Should I go bareback and go on prep

[BB-new]

On 8/18/2021 at 6:52 PM, BootmanLA said:

Some doctors may advise off-label use like this, but every one I've asked has said, point blank, take it every day.

Hi,

So you've asked doctors, and gotten this advice for your personal situation? 

Otherwise they are technically right that it's 'off-label use' but they don't know anything about it I think.

 

Besides in France and The Netherlands, both options (daily or intermittently) are also given for gay and bisexual men bij the NYC health officials:

[think before following links] https://www1.nyc.gov/site/doh/health/health-topics/pre-exposure-prophylaxis-prep.page

 

 

[BootmanLA]

10 hours ago, BB-new said:

Hi,

So you've asked doctors, and gotten this advice for your personal situation? 

Otherwise they are technically right that it's 'off-label use' but they don't know anything about it I think.

 

Besides in France and The Netherlands, both options (daily or intermittently) are also given for gay and bisexual men bij the NYC health officials:

[think before following links] [think before following links] https://www1.nyc.gov/site/doh/health/health-topics/pre-exposure-prophylaxis-prep.page

Please do not assume that you know anything about my "personal situation". Though I do appreciate you acknowledging that I am right (and that so are the doctors I'm mentioning). In reviewing the link you so helpfully provided, it notes that THE (not "a") recommended way to use PrEP is daily. It acknowledges that people CAN use it in the "on demand" manner - as a throwaway comment, with no detail as to how one should do that.

I am not suggesting that gay men do not, or should not, use the on-demand PrEP option. I have made it clear that it's harder to stick to a non-standard routine than a standardized daily one - taking a pill every day, especially in conjunction with a daily activity like a meal is easier to remember than planning ahead of every time one might have sex, avoiding sex long enough in a "spur of the moment" situation if the medication was taken too recently, remembering what time you have to take the follow-up doses to maximize their impact after sex, etc.

But speaking factually:

--It undoubtedly works most of the time, but there are multiple potential points of failure with the on-demand method;

--It has been studied, but not nearly as extensively as daily dosing. 

That's all I'm saying. Some people seem determined to cast that as "he's saying on-demand doesn't work", while others seem determined to keep popping up and saying "PrEP fails all the time". To both groups I say: read the literature, examine the data, and stop with the bullshit.

 

[BB-new]

2 hours ago, BootmanLA said:

Please do not assume that you know anything about my "personal situation". Though I do appreciate you acknowledging that I am right (and that so are the doctors I'm mentioning). In reviewing the link you so helpfully provided, it notes that THE (not "a") recommended way to use PrEP is daily. It acknowledges that people CAN use it in the "on demand" manner - as a throwaway comment, with no detail as to how one should do that.

I am not suggesting that gay men do not, or should not, use the on-demand PrEP option. I have made it clear that it's harder to stick to a non-standard routine than a standardized daily one - taking a pill every day, especially in conjunction with a daily activity like a meal is easier to remember than planning ahead of every time one might have sex, avoiding sex long enough in a "spur of the moment" situation if the medication was taken too recently, remembering what time you have to take the follow-up doses to maximize their impact after sex, etc.

But speaking factually:

--It undoubtedly works most of the time, but there are multiple potential points of failure with the on-demand method;

--It has been studied, but not nearly as extensively as daily dosing. 

That's all I'm saying. Some people seem determined to cast that as "he's saying on-demand doesn't work", while others seem determined to keep popping up and saying "PrEP fails all the time". To both groups I say: read the literature, examine the data, and stop with the bullshit.

 

I read I'm forbidden to use other languages than English on this website, so I can't give you the text but in my country both uses of PrEP are part of the guide-lines our general practitioners use. The local health counsels who offer sexual health clinic also use these.

Wikipedia too says 2-1-1 is off-label, but in Europe there are two ways to take this medication and it's up to the doctor. 

Mine told me she hadn't heard of it before when I asked for it. So she did her research first, and she told me initially she wasn't keen on proscribing it because it seemed illogical to give medication to someone who isn't ill. 
But anyway, in my case she was still a bit worried about my kidney-function as I'm also taking other medication and we had a very open talk about dating. 
She made me promise to really stick to the event-schedule which starts with waiting 2 hours between taking PrEP and having sex. 

That's not a problem because having a shower, cleaning out, brushing my teeth and getting dressed usually takes me about an hour to an hour-and-half  already. So if my date comes to my house I jus have him come half an hour after that and if I go to my date it's almost always two hours later. 

Last time I dated I used the alarm-clock on my smart-phone which was really funny when it went off when I was at this guys house. LOL

Oh and my doctor told me that if I did make a mistake by missing a dose or take it to late or don't wait long enough to get in touch immediately if I had sex without a condom, and ask for PEP.

 

So I do not think you are right and I trust my own doctor more than I trust you.

You are not very clear what your are saying. 
What do you mean when saying half way through you are not suggesting one way to use PrEP or the other, but after that you list only reasons do use it daily.  

I don't mean to insult you, but there are people online saying stupid things about Covid-19 not being real and that vaccinations don't work or are a conspiracy who tell me to read for myself, examine the data for myself, bla bla bla.
I'm not doing that, I had my two slabs and no problem.

So I hope you don't mind I don't listen to you now. Yo

[BB-new]

15 hours ago, BootmanLA said:

Please do not assume that you know anything about my "personal situation".

I did not.
I asked a question to know if what the doctors (allegedly) told you was in general or meant for your personal medical situation.

 

And please do not assume to know what is better for my health than me and my doctor who HAS studied medicine, is aware of my dating habits AND knows my medical history!

 

Talked bout this with a friend because I was a little upset after reading your posts. He straightened me out. 

 

[BootmanLA]

19 hours ago, BB-new said:

She made me promise to really stick to the event-schedule which starts with waiting 2 hours between taking PrEP and having sex. 

That's not a problem because having a shower, cleaning out, brushing my teeth and getting dressed usually takes me about an hour to an hour-and-half  already. So if my date comes to my house I jus have him come half an hour after that and if I go to my date it's almost always two hours later. 

Last time I dated I used the alarm-clock on my smart-phone which was really funny when it went off when I was at this guys house. LOL

Oh and my doctor told me that if I did make a mistake by missing a dose or take it to late or don't wait long enough to get in touch immediately if I had sex without a condom, and ask for PEP.

 

So I do not think you are right and I trust my own doctor more than I trust you.

A few points:

1. Your doctor made the same point I did about sticking to the event schedule. YOU find it easy because you (apparently) are using it in conjunction with *dating* - something you plan ahead and can work into a schedule. It may come as a surprise to you but a lot of guys don't date - they just have sex, with whomever wants it, whenever the opportunity arises, and that occurs, not infrequently, without the 2 hour prep time needed. In large cities with sex clubs and bathhouses right in the gay neighborhoods where people live, it's not unusual at all for a guy to get horny and be naked in the club or bath within 15 minutes.

2. Your doctor also drove home my other point - that mistakes get made and the only way to stay safe, in those cases, is to realize it and take PEP. Which is great - I'm glad she's on top of that - but again, that's assuming the person isn't still high on whatever tweaking substance du jour he's on, and remembers when he took what doses and when he took a load, so as to calculate 24 and 48 hours after that. That's something you might never do - hurray for you - but again, there are plenty of guys who are not so careful.

Which is why "on demand" PrEP - which I'm happy to acknowledge apparently works fine for YOU in YOUR circumstances - has a higher failure rate than daily. You seem to be misreading what I'm saying - perhaps because English isn't your primary language? - as though I were saying "on demand" never works, or is always a bad idea, or something similar. And I'm not.

Nor am I telling you to ignore your doctor's advice. If your doctor has decided you're a good candidate for on-demand usage - and it appears she took into account the effects on kidneys, and knows you well enough to believe you'll be careful with your dosing - that's great. It shows she's doing her job well. 

[Kimberley]

this topic is hilarious. if he want to go bareback on prep then do it. why are people going to argument about swallow daily or on demand prep hahaha 🤣

[BootmanLA]

1 hour ago, Kimberley said:

this topic is hilarious. if he want to go bareback on prep then do it. why are people going to argument about swallow daily or on demand prep hahaha 🤣

Because he did not say "I want to do X" - he asked *IF* he should do X. In other words, he asked for advice. Advice may differ, depending on who's offering it and their perspectives. This is not rocket science, to use an American English idiom with which you may or may not be familiar.

[swoll]

Well you're on here making threads about it so it's firmly lodged in your mind, it's not going anywhere. So YES, you shouldn't waste anymore of this short life and should get to taking raw cock. I promise you won't look back! 

 

As for prep and how to dose it, I've done daily and on demand. I much prefer daily just because I find it makes me quite gassy when I take it intermittently 

[rawTOP]

On 8/18/2021 at 12:52 PM, BootmanLA said:

Except "intermediately" [sic] PrEP is not an approved use of PrEP and while apparently *largely* effective, it has neither been studied as extensively as daily PrEP nor is it as easy to manage.

For instance: it requires that the first, "double" dose be taken at least 2, but no more than 24, hours before sex. We all know of people who don't plan an hour ahead, much less 2. So if Johnny goes out and happens to meet Bob, and they're both horny and decide to get it on, chances are high they aren't going to wait 2 hours after Johnny takes his pills to get started. I have my doubts that in such a case, he's also going to remember the doses 24 and 48 hours after the sex (the timing of which is apparently considerably more important than daily PrEP because the level of medication in the system is not already at a protective level).

Some doctors may advise off-label use like this, but every one I've asked has said, point blank, take it every day. It's probably better than nothing, but unless PrEP is inordinately expensive for the individual, he's *always* better off following the standard, approved daily regimen. 

What @BareLover666 said is almost verbatim what the CDC says…

https://www.cdc.gov/hiv/basics/prep/on-demand-prep.html

On-demand PrEP is highly effective when your risk is receptive anal sex. As BareLover666 and CDC say - "talk to your doctor to see if it's right for you".

[BootmanLA]

4 hours ago, rawTOP said:

What @BareLover666 said is almost verbatim what the CDC says…

[think before following links] https://www.cdc.gov/hiv/basics/prep/on-demand-prep.html

On-demand PrEP is highly effective when your risk is receptive anal sex. As BareLover666 and CDC say - "talk to your doctor to see if it's right for you".

Except it's not, RawTop. The CDC *acknowledges* that it's being used this way. But right on the page you cite, it says, clearly:

"This type of use is not currently part of CDC’s guidelines for PrEP use, which still recommends daily use for those at risk for HIV. Taking PrEP once a day is currently the only FDA-approved schedule for taking PrEP to prevent HIV. When taken as prescribed, PrEP is highly effective for preventing HIV."

I'm not sure how much clearer "not currently part of CDC's guidelines for PrEP use" could be.

And it says,  point blank, that daily dosing is the only FDA-approved schedule - and WHEN TAKEN AS PRESCRIBED - which means daily, because any other use is off-label - it's highly effective. 

I'm not saying it's useless - obviously, there's evidence that IF you take it exactly as the off-label guidelines say (at least 2, no more than 24 hours before sex; and 24 and 48 hours after sex) it has a good track record. But that glosses over the reality of a lot of gay sex:

-guys who decide on the spur of the moment to have sex, and take the pills right before, without giving them time to start taking effect;

-guys who concurrently are using IV drugs;

-guys who have 3 or 4 hours of sex during the "bout" of sex and then misjudge when to start the 24 hour and 48 hour doses;

-guys who know the timing but still miss-time one or both of the follow-up doses;

-guys who have additional sex during the same period but do not alter the dosage schedule;

and so on.

The point is that "on demand" has far more potential failure points than daily does - especially since taking it daily isn't tied to the frequency or amount of sex you're having. In fact, if you have sex more than a couple of times a week, you're actually putting MORE PrEP meds into your system than if you just took it daily and maintained a steady level, because of all the days you have to "double dose" before sex.

I get the point that "on demand" is better than "never". But the studies show it's effective, though not as effective as daily dosing, even if taken exactly on the 2-1-1 schedule; it's got more avenues to fail; and for a guy who's reasonably sexually active (sex 3 times a week) he's taking higher doses of the drug than daily would provide. At one time, when lots of insurance in the US didn't cover it, I could understand wanting to conserve pills. Now that it's required to be covered with no copay, it's a no-brainer to use daily for almost everyone.

[BlackDude]

I take it daily, no exceptions. I really don’t get what’s so hard about taking a pill everyday. 

[Pozguyinchi]

1 hour ago, BlackDude said:

I take it daily, no exceptions. I really don’t get what’s so hard about taking a pill everyday

1 hour ago, BlackDude said:

I take it daily, no exceptions. I really don’t get what’s so hard about taking a pill everyday. 

I have living with HIV since I was 19. I take meds daily and don’t see an issue either. 

[xxbjn2]

Just fuck raw and enjoy it.  You either take Prep daily now and avoid HIV or you get HIV and take a pill daily to avoid Aids.  One way or another if you want to fuck raw you'll be taking a daily pill, unless you don't give a shit about your health.

[BlackDude]

For those who came up in the 80s, 90s and 00s, if you would have told the contraction of HIV could be prevented with the use of a SINGLE daily pill, we would have thought you insane, even 10 years ago. You still have folks from that era who still won’t take prep, despite the research. That’s how much fear was/is out there. 

For the rest, we may not even believe in prep fully. We just have hope it MAY work as much as they say, and if all it takes is a daily pill, we are going for it. 

[fskn]

For those referencing the US CDC PrEP guidelines, once again, the 2021 revision is pending (comments were received in May) and intermittent or 2-1-1 PrEP is in the document.

Some people have mentioned fear and trauma from the early days of the HIV epidemic, and while it's important to acknowledge fear, because it does affect health-related decisions for some people, it's also important not to stoke further fear (or to sow doubt). The research is unequivocal: daily Truvada (and now Descovy) for PrEP is extremely effective in preventing HIV infections in real-world use (and so is Truvada used intermittently according to 2-1-1 rules).

Edited August 28, 2021 by fskn
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