Buyers Remorse. Should I Go Off Prep?

[fskn]

Yes, I should have said observed risk reduction rather than efficacy. From Page 1 of your article:

"Most importantly, as with iPrEX, drug level results were highly correlated with incidence of HIV during follow up, with risk reductions (95%CI) of 44% (-31 to 77%), 84% (21 to 99%) and 100% (86-100%) for the <2, 2-3 and >4 doses/week groups.

And yes, I understand confidence intervals and the influence of study length and size.

Taken with the sexual-behavior-adjusted risk reduction figure of 95% from the original iPrEx study, iPrEX OLE demonstrates a risk that is very close to zero.

Nothing is certain in life. Why is it that, as soon as we have systemic evidence of the effectiveness of a new prevention strategy, we forget that no prior strategy (other than abstinence) ever provided ironclad guarantees, either. 95% risk reduction for the iPrEx participants who adhered, and 100% for the iPrEx participants who adhered even 4 of 7 days, is good enough for me.

If we consider treatment status of Poz partners as well, the results from the first two years of the PARTNER study suggest that people having sex with Poz partners known to be undetectable don't need PrEP or condoms. PARTNER involves a large, diverse group of serodiscordant couples.

Finally, the writer of the article seems to have an axe to grind. If it was intended as an unbiased commentary, why would he add the epithet: "it might be an important caution before suggesting that alternate dosing is as acceptable"? No one has suggested alternate-day dosing on any basis, let alone on the basis of the iPrEX OLE results. I heard Dr. Robert Grant speak a few weeks ago, and he himself recommends daily dosing.

Let us note that Simon Collins is not a doctor or a researcher, but a community advocate, and that his articles are not peer-reviewed.

This is not true.

 

Just because in this particular study people with >4 more doses did not seroconvert does not translate into 100% efficacy in the general case. It's all a matter of statistics, and there is a great summary of exactly this issue on this article:

Open-Label Oral PrEP at 4 Doses a Week: Why Zero Infections Does Not Equal 100% Efficacy ( http://goo.gl/yTHd8s )

 

From the article above, the actual efficacy after the number crunching for >4 doses a week is somewhere between 86% and 100%, which is good, but not 100% or anywhere close to it. Had the study run for a longer time, with more people they would have been able to narrow the number down to the real thing. This of course cost money and time.

People are making the mistake thinking that it's 100% even with perfect adherence. It's likely not, and folks should use PrEP knowing that the possibility of seroconverting is still there albeit reduced. Obviously if you are taking lots of loads your chances of seroconversion are nudged higher.

[Pitt1988]

I had no idea SF was so much fun..... and full of action, here in west PA guys are demanding and crude as fuck, you literally have to be perfect, with abs, ripped, and a perfect face just to get laid by a decent guy; i've had to settle many a time just because i was horny; when you go out there is tons and tons of hot guys, but when you go online it is always the least unattractive ones u meet, as the average joes and hot ones are too demanding to even want to talk to you; i used to live in Florida; and it was slightly the same way, i've had other dudes say the same thing; so i assumed it was the same all over the country 

[discreetmpls]

I would say absolutely to stay on PrEP.  As others have noted, this seems to be about some kind of shame you feel over being "slutty".  What it feels like to me is that you are going through a phase.  For a long part of your life you were extremely careful.  You now feel like you don't have to be careful, and you are letting go a little bit.  Your pendulum is swinging back and you are starting to question quality over quantity.  This happens for most men but usually ends with someone HIV+ (gay men) or pregnant (straight men).  Because you are on PrEP, you have protected yourself during the "letting loose" phase.  

 

Now you can re-evaluate what you want out of your sexual encounters and make some changes, maybe have fewer but more regular partners, or have dates/drinks before sex so you feel more connection than Grindr/Scruff.  My rule is that no one gets fucked (anymore) unless they are willing to spend the night, otherwise, it's just oral and on your way.  I've reduced the amount of anal sex that I have, but I like it a lot more when I do it.  And even though most of my partners are low risk oral, I am on PrEP because it's silly not to be.

[seaguy]

Yes, I don't feel good about letting so many guys coming in my ass after the fact, although being on PrEP makes it easier.

 

I think where you live and the amount of gay people around you matters. I live in SF and if you wanted here you could be fucking all day non stop. There are always hot guys 1 mile away ready for action. While it's easy of thinking to try to get the number down, if you are using the GPS apps here they are almost always buzzing with people looking for action, it's difficult to avoid and not hook up if you are horny. I've hooked up many times in half an hour from the first message. It's that efficient. Looks are somewhat important, but if you are available and they are horny, sex will happen.

 

I'm somewhat older than you and I've had many 3ways, 4ways and everything in between. Sort of a miracle I'm still negative.

Have you tried deleting the apps from your phone or would you just end up adding them once you got horny.  I know what your saying there are always guys online here in Seattle but I hold back because I just don't want to be that slutty.  Of course I have social anxiety so that is somewhat of what keeps from being to much of a whore.

[Pitt1988]

Hows your situation going rawfuckr? did you decide to stay on prep?