Prep or Truvada should be considered carefully before use

[Jabberwocky]

Can you show an example of someone who had hiv but at undetectable levels infecting someone else?

I did some research on Google but couldn't find anything.

I don't see how you can blame the medicine for people's behavior though.

I believe this is the same status as people like us who have been ‘cured’ of Hep C. What we actually have is undetectable levels of Hep C though plenty of antibodies to show evidence of infection.

 

[PriestTheyCalledHim]

Can you show an example of someone who had hiv but at undetectable levels infecting someone else?

I did some research on Google but couldn't find anything.

I don't see how you can blame the medicine for people's behavior though.

Failure of pre-exposure prophylaxis with daily tenofovir/emtricitabine and the scenario of delayed HIV seroconversion

Pre-exposure prophylaxis (PrEP) with co-formulated tenofovir disoproxil fumarate (TDF, 300 mg) and emtricitabine (FTC, 200 mg) (Truvada) has been proven to be effective for preventing HIV transmission (Fonner et al., 2016). Standard guidelines are in place to ensure effective implementation of...

www.ijidonline.com

Meet the Man Who Got HIV While on Daily PrEP

In this sexually frank POZ Q&A, he recounts events around his seroconversion and what he now thinks of Truvada’s ability to prevent HIV.

www.poz.com

Search for Truvada/prep failure.

 

[cduggles]

Failure of pre-exposure prophylaxis with daily tenofovir/emtricitabine and the scenario of delayed HIV seroconversion

Pre-exposure prophylaxis (PrEP) with co-formulated tenofovir disoproxil fumarate (TDF, 300 mg) and emtricitabine (FTC, 200 mg) (Truvada) has been proven to be effective for preventing HIV transmission (Fonner et al., 2016). Standard guidelines are in place to ensure effective implementation of...

www.ijidonline.com

Meet the Man Who Got HIV While on Daily PrEP

In this sexually frank POZ Q&A, he recounts events around his seroconversion and what he now thinks of Truvada’s ability to prevent HIV.

www.poz.com

Search for Truvada/prep failure.

@JessFR requested a story of someone with undetectable viral load infecting someone, not PrEP failure.

 

[PriestTheyCalledHim]

@JessFR requested a story of someone with undetectable viral load infecting someone, not PrEP failure.

Well obviously the other person who was HIV+ mentioned in the article was on medications and was at some point undetectable, but the guy who was on the Truvada was highly sexually active and having lots of unsafe sex with random men, so it could have been anyone he was having unsafe anal sex with.

 

[cduggles]

it could have been anyone he was having unsafe anal sex with.

Which means it’s not a story about an individual with an undetectable viral load infecting someone. Rather, it’s a story about how someone on PrEP can become infected.,

 

[cduggles]

he says he’s negative. I prefer to be with people who are positive and know it and are on meds—I’m on PrEP, you’re undetectable, the chances of transmission are like negative 10 percent—but I broke my rule with this guy. So it was with him, I think—it was a bit of a busy period. I reached out to him and he says, “Well, I’m not worried, I’m OK. But I’ll go see a doctor.” And I checked in with him again: “Have you gone? What are the results?” “Oh I’m really busy and haven’t had a chance.” I checked in again. “Oh, I’m out of town on work.” Checked again, and he stopped replying to me. To be honest, I gave up. I don’t need to be vindicated or have him say I’m sorry or whatever. I just wanted to let him know. It’s being socially responsible.

 

[PriestTheyCalledHim]

Which means it’s not a story about an individual with an undetectable viral load infecting someone. Rather, it’s a story about how someone on PrEP can become infected.,

Undetectable does NOT mean cured/HIV-.
Undetectable does NOT mean disease free/untransmissible.
If you have HIV, you can infect others.
Stop trying to kill each other just to get an orgasm.

 

[PriestTheyCalledHim]

The Canadian guy was having unsafe anal sex with HIV+ sexual partners, that is extremely high risk for HIV infection.

What a stupid argument.

Are you going to take the word of some random Grindr ho that he's undetectable?

That's what you need to think about.

Undetectable only means you were undetectable when you last had a blood test done.

 

[cduggles]

I understand that terminology perfectly well. You don’t need to explain undetectable viral load or viral suppression to me.

What JessFR was asking for was an account of an individual with undetectable viral load infecting an HIV- individual. Not a story about PrEP failure.

 

[PriestTheyCalledHim]

I understand that terminology perfectly well. You don’t need to explain undetectable viral load or viral suppression to me.

What JessFR was asking for was an account of an individual with undetectable viral load infecting an HIV- individual. Not a story about PrEP failure.

Would you feel comfortable having unsafe sex with anyone that is HIV+ but claims to be undetectable? I wouldn't.

HIV/AIDS organizations are run by HIV-positive men. A lot of them will tell people to use condoms, have safer sex, etc. but they do not do any of this when they have sex with other people.

I know multiple people who are HIV+ in HIV/AIDS educational and testing organizations who do this.

Since the 1990's, their priorities have been the "cocktail" and reducing HIV stigma. Their ad campaigns spent millions to convince young gay and bisexual men that Poz guys are hot and fuckable, and that HIV meds do not have bad short or long term side effects.

Erased from the agenda? Research for a cure. Research for a vaccine. HIV prevention activists are nearly all in bed with Gilead, the makers of Truvada.

HIV/AIDS organizations are hellbent on telling young gay and bisexual men that "HIV undetectable" men are safe and if you take "PreP" there's zero chance of contracting HIV and that it is fine to not use condoms.

Personally, a strategy of condoms, safer sex, and sero-sorting has kept me negative since I became sexually active in the late 1980s. Use condoms and avoid sex with HIV-poz men and women, IV and hard drug users, even if they tell you that they're "undetectable." or on meds. It works!

Condoms PLUS sero-sorting works.

Young gay and bisexual men need to be told to use condoms, and even with condoms avoid sex with poz guys.

Our current "reduced stigma" environment is what has young guys deluged with 60 second bareback porn clips on Tumblr. It's a constant indoctrination of dicks going into asses with condoms. And unfortunately, "monkey see, monkey do." is why STD rates are skyrocketing.

I've even seen HIV-positive guys on websites claiming themselves as "STD-free." Say what!?!

"Undetectable" is an HIV-positive man with a significantly lower chance of infecting you in the extremely rare case of a condom failure, it does not mean that it is perfectly safe and fine to not use condoms with someone that is HIV+ even if you are on the Truvada.

 

[Foreigner]

Regarding your former comment, do you have any way I can verify that? Like I'm not saying you're wrong, I just don't know and I'm curious. I'll probably Google some more regardless, unfortunately what I found when I did some searching earlier was pretty vague on these points. Like it's easy to find a lot of fairly convincing information that you can't transmit hiv provided your viral load is low enough. But finding specifics about how fast that changes depending on how you take the meds seems a lot less clear.

I also did some googling on your second point. These long term side effects seem to be relatively rare, I would think they would have to be a lot more common to compete with the harms caused by HIV that the drug helps prevent.

To be clear I'm neither gay nor a man, I don't have any particularly strong stake in this debate. I'm mainly curious. And also I think big pharma gets a bad rap. I've never caught HIV but I did have hep c and was fortunate to have it cured by the medicines developed by big pharmaceutical companies.

I work in healthcare (alternative, but I am still required to know this stuff) so I can give you some stats.

You can miss 3 doses of prep in a single week and it'll still be 96% effective. It's because it builds up in the body. The initial loading period for first time users is 7 days, and then the protection is more lasting. However, prep in general is not 100% effective. It's like condoms. They are 99% effective and then on the rare occasion it doesn't work. They are still researching this... but the instance of failure is extremely rare. Nonetheless, there is theoretically higher chance of contraction with each missed dose, and they don't know if missing 3 doses in one week is equivalent to missing 3 doses every week.

Added to this, if you're an HIV- top who tops an HIV+ bottom who is detectable, your chances of getting HIV are less than 1%. The risk is mostly for the bottoms. The CDC's stated risk for tops is 11/10,000.

Added to this, incurable viruses like HPV and HSV are still a concern as these can cause dysplasia in the rectums of men who contract them, leading to higher colon cancer risk. And like I said, even the so-called curable STIs all require antibiotics which have long-term deleterious effects on people's immune systems.

Nature is smarter than us. It will figure out a workaround eventually.

 

[cduggles]

Would you feel comfortable having unsafe sex with anyone that is HIV+ but claims to be undetectable? I wouldn't.

HIV/AIDS organizations are run by HIV-positive men. A lot of them will tell people to use condoms, have safer sex, etc. but they do not do any of this when they have sex with other people.

I know multiple people who are HIV+ in HIV/AIDS educational and testing organizations who do this.

Since the 1990's, their priorities have been the "cocktail" and reducing HIV stigma. Their ad campaigns spent millions to convince young gay and bisexual men that Poz guys are hot and fuckable, and that HIV meds do not have bad short or long term side effects.

Erased from the agenda? Research for a cure. Research for a vaccine. HIV prevention activists are nearly all in bed with Gilead, the makers of Truvada.

HIV/AIDS organizations are hellbent on telling young gay and bisexual men that "HIV undetectable" men are safe and if you take "PreP" there's zero chance of contracting HIV and that it is fine to not use condoms.

Personally, a strategy of condoms, safer sex, and sero-sorting has kept me negative since I became sexually active in the late 1980s. Use condoms and avoid sex with HIV-poz men and women, IV and hard drug users, even if they tell you that they're "undetectable." or on meds. It works!

Condoms PLUS sero-sorting works.

Young gay and bisexual men need to be told to use condoms, and even with condoms avoid sex with poz guys.

Our current "reduced stigma" environment is what has young guys deluged with 60 second bareback porn clips on Tumblr. It's a constant indoctrination of dicks going into asses with condoms. And unfortunately, "monkey see, monkey do." is why STD rates are skyrocketing.

I've even seen HIV-positive guys on websites claiming themselves as "STD-free." Say what!?!

"Undetectable" is an HIV-positive man with a significantly lower chance of infecting you in the extremely rare case of a condom failure, it does not mean that it is perfectly safe and fine to not use condoms with someone that is HIV+ even if you are on the Truvada.

All very interesting, but it still doesn’t answer JessFR’s question.

You seem to think people would lie about being undetectable, which they very well might, but they you don’t seem to feel that someone might lie about adhering to a daily medication regimen, as was stated in the story about PrEP failure that you posted. A lot of people lie about medication adherence to their doctors. I wouldn’t believe them. You’re very selective in what you do and don’t believe.

 

[tubgirl.jpg]

You’re very selective in what you do and don’t believe.

Everything leading up to it was excellent, as always, and the ending didn't disappoint, but god, that's brutal.
Sticks and stones may break your bones but a simple sentence can destroy you.


I like it.

 

[Jabberwocky]

I think there is a valid point to be made that a huge amount of effort in supposedly HIV prevention organisations is expended through gay de-stigmatisation programs. As @PriestTheyCalledHim said, to make young gay guys look hot and fuckable. This occurred to me while I was searching for statistics to verify some of the claims and counter claims made in this thread.

The gay industry organisations (for want of a better term) do come across as somewhat evangelistic about PrEP and few sites I looked at carried or linked to detailed risk analysis of the medications in question. However, that’s common enough with medications for other diseases where the number of lives saved by a medication far outweigh those lost from side effects from those medications. It’s only with media attention to Covid-19 vaccines that side-effect statistics are being shown to (and generally misunderstood by) the general public.

 

[cduggles]

I think PrEP addresses the reality that people want to have unprotected sex.
In subSaharan Africa, it’s more of an issue with serodiscordant heterosexuals, and that’s the focus of HIV prevention interventions there. It’s easy to get tied up with what the US focuses on as opposed to a more international perspective.

 

[Jabberwocky]

I think PrEP addresses the reality that people want to have unprotected sex.
In subSaharan Africa, it’s more of an issue with serodiscordant heterosexuals, and that’s the focus of HIV prevention interventions there. It’s easy to get tied up with what the US focuses on as opposed to a more international perspective.

That’s true. In which case the population pertinent to the analysis is not really all men who who sex with men, but all people who have unprotected anal sex with men. Looking at that specific population (which includes gay, bi, straight, and trans identifying people) I suspect that the benefits of not contracting HIV,and the reduced likelihood (as a population) of contracting it, far outweigh any side-effects from PrEP. Very hard to find stats though.

 

[PriestTheyCalledHim]

All very interesting, but it still doesn’t answer JessFR’s question.

You seem to think people would lie about being undetectable, which they very well might, but they you don’t seem to feel that someone might lie about adhering to a daily medication regimen, as was stated in the story about PrEP failure that you posted. A lot of people lie about medication adherence to their doctors. I wouldn’t believe them. You’re very selective in what you do and don’t believe.

There are people who know fully well they are HIV+, and say they are HIV- or HIV- and on Truvada. So why wouldn't men who are HIV+ but not 'undetectable' claim they are poz undetectable?

Unless you have seen their blood test that says they are undetectable you have no idea if they are being truthful or not or if they even know themselves about viral levels, etc.

People are supposed to get the Truvada through their doctor but many people order it online.

I just assume everyone is HIV+ or could be and have safer sex. It works.

 

[Jabberwocky]

There are people who know fully well they are HIV+, and say they are HIV- or HIV- and on Truvada. So why wouldn't men who are HIV+ but not 'undetectable' claim they are poz undetectable?

Unless you have seen their blood test that says they are undetectable you have no idea if they are being truthful or not or if they even know themselves about viral levels, etc.

People are supposed to get the Truvada through their doctor but many people order it online.

I just assume everyone is HIV+ or could be and have safer sex. It works.

Your strategy for personal sexual safety makes sense and I think everyone would be sensible to adopt it.

However throughout the thread you’ve kind of conflated ‘many people are deceitful or ignorant about their infection status’ with ‘the drugs are no good’.

The drugs could be marvellously suited to their purpose but you’d still have the problem of not having full knowledge of your partner’s sexual status. Fucking someone is like taking your drug dealer’s word the stuff is pure. You don’t know anything for sure without reagent testing it yourself, and even then you can’t be certain it’s 100 %.

However, unlike with drugs, you can can take steps to ensure your own safety by taking PrEP and managing your own risk of becoming infected within the parameters offered by the drug’s protection, which are pretty good if you follow the dosing protocols.

Saying the ONLY answer is condoms is impractical advice. And for many people PrEP offers a very good means of mitigating their risk of becoming infected.

 

[PriestTheyCalledHim]

I work in healthcare (alternative, but I am still required to know this stuff) so I can give you some stats.

You can miss 3 doses of prep in a single week and it'll still be 96% effective. It's because it builds up in the body. The initial loading period for first time users is 7 days, and then the protection is more lasting. However, prep in general is not 100% effective. It's like condoms. They are 99% effective and then on the rare occasion it doesn't work. They are still researching this... but the instance of failure is extremely rare. Nonetheless, there is theoretically higher chance of contraction with each missed dose, and they don't know if missing 3 doses in one week is equivalent to missing 3 doses every week.

Added to this, if you're an HIV- top who tops an HIV+ bottom who is detectable, your chances of getting HIV are less than 1%. The risk is mostly for the bottoms. The CDC's stated risk for tops is 11/10,000.

Added to this, incurable viruses like HPV and HSV are still a concern as these can cause dysplasia in the rectums of men who contract them, leading to higher colon cancer risk. And like I said, even the so-called curable STIs all require antibiotics which have long-term deleterious effects on people's immune systems.

Nature is smarter than us. It will figure out a workaround eventually.

There are lots of 'raw tops' who see the statistics of HIV risk and figure that it is completely 1,000% safe or that HIV infection this way is rare so there is no need for them to use condoms.

This is not true. I know people who became infected from unsafe anal sex as top/giver and it was from a single sexual encounter.

There are lots of heterosexual people worldwide who became infected by unsafe insertive anal or vaginal sex.

Is,it as risky as unsafe receptive anal or vaginal sex? No but this does not make it completely safe.

 

[PriestTheyCalledHim]

Your strategy for personal sexual safety makes sense and I think everyone would be sensible to adopt it.

However throughout the thread you’ve kind of conflated ‘many people are deceitful or ignorant about their infection status’ with ‘the drugs are no good’.

The drugs could be marvellously suited to their purpose but you’d still have the problem of not having full knowledge of your partner’s sexual status. Fucking someone is like taking your drug dealer’s word the stuff is pure. You don’t know anything for sure without reagent testing it yourself, and even then you can’t be certain it’s 100 %.

However, unlike with drugs, you can can take steps to ensure your own safety by taking PrEP and managing your own risk of becoming infected within the parameters offered by the drug’s protection, which are pretty good if you follow the dosing protocols.

Saying the ONLY answer is condoms is impractical advice. And for many people PrEP offers a very good means of mitigating their risk of becoming infected.

I am going by my own experiences. I know someone who is HIV+ but they would lie and say they are HIV-.

Yes it is illegal to do this, but it is super common.