Poz Guy Against PrEP = A Guy Against Abortion? None of their business?

[VersatileBreeder]

But first, neg guys have to be comfortable enough to initiate the discussion about PrEP with a doctor. Then there's the issue of medical professionals who may - because of their own beliefs about unsafe sex - not be supporters of PrEP who in turn use their position of authority to dissuade people. Let's face it, many people place a lot of weight on what doctors say. If your doctor says, no you are still at risk for contracting HIV, will you continue to shop for a doctor that tells you what you want to hear?

bbzh, you make a great point here. I knew about PrEP for probably a good year before I became poz. I had considered looking into it many times, but what detracted me from doing so was dreading having "the talk" with my doctor about it. I was certain that he would push condoms on me instead of just prescribing me the PrEP, which is why I put off pursuing it. It does take a lot of courage to have that discussion with the doctor.

Let's just say that I DID have that conversation with my doctor a year ago (when I was neg). Let's say that, as suspected, he DID dismiss my wishes to pursue PrEP as a tool for HIV prevention, but rather pushed condoms at me. Would I have followed his advice? Would most guys in my shoes have followed his advice? FUCK NO. We are barebackers. It's what we are and it's what we do. If I had a dollar for every time a doctor, nurse practitioner, clinician, etc, offered me condoms and tried to push them on me as a way to protect myself, I would have my own private jet right now with 24 hour standby. It never worked for me, and it is never going to work for guys who bareback. PrEP is the answer.

This may sound a bit far-fetched, but I think a great way to get guys to have a comfort level to have this discussion with their doctor would be to have an online directory of doctors that are pro-PrEP. The directory can include the name/address/phone number of their practice and clinic. Then again, I might be dreaming, but if such a thing did exist, I am sure that would be the number one spot guys would go to look for a local doctor that would support them in their decision to go on PrEP.

[GermanFucker]

See, I would disagree. Maybe it's because in undergrad and grad school I had some pretty strident feminists teach me that men really should have no voice in the discussion of abortion - it's not their bodies, hence it's none of their business. So right to you're opinion? Sure. But right to express it - not so much. I think they should stay out of the discussion.

Now I'd have to disagree. I don't think either question should always be discussed as an absolute. While in general men can't say much about what it feels like to be pregnant, if some some woman wants to have a 36th week abortion I don't really see much difference to smothering a newborn with a pillow. In a civilized society one should be able to discuss that wider moral question - in a respectful way - without having to own a uterus. IMHO there are valid ASPECTS (like scientific questions regarding in-utero development) that form an exception to the rule "not your body, none of your business".

As to PrEP: I do believe poz guys can contribute when it comes to the reality of living with meds. Again, that's a specific aspect, that should be open to dialogue as long as that happens in a respectful way. That means respecting the reality that in the end it's the neg guy's decision what he is doing with his body. Especially as no there is little potential for harming other persons.

So right to comment on certain aspects as part of an ongoing discourse? Sure. Right to influence what is someone's personal decision? No.

[rawTOP]

Let's just say that I DID have that conversation with my doctor a year ago (when I was neg). Let's say that, as suspected, he DID dismiss my wishes to pursue PrEP as a tool for HIV prevention, but rather pushed condoms at me. Would I have followed his advice? Would most guys in my shoes have followed his advice? FUCK NO. We are barebackers. It's what we are and it's what we do. If I had a dollar for every time a doctor, nurse practitioner, clinician, etc, offered me condoms and tried to push them on me as a way to protect myself, I would have my own private jet right now with 24 hour standby. It never worked for me, and it is never going to work for guys who bareback. PrEP is the answer.

I think you have grounds for a malpractice suit. Nothing motivates doctors to do the right thing more than the fear of a lawsuit. If doctors start hearing that they can be sued over it, they won't say no when guys ask to go on PrEP.

[rawTOP]

Now I'd have to disagree. I don't think either question should always be discussed as an absolute. While in general men can't say much about what it feels like to be pregnant, if some some woman wants to have a 36th week abortion I don't really see much difference to smothering a newborn with a pillow. In a civilized society one should be able to discuss that wider moral question - in a respectful way - without having to own a uterus. IMHO there are valid ASPECTS (like scientific questions regarding in-utero development) that form an exception to the rule "not your body, none of your business".

Are you saying that women need men's point of view to come to the right conclusion? That they can't figure out the moral issues on their own? What exactly will men contribute to the conversation that women can't figure out on their own? How is it any of men's business? It's not their bodies.

As to PrEP: I do believe poz guys can contribute when it comes to the reality of living with meds. Again, that's a specific aspect, that should be open to dialogue as long as that happens in a respectful way. That means respecting the reality that in the end it's the neg guy's decision what he is doing with his body. Especially as no there is little potential for harming other persons.

I disagree. Neg guys have a very different relationship to ARVs than poz guys. We can can skip does, etc. The poz perspective can color the discussions in ways that are unhelpful. That said there are times when the poz perspective can be useful (when the neg guy gets to the point of having side effects) or when they're the only people around who have any experience with ARVs (e.g. "don't worry - I take multiple pills and it's no big deal for me"), but I think the poz guy has to keep reminding themselves that there's a decent chance the neg guy is having a different experience with the meds - and that's not an easy thing to keep in mind.

[bearbandit]

When PrEP was first available, I was extremely doubtful about it, having just nearly died from kidney damage caused by one of truvada's ingredients - I was still in hospital when PrEP became available. But it appears that neg guys and poz guys appear to process the two drugs differently, with the neg guys handling the two drugs better than us. PrEP offers us a proof of concept and if we can get so close to right at the first attempt who's to say that what comes next won't be better and cheaper? I think the poz guy's role in PrEP is to support the decision to take it and also, if he's taken truvada himself and notices side effects happening (and they can be insidious) to act as an alarm bell. But then I took truvada for seven years without apparent problems. If you start thinking things aren't quite right, who're you going to talk to in the wait for you doctor's appointment? Me, I'd be asking someone else who's taken the same drug...

Frankly I'd rather fuck with someone on PrEP than someone who tested "negative a few months ago" because the few months ago can turn out to be a lot longer time ago and the protocols for dispensing PrEP demand an STI workup. Guys on PrEP have to take better care of their sexual health if they want to stay on PrEP. I'd warn against skipping doses, though: it's possible to skip the wrong one and end up with an unwanted passenger. I take something like 25 to 30 pills a day and medication fatigue is an easy trap to fall into. Easier, I'd imagine, for someone taking something prophylactically than for someone taking meds as treatment.

[fskn]

That means respecting the reality that in the end it's the neg guy's decision what he is doing with his body. Especially as no there is little potential for harming other persons.

With respect to this comment and to a similar comment from another poster, a person's choice to use PrEP benefits others. It is a choice that is both self-regarding and other-regarding.

In an epidemiological context, an action that reduces disease transmission and accelerates disease detection benefits the entire susceptible population. High vaccination rates, for example, reduce exposure even for people who refuse to be vaccinated. (And conversely, each refusal increases risk for others.)

PrEP is effective at preventing HIV transmission, and there's no need to go back over the study evidence here or to split hairs about effectiveness rates in the upper nineties.

What no one mentions in the public debate is the FDA prescribing guidelines. The FDA tells doctors to order quarterly HIV and STD tests when prescribing PrEP. Some health providers, like Kaiser -- one of the USA's largest -- require monthly tests. More people getting more tests means that HIV and other STDs will be caught sooner, treated, and not transmitted further. Remember that we are talking about diseases whose early symptoms are ambiguous and often not evident at all.

It is very easy to sway individuals against trying PrEP, and it would be easy to sway public opinion against insurance coverage, further research, continued FDA approval, or continued CDC or WHO recommendation. Remember that the USA still forbids use of federal government money for abortion, still forbids use of foreign aid money for contraception, twice delayed the availability of the morning after pill, etc., etc.

Efforts to spread fear and doubt about PrEP, masked as voicing "opinions", are unethical. We can't stop them, but we need to respond with medical science each time.

Another poster mentioned that the idea of taking medication for prevention was foreign to him. Some of the most popular drugs, such as cholesterol, blood pressure and insulin regulators, are prescribed to prevent diseases such as heart disease, high blood pressure, and adult diabetes (and also to lessen the symptoms, if a person has been diagnosed). I don't understand how taking an FDA-approved (i.e., clinically proven safe and effective) drug is different from doing any other kind of preventive action, such as exercising or dieting.

[bbzh]

Another poster mentioned that the idea of taking medication for prevention was foreign to him. Some of the most popular drugs, such as cholesterol, blood pressure and insulin regulators, are prescribed to prevent diseases such as heart disease, high blood pressure, and adult diabetes (and also to lessen the symptoms, if a person has been diagnosed). I don't understand how taking an FDA-approved (i.e., clinically proven safe and effective) drug is different from doing any other kind of preventive action, such as exercising or dieting.

Exercising or dieting: 1) don't cost as much as PrEP and 2) don't require me to present myself for monthly screening just to get the drug. The challenge is adjusting to the idea of taking medication - which may have side effects - when you don't have a chronic condition and don't consider yourself "sick". The amount of testing being done just to continue getting PrEP is going to turn a lot of people away. Why? Because being screened for STIs does have a shaming aspect to it. "Hi Mr Smith, your results are back. You've got syphilis. You'll need a series of shots to clear that up. And here's your PrEP prescription. See you next month. Whore." Mr. Smith is going to have to be a pretty special character to withstand that kind of "pressure" on a monthly basis.

I'm about as piggy as they come and I rarely catch anything. But still, during my visits to my HIV doctor every 6 months by the way, I get asked if I have had unprotected sex with anyone besides my bf. I usually fib and say "no" because I know I am being screened for everything anyway. One time I answered "yes" and the nurse was clearly disgusted. I thought hmm, I'll just lie next time.

As I said in an earlier post, PrEP is going to take a beating in the court of public opinion because basically the gay community's sexual habits are going to undoubtedly become part of the debate. As long as HIV transmission rates remain under control for heterosexuals - i.e. the majority - PrEP is going to be a tough sell. The majority seldom wants to support or pay for something that benefits the minority. And unfortunately, those of us who live in democratic societies can't ask for an opt-out clause because we can't get majority support for something.

[wood]

I have a natural aversion to popping pills. I prefer to take them only when something is wrong with me with the hope that I can eventually stop taking the pill. I take HIV meds because I have a chronic condition that I need to control. Medication as a prevention tool - which is what PrEP is - is a foreign concept to me. Let's say a drug was found to be effective against prostate cancer. Would I seek it out and take it proactively even though as an African-American male I am at a higher risk for prostate cancer? I don't know. Maybe I should.

But first, neg guys have to be comfortable enough to initiate the discussion about PrEP with a doctor. Then there's the issue of medical professionals who may - because of their own beliefs about unsafe sex - not be supporters of PrEP who in turn use their position of authority to dissuade people. Let's face it, many people place a lot of weight on what doctors say. If your doctor says, no you are still at risk for contracting HIV, will you continue to shop for a doctor that tells you what you want to hear?

Now there are people who will always believe science over people. But anybody who has some knowledge about statistics and the darker side of academia knows how very easily statistics can be manipulated to support a particular point of view. It's really hard to know who to believe sometimes. I remember clearly one of my professors at Harvard telling us to be wary of academics who craft their message FIRST and then float the numbers that support their claims.

Not to be too blunt, but dont you see the irony in having an aversion to popping pills, yet needing too everyday? I could stop taking PrEP today, stop some behaviors, jerk off more, etc, PrEP gives me that option. After you have HIV its really not an option. The prostate cancer analogy is somewhat true, but there are tons of small things a man can do to help avoid prostate cancer. Hell getting off more has been shown to help that. With HIV, and gay men the options are really limited, its no sex, condom sex, or PrEP, thats it.

With doctors some people are not nearly blunt enough, and people forget that the patient is a customer, they have the right to get the service they request, albeit within reason. PrEP is CDC and WHO approved and sanctioned in the US, there is no reason a properly educated patient shouldn't be able to get it from their doctor.

I am fully well aware of how statistics can be manipulated, but the concept of PrEP is simple, and has been shown to work for other infectious diseases. Are you an American going to Asia, or some other tropical place? you will probably go on preexposure prophylaxis for it on some antibiotic. With that said the science behind PrEP is sound, and is backed up with multiple studies, and there were not statistics released before the studies began. But really if you want to look at the flaws in Science its almost always people. Science doesnt give a shit, people are the ones who manipulate messages. Look at Michael Weinstein and the AHF, Without ANY scientific proof, he crafted a message that said PrEP wont work, and it will increase HIV infections. Sorry, but no I will go back to the science instead of him.

[wood]

I disagree. Neg guys have a very different relationship to ARVs than poz guys. We can can skip does, etc. The poz perspective can color the discussions in ways that are unhelpful. That said there are times when the poz perspective can be useful (when the neg guy gets to the point of having side effects) or when they're the only people around who have any experience with ARVs (e.g. "don't worry - I take multiple pills and it's no big deal for me"), but I think the poz guy has to keep reminding themselves that there's a decent chance the neg guy is having a different experience with the meds - and that's not an easy thing to keep in mind.

This cant be stressed enough. Its important to remember than for HIV+ people on truvada, or any medication containing its components, they WILL also be taking other medication that may further stress the body. Atripla is a prime example, Its 2/3 Tenofovir/Emtricitabine, just what Truvada is, but it also contains Efavirenz, Which is well known for its side effects.

With HIV- people on it for PrEP, it could be the opposite. I'm a good example. Its the only medication I take regularly. Studies are also starting to show that HIV- people on PrEP are experiencing a significantly lower amount of side effects compared to HIV+ people taking the same medication.

[wood]

I'm about as piggy as they come and I rarely catch anything. But still, during my visits to my HIV doctor every 6 months by the way, I get asked if I have had unprotected sex with anyone besides my bf. I usually fib and say "no" because I know I am being screened for everything anyway. One time I answered "yes" and the nurse was clearly disgusted. I thought hmm, I'll just lie next time.

As I said in an earlier post, PrEP is going to take a beating in the court of public opinion because basically the gay community's sexual habits are going to undoubtedly become part of the debate. As long as HIV transmission rates remain under control for heterosexuals - i.e. the majority - PrEP is going to be a tough sell. The majority seldom wants to support or pay for something that benefits the minority. And unfortunately, those of us who live in democratic societies can't ask for an opt-out clause because we can't get majority support for something.

I say this all the time on here, its idiotic to lie to your doctors. If you don't like their response, go somewhere else. Doctors can't treat people correctly if they are lying. Think about the early days of aids, and if you went to the doctor and said "No, I'm only having sex with my man" They may not inform you of other potential risks, or downplay them. About 6 months ago I went to a walk in clinic to get tested for other STI's, and it happened to be at a bathhouse. When asked if I had symptoms I didnt lie, and I said no. I also said that I had been to the bathhouse alot recently, and dont use condoms all the time, and that its probably a good idea. They agreed.

Lastly I could give two fucks about the court of public opinion. If it reduces HIV infection rates, and protects me, I am all for it. Also people already assume gay men are sluts so really I don't think PrEP will have any effect on public opinion.

[bbzh]

wood: I sent you a private message as I think your comments are taking the thread off topic.

[GermanFucker]

Are you saying that women need men's point of view to come to the right conclusion? That they can't figure out the moral issues on their own? What exactly will men contribute to the conversation that women can't figure out on their own? How is it any of men's business? It's not their bodies.

I'm saying that we have to separate two different kinds of discussion: the academic and societal discourse on the one hand from everyday personal decisions on the other. It is certainly not my business if a 15-year-old girl finds out she's three weeks pregnant and decides to have an abortion. However, I believe that when discussing legal and societal questions like whether one should allow on-demand abortions two weeks before delivery (yeah, a somewhat unrealistic scenario, I couldn't come up with a better one) one should follow the best scientific knowlegde. That doesn't mean MEN know better. It just means that there are certain aspects to a question where gender becomes irrelevant.

Just like I can imagine certain aspects where serostatus becomes irrelevant, e.g. when it comes extending the duration of ARV patents because a pharmaceutical company has found a new use for them (e.g. PrEP). Maybe I gave you the wrong impression: For the most part I do agree with you that if a poz guy is ranting just because he doesn't like the idea of PrEP, it really is none of his business. I just don't think that a poz guy can never say anything if it has remotely to do with PrEP. I think there are specific aspects and broader implications that can be discussed academically regardless of gender or serostatus.

I disagree. Neg guys have a very different relationship to ARVs than poz guys. We can can skip does, etc. The poz perspective can color the discussions in ways that are unhelpful. That said there are times when the poz perspective can be useful (when the neg guy gets to the point of having side effects) or when they're the only people around who have any experience with ARVs (e.g. "don't worry - I take multiple pills and it's no big deal for me"), but I think the poz guy has to keep reminding themselves that there's a decent chance the neg guy is having a different experience with the meds - and that's not an easy thing to keep in mind.

That is exactly what I said / meant: There are certain ASPECTS (like side effects) where having more voices can be helpful. You also gave an example of what I meant by discussing such topic in a respectful way: keeping in mind that the experience for a neg guy will most likely be somewhat different. It also means looking at broader picture. I do belive that PrEP will also help poz guys with their therapy. Because for the first time you have a reference group to compare and contrast. Like some side effects that were considered to be caused by meds, but might also be the result of viral activity. With a multitude of PrEP users, over time, we will know for sure.

[pigpozdad]

I advise bttms now "well get pozzed or get on PrEP so you can hurt yourself"

[relief4u]

First time I've posted here so apologize in advance if I do or say something wrong. This one just hit me the wrong way today.

Responding to the question of who should have a voice in the debate - it's everyone. There will always be those who say things just to get a rise out of others. That doesn't mean we then limit who can comment or join the discussion.

If PrEP can help end or nearly end HIV then there is no reason not to have it as an option - assuming we continue the effort to find a way to cure those already living with HIV. I'd love to wake up some day and not have to think about taking pills. I'd also like knowing there isn't something in my body actively trying to kill me every day.

I didn't make a choice 20+ years ago but many now assume I did - because "everyone" knows to use a condom or abstain or, now, to use PrEP. So just consider that someone who expresses a negative view about PrEP may be just as RawTop said, upset that he didn't have the option. And, he doesn't want to see "neg + PrEP" or "disease-free" in another profile as someone else mentioned seeing. Maybe it's better to uncover the real reason someone would react negatively before saying that all HIV+ people should be excluded - many of have dealt with enough of that already. Thanks for listening.