PrEP On The Sly

[Guest]

I'm HIV neg and want to stay that way but I;'m obsessed with getting fucked raw and being bred.  I've taken bareback loads before by trying to be careful who I bottom for but we all know that is a risk.  I know that PrEP is an option to reduce the rick of infection and that there are a lot of clinics in the area to get a prescription.  But what worries me is my Primary Care Physician.  I've been going to him for years, like him a lot but he's very aggressive with his health care, he would never approve, and I don't want him to know that I have sex with men.

So my question is it possible for me to take PrEP without him knowing it?  And will the medication show up in blood tests when I have my physical every 6 months?  If yes, can I stop the PrEP before the blood test for my 6 month physical so that it doesn't show up?

I also heard or read about single doses where you take a dose either before or after getting bred.  What is that called?  Is it an option for me?  

Thanks in advance for positive feedback on this.

[kinkysuBB]

It will only show up if he does blood tests specifically for it, which would be a very strange thing for him to do. In very rare circumstances, he may notice a decrease in your kidney function, but if that happens, you will want him (and you) to know that's happening, so that you can fix it. But that would be very rare with PrEP.

I will say, though, that honesty with any doctor treating you is always the best policy. It's much easier for them to help you if they're fully informed. For example, PrEP can interact with other medications that he may unwittingly prescribe you, if he doesn't know you're on it. If you don't feel you can discuss something with a particular doctor, finding a doctor you feel more comfortable with is a far better solution than hiding things.

Edited February 1, 2021 by subBottomKink

[NastyRigPig]

Honestly?  Get a new healthcare practitioner.  You need to be completely open and honest with your healthcare, you are doing yourself a disservice here.

[blackrobe]

17 hours ago, takemeuseme said:

I'm HIV neg and want to stay that way but I;'m obsessed with getting fucked raw and being bred.  I've taken bareback loads before by trying to be careful who I bottom for but we all know that is a risk.  I know that PrEP is an option to reduce the rick of infection and that there are a lot of clinics in the area to get a prescription.  But what worries me is my Primary Care Physician.  I've been going to him for years, like him a lot but he's very aggressive with his health care, he would never approve, and I don't want him to know that I have sex with men.

So my question is it possible for me to take PrEP without him knowing it?  And will the medication show up in blood tests when I have my physical every 6 months?  If yes, can I stop the PrEP before the blood test for my 6 month physical so that it doesn't show up?

I also heard or read about single doses where you take a dose either before or after getting bred.  What is that called?  Is it an option for me?  

Thanks in advance for positive feedback on this.

First things first, I can't imagine how they might figure out you're on PrEP from any normal diagnostic blood test. Those tests use specific agents for specific things and they don't show up anything else other than what they are made for. They won't identify non-specific drugs in people's systems so that's not a factor you need to worry about.

You do need a trusted sexual health doctor you can be 100% honest with. If you don't want to leave your current doctor, you need to find a local sexual health clinic and get your full sexual health taken care of. That means getting on PrEP (perhaps Descovy as it has the lowest chance of showing kidney impact) and getting all your vaccinations - Gardasil for HPV and the vaccines for Hepatitis A and B.

PrEP wasn't approved for "On demand" use in the US last time I checked and, to be honest, your reasons for avoiding a safer "daily dose" regimen don't make any sense to me. It would be far better to have a doctor you can trust with your complete health, but using a secondary clinic works too. 

Next Steps: Call the Granite State PrEP Hotline: 508-686-PrEP (7737) to get any/all your questions answered about getting PrEP in your state and here is a list of the clinics in your area where you can go to get PrEP. Don't forget to talk to them about Hepatitis A and B vaccinations as well as HPV vaccination. Whether you've had HPV before or not, you need it. There is no way to know if you've been exposed to the carcinogenic variety already or not, so getting vaccinated is only prudent.

[Guest Porthos]

It will not show up in your routine metabolic blood tests. Most cities have healthcare centers that will prescribe you PrEP. They will require you to visit once every 3 months for an HIV test and kidney function before they renew the prescription. Your primary care physician will never know....However, I think you should find a gay friendly doc.

[BootmanLA]

Like several others, I think you need to examine your health care provider choice.

Where I'd start, though, is a frank discussion with your current doctor. Explain to him that you have sex with men (you do not need to tell him, at least at first, that you do so bare). He may surprise you and be more accepting than you think he would be. If he's not, then take that opportunity to thank him for his years of service but tell him you need a doctor who can deal with that in a non-judgmental way. Ask for a referral elsewhere, but don't feel obligated to use that doctor unless you like him or her.

Then, with whoever your doctor ends up being - this guy, or someone else - explain that you have sex with men (you don't say whether you're gay or bi, but I'd acknowledge whichever it is with the doctor) and that you want to go on PrEP as an additional layer of protection. I wouldn't recommend lying to him and saying you always use condoms if you never do, but you can fudge the issue. "Sometimes there are no condoms handy when we go to have sex and frankly we don't have the willpower to wait" covers the fact that you don't have them handy because you never buy any or pick them up.

The reason you need a doctor with whom you can be relatively honest: such a doctor is going to be looking out for your health a lot better than one who has no idea that you engage in risky behavior. He'll know to test for things like HIV and other STI's, something a doctor who assumes you're not sexually active will not necessarily do.

As for "on demand" PrEP - look in the PrEP forum for any number of threads about that. The bottom line there, though, is that while it's somewhat effective, it's nowhere near as effective as daily PrEP in preventing infection.

[Guest]

First of all, thanks for all the feedback.  It was sort of what I was expecting.  

If it comes down to telling my current doctor about M2M sex or replacing him with a new, gay friendly doctor then I will stick with my current doctor and drop the whole idea.  My current doctor is that good and my health is the most important thing, certainly better than sex.  

But one thing that hasn't been mentioned is taking daily PrEP (or a better substitute) for 5 months, ending it 1 month before lab work, then resuming for another 5 months after lab work.  

Even if I was taking PrEP (or suitable substitute) I would still be careful and selective with sex partners.  I know abstinence is the only safe sex but I'm willing to take some sort of risk, but I'd like to minimize that risk as much as possible.  I guess that I should talk to a local clinic and/or make an appointment.  

[kinkysuBB]

19 minutes ago, takemeuseme said:

But one thing that hasn't been mentioned is taking daily PrEP (or a better substitute) for 5 months, ending it 1 month before lab work, then resuming for another 5 months after lab work.  

@takemeuseme your doctor will not, I repeat, will not pick up that you’re using PrEP from routine bloodwork. He would have to request a tenofovir or emtricitabine level blood test (or whatever Descovy is, we don’t have that here). If he’s going around doing those tests for no apparent reason on patients who have never mentioned they’re taking PrEP, he needs his head examined. They’re not even routinely done for patients who are taking PrEP.

But my opinion remains that you should fully disclose any meds you are taking to your doctor. The fact that you are a man who has sex with men is hugely important from a medical point of view. You should have all sorts of vaccines as people have mentioned here, and also a primary care physician is interested in what’s called your “social history” i.e. jobs, relationships, living conditions, etc. Because that stuff impacts on your health.

Hiding stuff from a doctor and expecting them to do a good job treating you, is like getting a builder in to put in nice new ceilings, and not telling them there’s a big hole in the roof right above them.

Are you sure this doctor, whom you say is a decent person and you trust, is that judgmental? Most experienced doctors have seen everything and are unshockable. You will not be the first gay man he has treated. And whatever his personal views, it’s unethical for him to let that affect the treatment he gives a patient. This stuff is actually governed by professional ethics boards and there’s a whole code of conduct he’ll have signed up to, that is enforceable by his professional body.

But really and truly, if you feel you can’t disclose something to your doctor, to the point where you’re trying to manipulate your bloodwork, then whether the issue is yours or his, you need a new doctor.

Edited February 2, 2021 by subBottomKink

[kinkysuBB]

To add, being on PrEP isn’t something to be ashamed of. It’s being responsible for your health! Does your doctor judge women for taking the pill? If he does, call Noah and tell him one of the dinosaurs fell off the ark. And then get yourself a new doctor.

But again I’d be very surprised if that’s the case in this day and age, anywhere in the developed world.

[Guest]

I agree with the others that you really need to think about a new doctor regardless of Prep.  I go to a straight female doctor and just haven't changed because I like her, but I'm honest since day one that I'm gay, and she actually referred me to their Infectious Disease department when I first brought up Prep in 2014 since she didn't know what it was.  But I still feel like I should change doctors.  Straight doctors aren't even thinking that gay guys (bottoms) need to get stds checked up their asses and throat, where straight guys are most likely to get them in their dicks.  You could go a long time with something brewing in your ass without knowing it.  I was in your city last fall.  I loved it!  It was a decent size city but not too big.  There are bound to be plenty of doctors who are gay friendly there, and you should have one you can talk to.  You don't have to tell them EXACTLY what you're doing, but enough to let them make informed decisions 

[blackrobe]

1 hour ago, takemeuseme said:

But one thing that hasn't been mentioned is taking daily PrEP (or a better substitute) for 5 months, ending it 1 month before lab work, then resuming for another 5 months after lab work.  

Your fear of having your use of PrEP detected in routine blood work is, pardon my bluntness, complete nonsense.  

I get that you have a fear of it being discovered, for whatever reason, and I'm sympathetic, we've all had to come out in various ways and it can be emotionally taxing, but your fear of routine blood work is not rational, reasonable, or credible.

If your fears persist now that you've been told by multiple people that they are not justified, I really recommend finding a mental health professional to talk to.

Good luck to you.

[BootmanLA]

3 hours ago, takemeuseme said:

First of all, thanks for all the feedback.  It was sort of what I was expecting.  

If it comes down to telling my current doctor about M2M sex or replacing him with a new, gay friendly doctor then I will stick with my current doctor and drop the whole idea.  My current doctor is that good and my health is the most important thing, certainly better than sex.  

But one thing that hasn't been mentioned is taking daily PrEP (or a better substitute) for 5 months, ending it 1 month before lab work, then resuming for another 5 months after lab work.  

Even if I was taking PrEP (or suitable substitute) I would still be careful and selective with sex partners.  I know abstinence is the only safe sex but I'm willing to take some sort of risk, but I'd like to minimize that risk as much as possible.  I guess that I should talk to a local clinic and/or make an appointment.  

Let me add this. There are interactions between medications, and there are also side effects from medications that come up at times. For instance, some HIV-related medications, including some forms of PrEP, can interfere with kidney function over time.

So let's say you get on PrEP, and all's good for the first couple of years, and then your kidneys start showing signs of stress. If your regular doctor doesn't know you're on PrEP, much less whether it's a kidney-friendly version of the medication, then he's going to be chasing other things trying to figure out what's going on in your body. He may switch out things that are not a problem in order to see if a different medication for, say, cholesterol would cause less of a problem. But the problem isn't your cholesterol medicine; it's the PrEP he doesn't know you're on.

I'm not asking you to explain why neither (a) explaining things to your doctor or (b) finding a gay-friendly one is an option. I'd hazard a guess - just a guess - that this doctor is a family friend or relative, and you don't want him judging you, much less accidentally saying something to a family member. Maybe he treats others in your family as well; maybe he's just conveniently located and gives you a good break on costs. None of that matters as much as actually getting the right health care, for YOU. Assuming you're an adult, no health care provider in the US is going to risk his ability to practice over disclosing something you tell him, medically, in confidence - not to your mom, your dad, your sister, your cousin, or whomever. 

And it's not my place to decide where your loyalties should lie. But I will tell you this: you give strong hints that the allure of bareback sex is something you heed, and no amount of attempting to pre-screen people for whether they're "likely" to be positive is going to work over the long haul. You can rationalize it by saying you'll "minimize" the risk, but you have no way of knowing whether the next guy who tops you raw actually got bred by a poz guy who converted a month ago and has no idea he's infectious - even if you assume everyone who you sleep with tells you the truth, and there's certainly no guarantee of THAT.

If you don't use condoms and you don't use PrEP, and you get fucked even semi-regularly, the odds are good you'll end up pozzed. Not today, not tomorrow, but someday.

And if you do: What do you tell your doctor then? 

[drscorpio]

9 hours ago, takemeuseme said:

First of all, thanks for all the feedback.  It was sort of what I was expecting.  

If it comes down to telling my current doctor about M2M sex or replacing him with a new, gay friendly doctor then I will stick with my current doctor and drop the whole idea.  My current doctor is that good and my health is the most important thing, certainly better than sex.  

If your doctor is so uptight that you would rather risk your life than be honest with him, then no he isn't "that good." You aren't protecting your health; you are risking your life by seeing a doctor you cannot be honest with. What else do you not tell him because you aren't brave enough? Could any of that cause you problems because the doctor is working without the full picture. 

I see a doctor I have seen for 30 years. He flat out told me he didn't feel comfortable prescribing PrEP because he didn't know enough about it, so I went to an Infectious Diseases doctor in the nearest city. You could try that. 

[Guest]

On 2/2/2021 at 3:54 PM, blackrobe said:

Your fear of having your use of PrEP detected in routine blood work is, pardon my bluntness, complete nonsense.  

I get that you have a fear of it being discovered, for whatever reason, and I'm sympathetic, we've all had to come out in various ways and it can be emotionally taxing, but your fear of routine blood work is not rational, reasonable, or credible.

If your fears persist now that you've been told by multiple people that they are not justified, I really recommend finding a mental health professional to talk to.

Good luck to you.

 

You totally miss my questions and my intentions.  I do not have "fears" that you mention but simply seeking information and opinion so I can make the best decisions.

[BootmanLA]

3 hours ago, takemeuseme said:

 

You totally miss my questions and my intentions.  I do not have "fears" that you mention but simply seeking information and opinion so I can make the best decisions.

You won't get good information without providing good information. Simply stating that you aren't going to change doctors - with no explanation of why that's such an imperative - means nobody can give you informed advice. People who want honest advice need to be up front and honest themselves - and not just by "not lying" but by being forthcoming about relevant information. 

Because understanding the nature of the hold this doctor has on you - whatever it is - is an important part of why you're in the situation you're in. If you can't explain that, then don't expect people to be able to advise you on how to deal with it.