

I think time will tell on the side effects of PrEP, but I am wondering if some of the side effects of the truvada/tenofovir in the original studies, (and your situtation) were exacerbated by other medication being taken and by being positive. I know its too early to tell what the effects might be in people that are negative, but that will be interesting to see.

I'll always admit when I've changed my mind and I have on PrEP. Providing special attention is paid after a few years (by which time hopefully there'll be something be better) to the possibility of kidney damage and osteopenia, I'm in favour. What's swung it for me is the number of kids, sorry "young adults" on Grindr etc with a Daddy fixation and their abominable level of HIV knowledge. The broken off conversations don't bother me ("aids is nasty" <block>), I've got thicker skin that that: what does worry me is that these young men are going out and getting fucked with knowledge that approximates ours in 1982.

PrEP is coming up for approval in the UK soon, I believe, if it hasn't already. Certainly we've now got PEP. I just look forward to less toxic drugs being used.

You quoted this in the thread I wrote about my personal PrEP experience, and i quoted it here too, because really fit the article and how I feel about PrEP. There are A LOT of young gay men out there who simply don't care about HIV. They don't want it, but they also dont take the steps to avoid it. In the past year I have had hookups with roughly 5 younger guys. I'm 31, they ranged from 20-24. Not ONE asked for a condom, and not only that every single one lubed up my dick and stuck it in them unprotected. Mind you, I also didn't meet ANY of these guys off sites like BBRT.

New HIV infections are overall stagnant, and increasing as the article states at 22% among young people. That needs to stop NOW. I feel like its almost a disservice to people like you bearbandit, when people disregard HIV/AIDS so much when gay people essentially lost a majority of a generation. There needs to be a frank discussion among gay men about staying sexually healthy, and IMO PrEP NEEDS to be a part of that. The "always use a condom" message is obviously not working, so its time to move forward with a new strategy.

[bearbandit]

My "sex" article in www.beyondpositive.org stressed the fact that today's safer sex advice comes from an emergency panphlet written thirty years ago. What I didn't mention was that it wouldn't even be publishable today because of its language (sufferers, victims et al).

Every other day medication is probably not a good idea in adherence, especially in poz guys: even when I'm feeling pretty well (got told yesterday that my viral load was zero - that's the number, not under some artificial marker where it's deemed undetectable) I have to check what day it is. Easier and better for adherence in the long run to keep medication daily. Weekly is another matter.

I'm fully aware I've got a fucked about system with all the prescription drugs I've been through, but the fact remains that what I went through last year is listed on the cautions of the patient information leaflet: it's just incredibly rare. I'm just the proof that it can happen. Even the health worker at the charity I volunteer for refers to me as a "drug whore".

In the UK we had last year the highest number of new diagnoses since records began. SF blamed the bathhouses, the UK government would like to blame, but can't, the recently repealed laws on public sex, the prissy sex-phobic gay community blame bbrts, Grindr et al. I blame insufficient education. I don't see this rise as a disservice to or disrespect of me: I see it as a failure of the people who should be educating kids about sex and life. I'm quite happy to go into schools and scare the crap out of schoolkids about what can happen - I'm doing it soon for local social services workers and for London Lesbian and Gay Switchboard (big joke: it's nearly 200 miles to London and they couldn't find anyone closer prepared to say that they bb'ed!)

[Guest JizzDumpWI]

I was just reading that article and thinking of posting in this thread and voila, here 'tis. Nice.

GoodExercise; Um yeah, well PrEP isn't a condom at all... PrEP is 2/3 of the most common HIV cocktail. The beauty of PrEP, I think, is that all of the claims about how great it is to be pozzed are achieved on PrEP. No need to be concerned about the status of your bare partner; just have sex and enjoy the way nature intended. So to make a glib statement "PrEP is the new condom, and I don't like condoms" demonstrates incredible ignorance.

PrEP is a game changer. The resignation of many to put on the "chaser" coat because they are committed to raw sex, and thus conclude that it is really just a matter of time no longer is true. We do have a choice.

bearbandit (and my ID doc, and the article) are correct; the way for PrEP to work is a regular daily schedule. Skip it and the 99+% effectiveness drops. Just like with HIV poz guys and STI's - and STI can lessen the effectiveness of PrEP; so important to stay on top of those. There are many who glibly prattle on about going after STI's. One of my buddies went blind from undetected Syph. Maybe I'm nuts, but I fail to see how that is HOT and something to go after.

BTW, if you look at bearbandit's signature you'll see a reference to the UK group "Band Of Bears". If you haven't taken a listen, do so; a talented group.

[Guest GoodExercise]

Take Truvada now so that you don't have to take Truvada later. Gilead is brilliant and the PrEPsters are idiots.

[bearbandit]

Prevention is better than cure. Once HIV has had a go at your internals truvada is less effective and you're more likely to have the sort of drug reaction I had last year. PrEP is by no means perfect; it needs a lot more work, and in my opinion, different drugs, but if you want ti raw and don't want to chase the bug, it's the only option available as yet.

I have two pleas to people using PrEP: (1) take it properly as prescribed to protect yourselves and the rest of us should you be unlucky, and (2) keep up with the blood work: the side effects of tenofovir can get extremely nasty in less than three months. Read my posts from July 2012 to find out how.

[Guest GoodExercise]

The same guys that think that they can have bareback sex without risk will also never adhere to Truvada nor go for bloodwork. They are entitled to have all the fun that they want and to pop a pill when and as they see fit -- and lab needles are not going in their arms.

[Guest JizzDumpWI]

Who here is making claims of "no risk"? Not even condoms have that outcome... Your bold claim is false GoodExercise. I am on PrEP, adhere to the schedule, do the blood work. Does this imply I am taking "no risk"? Can you grasp what risk reduction is?

To your point about being on meds anyway.... True, on 2/3 of Atrypla. But if I stop I won't have HIV going to work ravaging my immune system. Since I have tested every 3 months anyway that hasn't changed for me... But for some yes, that is a change.

[bearbandit]

I'm afraid as optimistic as PrEP makes me feel as a stage one prophylaxis (and yes, I'm aware that this is a change of heart), I'm afraid you're probably right. I've heard of a guy in London who's breeding bottoms and giving them a single truvada capsule in case they change their minds. It might be urban legend, but PEP needs a full month's worth of truvada to approach being effective.

Some guys just don't get that it's not their own lives their playing with, it's other people's

[Guest JizzDumpWI]

Very true bearbandit... Many will not take the time to understand the why/what of PrEP. And perhaps that is natural selection at work... I can sure understand the attraction to a "one and done" after sex pill. And in a few years that may happen. But for now this seems to be a terrific risk reduction strategy for us confirmed barebackers.

To the point of other's lives. While indeed my being on Truvada means I won't be pozzing any unsuspecting guys: the real reason for me is to protect me. Very much like birth control pills reduce pregnancies.

Edited September 18, 2013 by JizzDumpWI

[bearbandit]

We must have been writing at the same time - I'm just slower at typing, Jizz. Complete agreement.