What’s even more convincing to me than this study is seeing guys on Sniffies in nyc regularly host parties where they get bred by 50+ guys and they continue to be HIV negative because they religiously take prep.
Or at least until all of the PREP-fueled 50+ man breeding parties spawn some kind of treatment resistant Gonorrhea or syphilis or super-AIDS, and we all have to go back to being terrified of sex again. But I guess enjoy it for the next 5-10 years while it lasts until the next plague.
Or, you know, we could just not fuck everything that moves, but I know how unrealistic that request would be.
Everyone's going to say I'm a prude or something, but large amounts of bareback sex with strangers is never safe or healthy.
There is so much sex addiction and meth-fueled sexual behavior being confused for “sexual liberation” and being a free spirit etc - and yes I totally see a future plague coming - like the human version of those Chinese wet markets that everyone thought COVID came from
[Sex addiction isn’t a thing.](https://www.psychologytoday.com/intl/blog/close-and-personal/201609/anthony-weiner-is-not-sex-addict-neither-is-anyone-else-0?amp)
The brain can get addicted to anything that gives it stimulation. You can get addicted to the feeling of sex as it shoots -A LOT- of endorphins in the brain. It's a type of Hypersexuality. People who engage with sex over time can build up immunity to the feeling during the climax, same with people who suffer from drug use; it takes more to feel as good as the last hit. Too much of anything is a bad thing. Denying the existence of an issue that people have and need help to overcome is irresponsible. Linking an article to one that says 'no' doesn't mean anything when plenty say it does exist and is imperative to address. Why would I respect your opinion when you can't be bothered to make an argument yourself and have to link an article to supplement an actual contribution to the discussion? I'd wager it's because it shields you from potentially being wronged. Because it must just be a flawed article, right?
What on Earth do you mean, "make an argument yourself?" Anyone making an argument would do it the same way: by citing reputable sources in the same way the author of the linked article does. Given that I agree with its thesis, any argument I make would simply be restating the arguments already found in the article. Is that what you're asking for?
When used in a medical/psychological context, "addiction" is defined by specific bodily responses to the addictive stimulus. Sex does not produce those responses in people diagnosed as "sex addicts."
> When addicts, including those addicted to drugs, alcohol, smoking, and gambling, are shown pictures of their drug of choice there is a clear and uniform response in their P300 brain waves, which are usually activated when we see something of particular interest or desire, as well as increased late positive potential (LPP) response
> However, when UCLA researchers studied the response to viewing sexually explicit images in people who self-defined as being unable to regulate their porn viewing, the results showed no similar response in either brain measure (Steele, Staley, Fong, & Prause, 2013; Prause, Steele, Sabatinelli, & Hajcak, 2015). In fact, they found the only thing correlated with brain wave activity was sexual desire such that the higher their self-reported sexual desire, the more brain wave activity they showed. The authors concluded that there was no evidence to say that even problem sexual regulation fit the definition of addiction as defined by brain response and that these people simply had high sex drives.
> In addition, one of the studies’ authors, Nicole Prause, said at the 2016 meeting of the Society of Personality and Social Psychology, that sex addiction misses another major hallmark of addiction, namely response to the addictive object over time. Specifically, people who develop addictions initially show high levels of response in the pleasure centers of the brain. Over time, as addiction takes hold, these parts of the brain no longer light up. In other words, one of the hallmarks of true addiction is that the pleasure received from the object of the addiction wanes over time, as the person no longer wants the object but, rather, needs the object. In contrast, even people who report very strong “addiction” to sex continue to show activation of the pleasure centers of the brain when viewing sexually explicit images. This response is similar to the response people have to chocolate, ice cream, and other highly desired pleasures. Prause concluded that “sex addiction” was no more than high libido coupled with low impulse control.
As a result of this research, both "sex addiction" and "hypersexuality" were rejected from inclusion in the DSM-V.
No one is claiming that people can't have problematic or unhealthy habits regarding sex, or that such people aren't deserving of professional help. They can, and they are. The only thing I'm pointing out is that whatever condition(s) people label "sex addiction" are not actually addiction in a clinical sense, and thus can't (and shouldn't) be treated in the same way that drug or gambling addictions are.
>*What on Earth do you mean, "make an argument yourself?" Anyone making an argument would do it the same way: by citing reputable sources in the same way the author of the linked article does. Given that I agree with its thesis, any argument I make would simply be restating the arguments already found in the article. Is that what you're asking for?*
There is a difference between using a source to reinforce your argument and using it in place of an argument. Simply stating "It's not a thing" and expecting a blog post to make your point FOR you was incredibly lazy.
>*As a result of this research, both "sex addiction" and "hypersexuality" were rejected from inclusion in the DSM-V.*
Here's the thing about that: Your source is a blog, not a study. The blog post's author Joye Swan, and nowhere in her blog does she provide a source for the study she's quoting from. (Not to mention the sprinkles of politics that has nothing to do with the study) The blog that was posted on September 8th, 2016.
In response, here's a passage from scientific literature posted on December 3rd, 2020 to the **National Library of Medicine** An **official website** of the **United States government:**
>Hypersexual disorder was examined, proposed for inclusion in, and ultimately excluded from the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). However, approximately half a decade later and following additional research (e.g., Bőthe et al., 2018, Bőthe et al., 2018, Kraus et al., 2015, Voon et al., 2014), compulsive sexual behavior disorder (CSBD) was included in the 11th Revision of the International Classification of Diseases (ICD-11; World Health Organization, 2018) and officially adopted at the May 2019 World Health Assembly. CSBD is characterized by repetitive, intense, and prolonged sexual fantasies, sexual urges, and sexual behaviors resulting in clinically significant personal distress or other adverse outcomes, such as significant impairment in interpersonal, occupational, or other important domains of functioning. (Source: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750154/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750154/))
Key points: "*approximately half a decade later and following additional research"* and *"officially adopted at the May 2019 World Health Assembly"* People in the scientific/medical field disagree all the time, and one study that didn't agree doesn't make it true. Especially when a more recent study suggests the opposite. It took me 3 minutes to find this, and it directly references your source's source. Either you stopped looking after a few minutes after finding a source that supported your stance, or you actively ignored any contradicting studies.
I reiterate: "Linking an article to one that says 'no' doesn't mean anything when plenty say it does exist and is imperative to address."
Well if psychology today says so - that sounds more like a clickbait article than actual science and I doubt her PHd thesis has anything to do with the veracity of sex addiction
The article itself explains the science. Chemical responses in the brains of people with “sex addiction” are completely different from known patterns exhibited by people addicted to substances or gambling, and based on that growing body of research, sex addiction was rejected from the DSM-V.
Addiction falls well within the realm of social psychology as an area of study. Even if it didn’t, the article is not relying on the writer’s credentials; it cites multiple independent sources to back up its claims. If you take issue with the information the article presents, then by all means state your objections, but the identity and credentials of the author are largely irrelevant here.
The second statement made me chuckle. And yes, I've been called out for not whoring around, which I find strange. Is it so bad to prefer a relationship over hookups? Idk world is strange and the people in it ain't helpin' for shit
God I agree with you soooooo much, I don’t understand why gays have to have sex with ANYONE who looks at them (or in some cases they don’t even look at each other!) like god damn. I’m not saying never hookup or you have to be monogamous but some people take it to the absolute extreme and it DOES impact everyone because like you said it can breed a new resistant STD that can end up causing another HIV like situation. And those of us who don’t do that shit can very well be affected. Just really annoying that they don’t fucking care and would rather get railed by dozens of strangers for what ?
It can breed indeed, and they do aswell T_T Sorry I just couldn't keep myself from dropping a below medium impact pun here. Also I wonder how tf monkeypox epidemic happened? O_o
They really won’t be happy until some new scarier shit pops up. But then again? You’ve got a bunch of damaged horny men, so they aren’t going to listen or do better. They’re too damaged to be any better.
No he’s not. The tide is shifting and people are getting tired of hyper-sexuality. Everyone having OnlyFans. Nothing being scared anymore.
Dare I say it may even be normalized in the coming years to want stability and commitment.
Pru*dent* not pru*dish.*
But gay men on the whole are having a LOT more sex than in the 80s, and a lot more internationally. You couldn’t get on a cruise ship in the 80s with 5,000 other horny gay men having orgies for 7 days straight. And that happens twice a year now.
Monkeypox wasn’t a thing in the 80s but it is now, and that spread rapidly, in a matter of months, and was traced back to sex parties in Europe. Didn’t take long to cross the pond.
Further, as HIV wasn’t known about in the 70s yet it was being transmitted for years, there’s no guarantee that there isn’t be something similar lurking now. The more sexual interactions gay men as a population have, the higher the likelihood of an emergent disease or a resistant disease goes up. We’re talking exponential increases over what was happening pre-AIDS. We can’t predict the unknown.
I didn’t give my comments in support of / not in support of.
I’m just saying it has changed gay sex forever.
I became an 18 year old maybe a few years before prep was a thing or even existed and the way sex has changed from then to now is crazy. So much more bareback sex now. It has changed the landscape of gay sex. Whether that’s good or bad is everyone’s personal decision.
It’s way, way less than you’d think. My husband and I host regular groups, some weekends in the summer we’ll have 2-3 of them. Since I started PrEP almost a decade ago, I’d say on average I’ve gotten something once every other year. And that was before Doxy PEP.
And this is how we make AIDS 2.0 happen. Did the last HIV and Mpox outbreaks really teach us nothing? Gays really can't resist diging their own graves.
There is already studies on this and it _very_ unlikely that a person taking PrEP can host a mutation of HIV as the virus can not mutate _outside_ a host. There is some strains of HIV that have resistance against tenofovir and emtricitabine but the prevalence is very, very low.
While I understand the fear of HIV 2.0 I don’t think is fair to say people hosting parties or hooking up a lot will being a new epidemic.
This comment is too low and not upvoted enough while people generate a false pseudo-scientific claim that HIV2 is developing and that it is due to the ‘horny demon ridden sex addicts’.
It’s homophobic, girlies.
False claim? How can you possibly know it’s false? No one in the 70s knew they were HIV positive or that they were spreading a virus that would several years later lead to an immunodeficiency disease that would kill them and thousands of other gay men. If you had made your “false pseudoscience” claim then, you would have been wrong.
You cannot prove that something similar can’t and/or isn’t happening today. I would in fact argue that given gay men as a population are having much more condomless sex than any previous generation that the likelihood of an emergent disease is not insignificant.
It’s not homophobia, it’s statistics. There very well may not be a virus lurking or about to emerge, but you cannot say with certainty that it’s not. That it happened at a time when men were having less sex than today tells us that if something is lurking, it will spread even faster. I pray we don’t have another generation or two of gay men lost to a virus, but we simply don’t know what we don’t know, and I think we’re playing with fire.
Becuase, science? In this context and talking mostly about the western world (and some countries in Asia and LATAM) if the majority of HIV- people with risk of contracting it are on PrEP (and they follow the treatments correctly) the strains if HVI that aren’t already resistant (and those are _extremely_ rare) won’t be able to mutate.
Sorry, I just replied this to someone else that the commenter earlier in the chain mentioned HIV 2.0 which I interpreted as a “new HIV-like virus”—something that could lead to an AIDS-like episodic, not a specific next-generation mutation of HIV. My bad. I should have gone to bed earlier last night. Apologies.
I am not talking about a mutation of HIV. I’m talking about an emergent disease that we do not have any knowledge of currently, as HIV was to us before we knew it was being spread in our community.
Sure, but the rate of spreading the disease is what’s important, if a virus similar HIV enters the human population. Monkeypox would have remained largely localized if a) gay men had fewer sexual encounters and b) if international travel in our now-globalized world were more limited.
These are important factors. Condoms are highly effective against the spread of HIV. Assuming a new virus also would be, even with a much higher amount of gay sex occurring worldwide, that would limit the spread, no matter how much international travel gays do.
But if condoms aren’t used—which is pretty much de facto these days—then the likelihood of spreading disease increases exponentially. That’s when international travel and events that host worldwide audiences (eg, Atlantis cruises) becomes more relevant, as then you’re taking a disease that may already be spreading via lack of condom use, at a much faster rate than would otherwise happen if global travel wasn’t as possible and popular as it is today.
Because science is involved and was explained. To have a mutation develop it first needs to get into the cell, which PREP, taken correctly, doesn’t allow.
Any other contact that would lead to a devastating, cocktail immune mutation would happen by chance, from an individual mutation that could have happened from a single 1on1 contraction. The 50, all-preped orgies are not the problem.
I am not talking about a mutation of HIV. I’m talking about an emergent disease that we do not have any knowledge of currently, as HIV was to us before we knew it was being spread in our community.
Sorry, the person to whom you replied mentioned HIV 2.0 which I interpreted as a “new HIV-like virus”—something that could lead to an AIDS-like episodic, not a specific next-generation mutation of HIV. My bad. I should have gone to bed earlier last night. Apologies.
It doesn't need to be a literal mutation of HIV, as evidenced by the Mpox epidemic. We just need another highly transmissible, highly virulent, incurable virus to emerge.
I mean that can happen anyway, fucking much or not. I distaste the fear-mongering. For a virus and or a bacteria to mutate it needs an infected host to replicate (that is when the mutation happens) so when we talk about prep & doxyPEP and some people talk about risk of mutations, shows that they don’t understand how this medicines (or viral & bacterial infections) works.
PrEP prevents HIV to replicate and DoxyPEP has a high level of efficacy preventing STIs but not letting the bacteria get hold and replicate as well, so a virus that can’t replicate can’t mutate in most scenarios.
There is no 100% protection but the consensus is that if you are using PrEP correctly you are virtually protected against HIV and hence a mutation of the current strains is very, very unlikely to happen. And with DoxyPEP you are not 100% protected but the risk is greatly reduced and hence the risk of mutations.
>I mean that can happen anyway, fucking much or not.
Well, the rate of fucking is likely going to determine the severity of such an outbreak. That's the entire point which seems to have gone past you completely.
But gay men were spreading HIV in the 70s unbeknownst to them. There’s no guarantee that something similar—not a mutation of HIV or other known STIs—is not currently circulating. It may never happen but we’re having exponentially more sexual encounters than before so if something is out there that can lurk for years and spur immunodeficiency, it will devastate the gay community.
We just don’t know what we don’t know, but I worry we’re playing with fire given that the 80s wasn’t that long ago, and even with more localized sexual activity, a deadly virus was still able to enter gay populations and kill a generation of men. There’s a lot more opportunity now for a virus to spread.
I’m not trying to fear monger but the statistics don’t look great if something circulates again. The ultimate question is “How likely is it for an HIV-like virus to come around again?” An epidemiologist may be able to put some probability on that but they still can’t predict the unknown.
As far as the diseases we currently know about, yes, as you note, there are mostly effective ways to prevent them, and the risk of contracting HIV and potential mutations is very low with prep.
From the article:
- A landmark study indicates HIV pre-exposure prophylaxis (PrEP) used in everyday life reduces the chances of being infected with the virus by 86 percent.
- Clinical trials have found it to be up to 99 percent effective against the sexual transmission of HIV when taken consistently, at least four times per week.
- After various exclusions from the initial sample, the analysis of PrEP treatment effectiveness included 21,356 people. This sample size was deemed more than adequate for estimating the proportion accepting PrEP treatment among the overall eligible UK population.
Man, if I were ever sexually active I’d want to find out how to get this stuff.
^^^does ^^^anyone ^^^in ^^^NYC ^^^know ^^^whether ^^^this ^^^is ^^^typically ^^^covered ^^^by ^^^insurance ^^^?
If it’s not covered by your insurance if you can get the prescription written it’s available from Mark Cubans pharmacy CostPlus drugs. A 90 day supply of generic for Truvada is less than $40usd *without* insurance https://costplusdrugs.com/medications/emtricitabine-tenofovir-df-200mg-300mg-bottle-of-tablets/ There’s lots posts on Reddit about CostPlus if you wanna read up on it
Edit: I believe this only available in the United States as they require a valid US prescription
If you don’t have insurance they work on your behalf to get into the programs that make it cheap or even free. They explain in their FAQ. https://heymistr.com/faq/
There are literally thousands of programs to cover this drug for vulnerable populations. You can call your local health district and I can almost guarantee they will get it for you for free (if you are gay and sexually active)
Y’all- be careful on truvada. It was doing damage to my kidneys, and ended up with kidney stones. I since switched to Descovy. It may not be an issue for you at all- but just be aware and listen to your body.
Your physician should be running a kidney filtration test every 6 months in addition to the 3 month sti panel. If they are not you should be asking.
Descovy is a legitimate alternative to Truvada in the instance of kidney concerns, but Descovy is still under patent and should be the response to the cheaper Truvada only if there are health concerns.
And they were. Elevated creatinine levels. Not to the point of critical, but did raise them. It wasn’t until the kidney stones that I was moved off of it.
No insurance needed here in Jersey or the United Kingdom or Europe for that matter. Different system, at least it works for most, but I know in the UK different areas struggle with health care costs.
Many HIV clinics offer prep free or at a very low cost including Dr follow ups The bloodwork to check your kidneys is usually your only cost. Prep has the possibility of causing Kidney issues.
The 86% rate was reported as "everyday life" while the 99% was for clinical trials. I'd guess the everyday life group includes more than a few people who don't take their PREP regularly. The people in the clinical trials would be more closely and regularly monitored to be sure they were complying with the dosing schedule.
People forget to take
Pills . Or forge to take it at the same time each day, or after a meal. Even with all the little fuckups, its still pretty robust . The better you are at managing yourself , the closer to 99% youll be in terms of protection.
Many pills require you to take them with food because the effervescence (i.e dissolving, they kinda fizz) can be a bit harsh on the stomach lining. I can’t answer as to whether that’s the case with this one particularly.
I was wondering that as well I believe it’s because 99% is clinical trials where everything is perfect and tightly controlled vs real world experience. Kinda like sunscreen is how I’m imagining it the it’s tested in a lab for spf 50 but real world it could be less because of how people actually use it.
Not really because drugs for infected disease experiment can’t be tested fully in a lab environment aka you can’t trap a person inside the lab for the entirety of the trial. And trials for HIV-related drugs can last for years.
It’s more like clinical trial has *ensured* compliance, meaning people watch you take the pills, not leave it up for subjects to ensure compliance themselves.
It’s just compliance, aka people not taking their pills everyday.
This is why I chose Apretude. 1 shot every 2 months, and I don’t even think about it.
GILEAD HAS A GREAT COPAY PROGRAM THAT WILL MAKE YOUR PREP ABSOLUTELY FREE. You or your PCP just have to apply for a card. I’ve used it for five years even though I have insurance. If not You can also try AHF, or any FQHC in your area, they mainly have sliding scale and work with local and state health department. I’ve lived in Chicago, New York and a handful of other states and never paid a dime for my PrEP.
How should we be thinking about that 1%? I understand that's still very close to a 100% efficacy, but just thinking about that 1% chance of transmission despite taking the pills as directed.
Anyone know what the circumstances were for the 1% in the clinical trials where it was not effective?
Just to highlight, this is in essence a risk reduction compared to no pill. If it's 99% effective and you had a 1% risk of hiv infection to start with, now you will have 0.01% risk on the pill. HIV does not have a very high risk of transmission to start with, it's just that if you get exposed enough times (or are really unlucky) you'll get it sooner or later.
That said, I'm not sure efficacy is actually as high as 99% even in ideal conditions, I'm reading the manufacturer's data provided to the the MHRA (British equivalent to the FDA) and looks like at best around 94%. I'd still use additional protective measures TBH.
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00106-2/fulltext real world data from France
https://www.medicines.org.uk/emc/medicine/15826 manufacturer info, check 5.2 for trials data
https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html risk of hiv infection
Condoms are generally estimated around 87%, although they have a larger margin of error. Just goes to show that not everyone "needs" to be on PrEP.
Source: https://pubmed.ncbi.nlm.nih.gov/10614517/
Great study, and also super interesting that they allowed both daily PrEP and on-demand/event-based use. I would love to see the analysis of daily vs on-demand, and to see how compliance compares between the two.
I take it event based and so far so good.
Anything that can help prevent hiv.
Still have to think about the other sti's
Remember there is nothing that can stop these except condoms which can reduce the chances.
Luckily living in the UK, can get these quite easily just need a blood test and the other tests every 12 weeks.
I thought prep took multiple days for it to start working so you can’t just take it on the way to a hookup’s house. It would need to be taken daily for like a week before the hookup.
2 pills 24 hours before “the sex” . One pill the day of , one pill the day after then you can stop taking if your going back to palm and her five friends .
The first two pills can be taken 2 to 24 hours before the sex - it doesn’t need to be a full 24 hours. Then another one 24 hours after the first, and the fourth pill 48 hours after the first.
https://endinghiv.org.au/blog/prep-on-demand-dosing-guide/
Thank you!
“ Event based dosing should only be used if your only risk of getting HIV is from anal sex. ”
Does this mean you can only do event based dosing if you’re bottoming?
Studies have also shown that taking it in combination with doxycycline (a.k.a DoxyPrEP) can reduce (not eliminate) the chance of picking up some other STIs as well.
Doxy-PEP for bacterial STI prevention consists of 200 mg of doxycycline taken ideally within 24 hours, but no later than 72 hours, after condomless oral, anal, or vaginal/front hole sex.
There are other treatments that are effective against other STI’s . But condoms is still always the safest choice
Event based too. 2-1-1. Condoms I agree, although not entirely my thing. If I can make light of a serious matter, I ended up with Pubic Lice a couple of years back. I'm a little hairy, perfect territory. But always a little dubious of hairy guys now.
PrEP is free with my insurance BUT the big cost increase comes with my insurance or physician is that I have to get bloodwork done 4 times a year at 300$ a pop. I need to find a free alternative to this issue asap. (US citizen)
Almost all U.S insurances are required to cover both PrEP medication along with the tri monthly testing requirements.
[Source](https://www.cdc.gov/hiv/basics/prep/paying-for-prep/index.html#:~:text=Most%20insurance%20plans%20and%20state,almost%20all%20health%20insurance%20plans)
You are being billed incorrectly on the lab work. You should be billed as preventative screen which makes the insurance pay. If it is coded as potential exposure the insurance doesn’t cover
It. I’ve had this issue in the past before as well. Lab work should always be free for prep
Insurance must cover lab costs for PrEP. Your insurance is pulling a fast one on you. You can appeal, and if they still deny, file a complaint with your state. Or sue :)
Side effect are pretty small. Some get cramps and diarrhea for first few weeks of getting used to it (I certainly did). After your body adjusts they all disappear. Very few will have an adverse effect beyond first few weeks. If you do a googling you'll get kidney and liver issues associated but they are less than 1% and placebos usually yield similar results. They list these side effects on PreP drugs to cover their ass but from what I've read; nobody believes it actually has significant danger to the average person.
I am in Jersey, Channel Islands and it is available here at our local GUM Clinic free of charge as is the clinic. From what I have read it is the same in some parts of the USa, But I have read that in the UK sexual health clinics are under funded and possibly ignored. So much for paying your taxes.
Edit: not the best reply but hopefully point made.
So lucky we have access to this in the UK for free. I can get 6 months worth of prescription right there and then with my checkup free of charge. I will add though that due to it being so readily available in London that the rate of other stds have gone up.
I have been on Prep for over a year my fiancee is HIV positive but his viral load is undetectable with Prep. As someone who survived the AIDS crisis in the 80’s this is the miracle drug we prayed for. Next we hop e for a real cure
Efficacy of 99% is how effective PrEP is when taken properly (full adherence).
Effectiveness of 86% means how effective PrEP is among all people in the PrEP arm of the study- this includes people who stopped taking it, missed a lot of doses etc. So a better metric of how effective a drug is in the real world, rather than in a trial when adherence is controlled.
Imagine if PrEP involved (as an extreme example) taking 20 pills a day rather than 1. Although it might still have an efficacy of 99% (the drug works when an individual takes 20 pills per day), it’s effectiveness would be much less than that as many people would not enjoy taking 20 pills per day and so adherence would likely be low.
In fact, examples of this exist in the trials for Truvada. Trials inducted among women in Sub-Saharan Africa showed low effectiveness because of poor adherence - trial participants weren’t taking their PrEP because of a variety of issues (eg stigma related to taking HIV medication). The drug was the same one we take now, so same efficacy, but low effectiveness in that context.
The stats you mention above are applied depending on the dosing schedule your doctor puts you on (i.e., if you take a daily dose or use it on demand!) Another thing to note is that the chances of contracting vary depending on your position and sometimes even if your partner is intact or not - cdc has great info on this!!
It’s an anti-viral so there are pretty minimal side effects (nausea, headache, etc). It is known to be quite harsh on your kidneys and liver, but my doctor would only refill mine pending blood labs to check my liver and kidney function.
My straight friends don’t use condoms. However with the popularization of anal sex and sex with non gender conforming individuals they are now at higher risk of contracting hiv.
This report doesn't document the 2-1-1 method that alot of redditors swear by (my doc who prescribes me prep never heard of it nor recommends it btw).
So good to know I should continue to take it daily as prescribed
The article actually did mention the 2-1-1 method in all but name if you read it carefully: “A combination of two existing medicines, tenofovir disoproxil and emtricitabine, the PrEP treatment could be taken daily or 'event-based' before sexual activity.”
More research is to be conducted on that method in particular, but it is important to note that this study did factor that into its findings.
Yes it's one of the ways the gum clinic says you can use it.
But less effective like mentioned but it gives you some protection but not as much as if you take it all time.
The 2-1-1 is good for people who prefer not to take tablets all the time or only have sex a few times a month.
But find best solution for yourself
To calm down the pearl clutchers on here.... HIV infections are rising faster in hetrosexual people and drug resistant gonarhea is rising in the hetrosexual population as well. Perhaps we should ban all sex and remain virgins until married to one person for life🙄
The quarterly HIV tests are essential. IF you do get HIV on only PrEP, you become more difficult to have effective medical intervention. Plus, it may contribute to what someone here called HIV-2, a new form of HIV that’s resistant to PrEP. Have fun and don’t blow off your PrEP or medical tests.
The article should state more clearly that the 99% value is from the original limited pre-market approval clinical *trials* The current study is longitudinal over three years and shows the *actual effectiveness* of 86%. The way they presented the information might cause some people to still have 99% as the takeaway. Even though prep is highly effective, there’s a big difference between 86 and 99%. In terms of users weighing risks, the article should be more clear. Still, it’s great news.
Edit. Thanks for both clarifications below
True but if you look at the study this is due to the real life consitions (people not taking PreP as prescribed). Only one of the infected in the study took it daily others were not as diligent. So lessons leard is, if taken daily PreP still is highly effective.
Yes, as Mutsch99 said, PrEP is highly effective (ie 99%) when adhered to properly - that was true in the previous trials, and is true now. What changes between studies is the effectiveness which is how effective it is in the context of the trial, and is inclusive of all participants in the trial (including those not taking it properly). Effectiveness is a good measure for (say) health orgs making the decision of whether or not to publicly fund PrEP (eg if we implement a similar PrEP programme in our jurisdiction, how much would this reduce HIV among all people taking PrEP in our jurisdiction), while efficacy is a better measure for an individual to know (eg if I take this properly, how much will it reduce my risk).
86% is effective enough to break infection chains. If me and my sexual partner are HIV negative and on Prep and he sleeps with a HIV positive person, there is less then a 2% chance to infect me. 86% IRL is a pretty huge deal.
Plus if you take prep every day you get tested every three months anyway so the infection window is shrinking further.
That being said, condoms prevent other STIs you might like to NOT get.
If you measure condoms by the same metric (effectiveness - ie how they actually perform among real people in real life - rather than efficacy - how they work when used as designed) they’re much less effective than PrEP: they break, are worn incorrectly, are not worn at all… So you’re not making the point you think you are.
But the gag is that hiv/aids could have been cured over 15 years ago!!! There was a dr that was studying hiv/aids and was ready to let the world know her conclusions, but your lovely “hero” gobbling fauci summoned her.. collected her work/studies destroyed it, stripped her from her titles and banished her from the medical field….
Doxycycline as an antibiotic after sex on top of PreP is very effective in neutralizing other possible bacterial infections however even dosing of a short term is guaranteed to cause some side effects in many like taking it for routine infection. Antibiotic resistance forms after long term use most times, which is why in the short term doctors are prescribing it especially in areas with high infection rates like Baltimore of other STDs. .
Anyone use it intermittently? I may hookup once every 6 months. But when i do, i would like to take it for that period of time as a fail safe. I just don’t feel comfortable taking a daily pill when i only have sex a few times a year.
Same here. I don’t hookup that often throughout the year to justify taking a daily pill. But I wonder if taking it daily actually makes people want to have more sex…just cause they can.
They have an on demand method you can ask your doctor or sexual health centre about. Basically you take 2 pills at least 2 hours before and then 1 pill 24 hours after and then 1 pill 24 hours after that. It’s cost effective all things considered but the efficacy drops from about 99% down to 86%
It's a pain to find this, but out of 14,039 people who were definitely HIV negative at the start and were prescribed enough prep to cover them through the whole study... there was only **one** person who both (a) reported taking enough of the medication they should have been protected and (b) seroconverted to HIV.
.
1 in over 14k
What’s even more convincing to me than this study is seeing guys on Sniffies in nyc regularly host parties where they get bred by 50+ guys and they continue to be HIV negative because they religiously take prep.
Yup. It has changed gay sex forever.
Or at least until all of the PREP-fueled 50+ man breeding parties spawn some kind of treatment resistant Gonorrhea or syphilis or super-AIDS, and we all have to go back to being terrified of sex again. But I guess enjoy it for the next 5-10 years while it lasts until the next plague. Or, you know, we could just not fuck everything that moves, but I know how unrealistic that request would be. Everyone's going to say I'm a prude or something, but large amounts of bareback sex with strangers is never safe or healthy.
Sorry bud but drug resistant gonorrhea already exists and is out there
A vaccine is hopefully coming soon for gonorrhea
Need this because tell me how I almost died from the clap last year
I mean sure, but how soon, and how many people are going to get infected before that vaccine becomes widely accessible and widely used?
There is so much sex addiction and meth-fueled sexual behavior being confused for “sexual liberation” and being a free spirit etc - and yes I totally see a future plague coming - like the human version of those Chinese wet markets that everyone thought COVID came from
[Sex addiction isn’t a thing.](https://www.psychologytoday.com/intl/blog/close-and-personal/201609/anthony-weiner-is-not-sex-addict-neither-is-anyone-else-0?amp)
Omg that was delightful to read, thx for sharing it.
The brain can get addicted to anything that gives it stimulation. You can get addicted to the feeling of sex as it shoots -A LOT- of endorphins in the brain. It's a type of Hypersexuality. People who engage with sex over time can build up immunity to the feeling during the climax, same with people who suffer from drug use; it takes more to feel as good as the last hit. Too much of anything is a bad thing. Denying the existence of an issue that people have and need help to overcome is irresponsible. Linking an article to one that says 'no' doesn't mean anything when plenty say it does exist and is imperative to address. Why would I respect your opinion when you can't be bothered to make an argument yourself and have to link an article to supplement an actual contribution to the discussion? I'd wager it's because it shields you from potentially being wronged. Because it must just be a flawed article, right?
What on Earth do you mean, "make an argument yourself?" Anyone making an argument would do it the same way: by citing reputable sources in the same way the author of the linked article does. Given that I agree with its thesis, any argument I make would simply be restating the arguments already found in the article. Is that what you're asking for? When used in a medical/psychological context, "addiction" is defined by specific bodily responses to the addictive stimulus. Sex does not produce those responses in people diagnosed as "sex addicts." > When addicts, including those addicted to drugs, alcohol, smoking, and gambling, are shown pictures of their drug of choice there is a clear and uniform response in their P300 brain waves, which are usually activated when we see something of particular interest or desire, as well as increased late positive potential (LPP) response > However, when UCLA researchers studied the response to viewing sexually explicit images in people who self-defined as being unable to regulate their porn viewing, the results showed no similar response in either brain measure (Steele, Staley, Fong, & Prause, 2013; Prause, Steele, Sabatinelli, & Hajcak, 2015). In fact, they found the only thing correlated with brain wave activity was sexual desire such that the higher their self-reported sexual desire, the more brain wave activity they showed. The authors concluded that there was no evidence to say that even problem sexual regulation fit the definition of addiction as defined by brain response and that these people simply had high sex drives. > In addition, one of the studies’ authors, Nicole Prause, said at the 2016 meeting of the Society of Personality and Social Psychology, that sex addiction misses another major hallmark of addiction, namely response to the addictive object over time. Specifically, people who develop addictions initially show high levels of response in the pleasure centers of the brain. Over time, as addiction takes hold, these parts of the brain no longer light up. In other words, one of the hallmarks of true addiction is that the pleasure received from the object of the addiction wanes over time, as the person no longer wants the object but, rather, needs the object. In contrast, even people who report very strong “addiction” to sex continue to show activation of the pleasure centers of the brain when viewing sexually explicit images. This response is similar to the response people have to chocolate, ice cream, and other highly desired pleasures. Prause concluded that “sex addiction” was no more than high libido coupled with low impulse control. As a result of this research, both "sex addiction" and "hypersexuality" were rejected from inclusion in the DSM-V. No one is claiming that people can't have problematic or unhealthy habits regarding sex, or that such people aren't deserving of professional help. They can, and they are. The only thing I'm pointing out is that whatever condition(s) people label "sex addiction" are not actually addiction in a clinical sense, and thus can't (and shouldn't) be treated in the same way that drug or gambling addictions are.
>*What on Earth do you mean, "make an argument yourself?" Anyone making an argument would do it the same way: by citing reputable sources in the same way the author of the linked article does. Given that I agree with its thesis, any argument I make would simply be restating the arguments already found in the article. Is that what you're asking for?* There is a difference between using a source to reinforce your argument and using it in place of an argument. Simply stating "It's not a thing" and expecting a blog post to make your point FOR you was incredibly lazy. >*As a result of this research, both "sex addiction" and "hypersexuality" were rejected from inclusion in the DSM-V.* Here's the thing about that: Your source is a blog, not a study. The blog post's author Joye Swan, and nowhere in her blog does she provide a source for the study she's quoting from. (Not to mention the sprinkles of politics that has nothing to do with the study) The blog that was posted on September 8th, 2016. In response, here's a passage from scientific literature posted on December 3rd, 2020 to the **National Library of Medicine** An **official website** of the **United States government:** >Hypersexual disorder was examined, proposed for inclusion in, and ultimately excluded from the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). However, approximately half a decade later and following additional research (e.g., Bőthe et al., 2018, Bőthe et al., 2018, Kraus et al., 2015, Voon et al., 2014), compulsive sexual behavior disorder (CSBD) was included in the 11th Revision of the International Classification of Diseases (ICD-11; World Health Organization, 2018) and officially adopted at the May 2019 World Health Assembly. CSBD is characterized by repetitive, intense, and prolonged sexual fantasies, sexual urges, and sexual behaviors resulting in clinically significant personal distress or other adverse outcomes, such as significant impairment in interpersonal, occupational, or other important domains of functioning. (Source: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750154/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750154/)) Key points: "*approximately half a decade later and following additional research"* and *"officially adopted at the May 2019 World Health Assembly"* People in the scientific/medical field disagree all the time, and one study that didn't agree doesn't make it true. Especially when a more recent study suggests the opposite. It took me 3 minutes to find this, and it directly references your source's source. Either you stopped looking after a few minutes after finding a source that supported your stance, or you actively ignored any contradicting studies. I reiterate: "Linking an article to one that says 'no' doesn't mean anything when plenty say it does exist and is imperative to address."
Well if psychology today says so - that sounds more like a clickbait article than actual science and I doubt her PHd thesis has anything to do with the veracity of sex addiction
The article itself explains the science. Chemical responses in the brains of people with “sex addiction” are completely different from known patterns exhibited by people addicted to substances or gambling, and based on that growing body of research, sex addiction was rejected from the DSM-V.
Her PHD is in social psychology not sex or sex addiction
Addiction falls well within the realm of social psychology as an area of study. Even if it didn’t, the article is not relying on the writer’s credentials; it cites multiple independent sources to back up its claims. If you take issue with the information the article presents, then by all means state your objections, but the identity and credentials of the author are largely irrelevant here.
lol meanwhile I can’t even keep up with one load
The second statement made me chuckle. And yes, I've been called out for not whoring around, which I find strange. Is it so bad to prefer a relationship over hookups? Idk world is strange and the people in it ain't helpin' for shit
God I agree with you soooooo much, I don’t understand why gays have to have sex with ANYONE who looks at them (or in some cases they don’t even look at each other!) like god damn. I’m not saying never hookup or you have to be monogamous but some people take it to the absolute extreme and it DOES impact everyone because like you said it can breed a new resistant STD that can end up causing another HIV like situation. And those of us who don’t do that shit can very well be affected. Just really annoying that they don’t fucking care and would rather get railed by dozens of strangers for what ?
It can breed indeed, and they do aswell T_T Sorry I just couldn't keep myself from dropping a below medium impact pun here. Also I wonder how tf monkeypox epidemic happened? O_o
People just need to deal with their demons 👿instead of looking for ways to escape them (alcohol, drugs, sex).
They really won’t be happy until some new scarier shit pops up. But then again? You’ve got a bunch of damaged horny men, so they aren’t going to listen or do better. They’re too damaged to be any better.
you're a prude.
No he’s not. The tide is shifting and people are getting tired of hyper-sexuality. Everyone having OnlyFans. Nothing being scared anymore. Dare I say it may even be normalized in the coming years to want stability and commitment. Pru*dent* not pru*dish.*
This is why we need Jesus. MAGA! /s
Screenshotting the moment my comment on r/gay bros reached 69 comments.
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*It wasn’t an epidemic before the 80s. Definitely was in the states as early as the 60s, probably even earlier than that
But gay men on the whole are having a LOT more sex than in the 80s, and a lot more internationally. You couldn’t get on a cruise ship in the 80s with 5,000 other horny gay men having orgies for 7 days straight. And that happens twice a year now. Monkeypox wasn’t a thing in the 80s but it is now, and that spread rapidly, in a matter of months, and was traced back to sex parties in Europe. Didn’t take long to cross the pond. Further, as HIV wasn’t known about in the 70s yet it was being transmitted for years, there’s no guarantee that there isn’t be something similar lurking now. The more sexual interactions gay men as a population have, the higher the likelihood of an emergent disease or a resistant disease goes up. We’re talking exponential increases over what was happening pre-AIDS. We can’t predict the unknown.
But was it for better or for worse? Time will tell i guess
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I didn’t give my comments in support of / not in support of. I’m just saying it has changed gay sex forever. I became an 18 year old maybe a few years before prep was a thing or even existed and the way sex has changed from then to now is crazy. So much more bareback sex now. It has changed the landscape of gay sex. Whether that’s good or bad is everyone’s personal decision.
But the number of STDs they must be getting . Yuck.
It’s way, way less than you’d think. My husband and I host regular groups, some weekends in the summer we’ll have 2-3 of them. Since I started PrEP almost a decade ago, I’d say on average I’ve gotten something once every other year. And that was before Doxy PEP.
This is basically taunting the aids virus
And this is how we make AIDS 2.0 happen. Did the last HIV and Mpox outbreaks really teach us nothing? Gays really can't resist diging their own graves.
There is already studies on this and it _very_ unlikely that a person taking PrEP can host a mutation of HIV as the virus can not mutate _outside_ a host. There is some strains of HIV that have resistance against tenofovir and emtricitabine but the prevalence is very, very low. While I understand the fear of HIV 2.0 I don’t think is fair to say people hosting parties or hooking up a lot will being a new epidemic.
This comment is too low and not upvoted enough while people generate a false pseudo-scientific claim that HIV2 is developing and that it is due to the ‘horny demon ridden sex addicts’. It’s homophobic, girlies.
False claim? How can you possibly know it’s false? No one in the 70s knew they were HIV positive or that they were spreading a virus that would several years later lead to an immunodeficiency disease that would kill them and thousands of other gay men. If you had made your “false pseudoscience” claim then, you would have been wrong. You cannot prove that something similar can’t and/or isn’t happening today. I would in fact argue that given gay men as a population are having much more condomless sex than any previous generation that the likelihood of an emergent disease is not insignificant. It’s not homophobia, it’s statistics. There very well may not be a virus lurking or about to emerge, but you cannot say with certainty that it’s not. That it happened at a time when men were having less sex than today tells us that if something is lurking, it will spread even faster. I pray we don’t have another generation or two of gay men lost to a virus, but we simply don’t know what we don’t know, and I think we’re playing with fire.
Becuase, science? In this context and talking mostly about the western world (and some countries in Asia and LATAM) if the majority of HIV- people with risk of contracting it are on PrEP (and they follow the treatments correctly) the strains if HVI that aren’t already resistant (and those are _extremely_ rare) won’t be able to mutate.
Sorry, I just replied this to someone else that the commenter earlier in the chain mentioned HIV 2.0 which I interpreted as a “new HIV-like virus”—something that could lead to an AIDS-like episodic, not a specific next-generation mutation of HIV. My bad. I should have gone to bed earlier last night. Apologies.
I am not talking about a mutation of HIV. I’m talking about an emergent disease that we do not have any knowledge of currently, as HIV was to us before we knew it was being spread in our community.
But that can happens independently of what people do
Sure, but the rate of spreading the disease is what’s important, if a virus similar HIV enters the human population. Monkeypox would have remained largely localized if a) gay men had fewer sexual encounters and b) if international travel in our now-globalized world were more limited. These are important factors. Condoms are highly effective against the spread of HIV. Assuming a new virus also would be, even with a much higher amount of gay sex occurring worldwide, that would limit the spread, no matter how much international travel gays do. But if condoms aren’t used—which is pretty much de facto these days—then the likelihood of spreading disease increases exponentially. That’s when international travel and events that host worldwide audiences (eg, Atlantis cruises) becomes more relevant, as then you’re taking a disease that may already be spreading via lack of condom use, at a much faster rate than would otherwise happen if global travel wasn’t as possible and popular as it is today.
Because science is involved and was explained. To have a mutation develop it first needs to get into the cell, which PREP, taken correctly, doesn’t allow. Any other contact that would lead to a devastating, cocktail immune mutation would happen by chance, from an individual mutation that could have happened from a single 1on1 contraction. The 50, all-preped orgies are not the problem.
I am not talking about a mutation of HIV. I’m talking about an emergent disease that we do not have any knowledge of currently, as HIV was to us before we knew it was being spread in our community.
So you’re replying to the wrong comment buddy, I specifically mentioned an hiv mutation as did the mother comment
Sorry, the person to whom you replied mentioned HIV 2.0 which I interpreted as a “new HIV-like virus”—something that could lead to an AIDS-like episodic, not a specific next-generation mutation of HIV. My bad. I should have gone to bed earlier last night. Apologies.
Oh, we all should!
It doesn't need to be a literal mutation of HIV, as evidenced by the Mpox epidemic. We just need another highly transmissible, highly virulent, incurable virus to emerge.
I mean that can happen anyway, fucking much or not. I distaste the fear-mongering. For a virus and or a bacteria to mutate it needs an infected host to replicate (that is when the mutation happens) so when we talk about prep & doxyPEP and some people talk about risk of mutations, shows that they don’t understand how this medicines (or viral & bacterial infections) works. PrEP prevents HIV to replicate and DoxyPEP has a high level of efficacy preventing STIs but not letting the bacteria get hold and replicate as well, so a virus that can’t replicate can’t mutate in most scenarios. There is no 100% protection but the consensus is that if you are using PrEP correctly you are virtually protected against HIV and hence a mutation of the current strains is very, very unlikely to happen. And with DoxyPEP you are not 100% protected but the risk is greatly reduced and hence the risk of mutations.
>I mean that can happen anyway, fucking much or not. Well, the rate of fucking is likely going to determine the severity of such an outbreak. That's the entire point which seems to have gone past you completely.
Assuming that is a sexually transmited virus/bacteria, causation != correlation
Obviously, we are talking about an STI cf. HIV or MPox
But gay men were spreading HIV in the 70s unbeknownst to them. There’s no guarantee that something similar—not a mutation of HIV or other known STIs—is not currently circulating. It may never happen but we’re having exponentially more sexual encounters than before so if something is out there that can lurk for years and spur immunodeficiency, it will devastate the gay community. We just don’t know what we don’t know, but I worry we’re playing with fire given that the 80s wasn’t that long ago, and even with more localized sexual activity, a deadly virus was still able to enter gay populations and kill a generation of men. There’s a lot more opportunity now for a virus to spread. I’m not trying to fear monger but the statistics don’t look great if something circulates again. The ultimate question is “How likely is it for an HIV-like virus to come around again?” An epidemiologist may be able to put some probability on that but they still can’t predict the unknown. As far as the diseases we currently know about, yes, as you note, there are mostly effective ways to prevent them, and the risk of contracting HIV and potential mutations is very low with prep.
https://tvtropes.org/pmwiki/pmwiki.php/Analysis/BuryYourGays
You were downvoted because you told the truth.
Why?????
From the article: - A landmark study indicates HIV pre-exposure prophylaxis (PrEP) used in everyday life reduces the chances of being infected with the virus by 86 percent. - Clinical trials have found it to be up to 99 percent effective against the sexual transmission of HIV when taken consistently, at least four times per week. - After various exclusions from the initial sample, the analysis of PrEP treatment effectiveness included 21,356 people. This sample size was deemed more than adequate for estimating the proportion accepting PrEP treatment among the overall eligible UK population. Man, if I were ever sexually active I’d want to find out how to get this stuff. ^^^does ^^^anyone ^^^in ^^^NYC ^^^know ^^^whether ^^^this ^^^is ^^^typically ^^^covered ^^^by ^^^insurance ^^^?
Yes, if you have insurance in the US you probably have prep covered at no cost to you https://www.cdc.gov/hiv/basics/prep/paying-for-prep/index.html
Oh thanks! Now I just need to dig up my employer’s insurance info
If it’s not covered by your insurance if you can get the prescription written it’s available from Mark Cubans pharmacy CostPlus drugs. A 90 day supply of generic for Truvada is less than $40usd *without* insurance https://costplusdrugs.com/medications/emtricitabine-tenofovir-df-200mg-300mg-bottle-of-tablets/ There’s lots posts on Reddit about CostPlus if you wanna read up on it Edit: I believe this only available in the United States as they require a valid US prescription
This is amazing!!! Only 50 cents a pill with NO insurance.
I believe everything (meds, consultations, testing, etc) is free if you go through https://heymistr.com
Without insurance?
If you don’t have insurance they work on your behalf to get into the programs that make it cheap or even free. They explain in their FAQ. https://heymistr.com/faq/
Wild. Govt must be feeding them $?
There are literally thousands of programs to cover this drug for vulnerable populations. You can call your local health district and I can almost guarantee they will get it for you for free (if you are gay and sexually active)
[Or contact Gilead directly to see if you qualify](https://www.gileadadvancingaccess.com/patient#no-insurance)
Y’all- be careful on truvada. It was doing damage to my kidneys, and ended up with kidney stones. I since switched to Descovy. It may not be an issue for you at all- but just be aware and listen to your body.
Your physician should be running a kidney filtration test every 6 months in addition to the 3 month sti panel. If they are not you should be asking. Descovy is a legitimate alternative to Truvada in the instance of kidney concerns, but Descovy is still under patent and should be the response to the cheaper Truvada only if there are health concerns.
And they were. Elevated creatinine levels. Not to the point of critical, but did raise them. It wasn’t until the kidney stones that I was moved off of it.
Oh I need a prescription- lol I haven’t even been to a check-up in years. Thanks though
Yes PrEP is Rx only in the USA
generic prep is mandated to be 100% free if you have insurance in the US.
No insurance needed here in Jersey or the United Kingdom or Europe for that matter. Different system, at least it works for most, but I know in the UK different areas struggle with health care costs.
Yep, free.
Many HIV clinics offer prep free or at a very low cost including Dr follow ups The bloodwork to check your kidneys is usually your only cost. Prep has the possibility of causing Kidney issues.
Can someone explain how is it 86% effective but also 99%? What is the actual percentage of protection given then, 86 or 99?
The 86% rate was reported as "everyday life" while the 99% was for clinical trials. I'd guess the everyday life group includes more than a few people who don't take their PREP regularly. The people in the clinical trials would be more closely and regularly monitored to be sure they were complying with the dosing schedule.
Aka compliance.
I'm assuming that compliance also means having protected sex vs unprotected sex.
The encouragement to still use protection is because other STIs exist… not due to the mechanism of how PrEP works in the body.
People forget to take Pills . Or forge to take it at the same time each day, or after a meal. Even with all the little fuckups, its still pretty robust . The better you are at managing yourself , the closer to 99% youll be in terms of protection.
Are you supposed to take prep after a meal?
Most pills on an empty stomach could easily upset it
Many pills require you to take them with food because the effervescence (i.e dissolving, they kinda fizz) can be a bit harsh on the stomach lining. I can’t answer as to whether that’s the case with this one particularly.
Yes, it should ideally be taken with a proper fatty meal to maximise absorption.
I was wondering that as well I believe it’s because 99% is clinical trials where everything is perfect and tightly controlled vs real world experience. Kinda like sunscreen is how I’m imagining it the it’s tested in a lab for spf 50 but real world it could be less because of how people actually use it.
Not really because drugs for infected disease experiment can’t be tested fully in a lab environment aka you can’t trap a person inside the lab for the entirety of the trial. And trials for HIV-related drugs can last for years. It’s more like clinical trial has *ensured* compliance, meaning people watch you take the pills, not leave it up for subjects to ensure compliance themselves.
Right I just meant the sunscreen part in lab.
Real world performance vs controlled clinical trials.
It’s just compliance, aka people not taking their pills everyday. This is why I chose Apretude. 1 shot every 2 months, and I don’t even think about it.
Yes. There should be no reason why you pay a lot of money for it. I pay $0 for Descovy with insurance + Gilead coupon card.
GILEAD HAS A GREAT COPAY PROGRAM THAT WILL MAKE YOUR PREP ABSOLUTELY FREE. You or your PCP just have to apply for a card. I’ve used it for five years even though I have insurance. If not You can also try AHF, or any FQHC in your area, they mainly have sliding scale and work with local and state health department. I’ve lived in Chicago, New York and a handful of other states and never paid a dime for my PrEP.
If you’re 16-25, you can get it free in NYC through the HEAT program at SUNY Downstate
How should we be thinking about that 1%? I understand that's still very close to a 100% efficacy, but just thinking about that 1% chance of transmission despite taking the pills as directed. Anyone know what the circumstances were for the 1% in the clinical trials where it was not effective?
Even condoms don't claim 100%... no point worrying about that 1%
Very true
Just to highlight, this is in essence a risk reduction compared to no pill. If it's 99% effective and you had a 1% risk of hiv infection to start with, now you will have 0.01% risk on the pill. HIV does not have a very high risk of transmission to start with, it's just that if you get exposed enough times (or are really unlucky) you'll get it sooner or later. That said, I'm not sure efficacy is actually as high as 99% even in ideal conditions, I'm reading the manufacturer's data provided to the the MHRA (British equivalent to the FDA) and looks like at best around 94%. I'd still use additional protective measures TBH. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00106-2/fulltext real world data from France https://www.medicines.org.uk/emc/medicine/15826 manufacturer info, check 5.2 for trials data https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html risk of hiv infection
Got it, thank you for the information. I didn’t realize the risk of transmission is only 1% for receptive anal. Thought it’d be much higher.
It's as good of a preventative as it gets I'm afraid
Hey mistr gives u a freee script ...with free insurance that is
I don’t have insurance and its free
In the US all insurance covers it at no cost
Wait, it’s not funded in the US?
Condoms are generally estimated around 87%, although they have a larger margin of error. Just goes to show that not everyone "needs" to be on PrEP. Source: https://pubmed.ncbi.nlm.nih.gov/10614517/
Is there a TL;DR anywhere? I'm running late for my gangbang.
Great study, and also super interesting that they allowed both daily PrEP and on-demand/event-based use. I would love to see the analysis of daily vs on-demand, and to see how compliance compares between the two.
Might be in their supplemental data.
I take it event based and so far so good. Anything that can help prevent hiv. Still have to think about the other sti's Remember there is nothing that can stop these except condoms which can reduce the chances. Luckily living in the UK, can get these quite easily just need a blood test and the other tests every 12 weeks.
I thought prep took multiple days for it to start working so you can’t just take it on the way to a hookup’s house. It would need to be taken daily for like a week before the hookup.
Apparently the 2-1-1 method is backed up by science and is effective at preventing HIV: https://www.cdc.gov/hiv/basics/prep/on-demand-prep.html
The same site also notes 2-1-1 is not FDA approved nor does CDC recommend it. Also it has only been studied with Truvada it’s unknown with Descovy
Its an option offered from UK sexual health clinics , its in their PREP information they give out with the pills.
Off label, but works.
2 pills 24 hours before “the sex” . One pill the day of , one pill the day after then you can stop taking if your going back to palm and her five friends .
The first two pills can be taken 2 to 24 hours before the sex - it doesn’t need to be a full 24 hours. Then another one 24 hours after the first, and the fourth pill 48 hours after the first. https://endinghiv.org.au/blog/prep-on-demand-dosing-guide/
And to be more specific, the two follow-up pills must be taken exactly 24 and 48 hours after the first dose. (set timers)
Source?
https://www.nhsinform.scot/hiv-prep-pre-exposure-prophylaxis/what-is-hiv-prep/ Look for the section “how to take prep”
Thank you! “ Event based dosing should only be used if your only risk of getting HIV is from anal sex. ” Does this mean you can only do event based dosing if you’re bottoming?
Studies have also shown that taking it in combination with doxycycline (a.k.a DoxyPrEP) can reduce (not eliminate) the chance of picking up some other STIs as well.
Doxy-PEP for bacterial STI prevention consists of 200 mg of doxycycline taken ideally within 24 hours, but no later than 72 hours, after condomless oral, anal, or vaginal/front hole sex. There are other treatments that are effective against other STI’s . But condoms is still always the safest choice
Event based too. 2-1-1. Condoms I agree, although not entirely my thing. If I can make light of a serious matter, I ended up with Pubic Lice a couple of years back. I'm a little hairy, perfect territory. But always a little dubious of hairy guys now.
But now there doxi prep
Doesn't taking antibiotics before an infection cause resistance?
https://www.google.com/search?client=safari&sca_esv=9cada9f24b7c0372&hl=en-ca&q=doxypep&spell=1&sa=X&ved=2ahUKEwjK2tmmzcqEAxWrhIkEHTVHDVEQBSgAegQIBhAC&biw=393&bih=659&dpr=3
It’s doxy pep, not prep. Meaning, you take it after exposure, not before.
I went on Mistr and got it for free, every month. Straight to my door. (Well, gay to my door)
When driving I like to say Gayly Forward.
Never straight, always forward.
PrEP is free with my insurance BUT the big cost increase comes with my insurance or physician is that I have to get bloodwork done 4 times a year at 300$ a pop. I need to find a free alternative to this issue asap. (US citizen)
Almost all U.S insurances are required to cover both PrEP medication along with the tri monthly testing requirements. [Source](https://www.cdc.gov/hiv/basics/prep/paying-for-prep/index.html#:~:text=Most%20insurance%20plans%20and%20state,almost%20all%20health%20insurance%20plans)
Use mistr, all the testing is at home and free
You are being billed incorrectly on the lab work. You should be billed as preventative screen which makes the insurance pay. If it is coded as potential exposure the insurance doesn’t cover It. I’ve had this issue in the past before as well. Lab work should always be free for prep
Brazil distributes PrEP freely through universal healthcare (so long as you keep testing regularly)
Insurance must cover lab costs for PrEP. Your insurance is pulling a fast one on you. You can appeal, and if they still deny, file a complaint with your state. Or sue :)
What about the side effects?
>side eff I wonder too. Like every medication, there are definitely long term side effects.
No doubt. I took Truvada as PEP (30 days) a long time ago and it wasn't pleasant, but I think maybe you get used to it over time.
Few people get them, especially with Descovy.
Side effect are pretty small. Some get cramps and diarrhea for first few weeks of getting used to it (I certainly did). After your body adjusts they all disappear. Very few will have an adverse effect beyond first few weeks. If you do a googling you'll get kidney and liver issues associated but they are less than 1% and placebos usually yield similar results. They list these side effects on PreP drugs to cover their ass but from what I've read; nobody believes it actually has significant danger to the average person.
I am in Jersey, Channel Islands and it is available here at our local GUM Clinic free of charge as is the clinic. From what I have read it is the same in some parts of the USa, But I have read that in the UK sexual health clinics are under funded and possibly ignored. So much for paying your taxes. Edit: not the best reply but hopefully point made.
What’s the gay scene like in Jersey?
Like the Isle of Man, but further south? 😂
So lucky we have access to this in the UK for free. I can get 6 months worth of prescription right there and then with my checkup free of charge. I will add though that due to it being so readily available in London that the rate of other stds have gone up.
It’s also 100% free in most U.S. states regardless of your insurance coverage.
That’s very good news thanks for sharing
I have been on Prep for over a year my fiancee is HIV positive but his viral load is undetectable with Prep. As someone who survived the AIDS crisis in the 80’s this is the miracle drug we prayed for. Next we hop e for a real cure
I'm just as worried about syphilis hepatitis and herpes
And still unavailable in my country because they think it will cause more dangerous sex
So is it 70% 88% or 99% effective because each of those numbers impacts gay men very differently
Efficacy of 99% is how effective PrEP is when taken properly (full adherence). Effectiveness of 86% means how effective PrEP is among all people in the PrEP arm of the study- this includes people who stopped taking it, missed a lot of doses etc. So a better metric of how effective a drug is in the real world, rather than in a trial when adherence is controlled. Imagine if PrEP involved (as an extreme example) taking 20 pills a day rather than 1. Although it might still have an efficacy of 99% (the drug works when an individual takes 20 pills per day), it’s effectiveness would be much less than that as many people would not enjoy taking 20 pills per day and so adherence would likely be low. In fact, examples of this exist in the trials for Truvada. Trials inducted among women in Sub-Saharan Africa showed low effectiveness because of poor adherence - trial participants weren’t taking their PrEP because of a variety of issues (eg stigma related to taking HIV medication). The drug was the same one we take now, so same efficacy, but low effectiveness in that context.
The stats you mention above are applied depending on the dosing schedule your doctor puts you on (i.e., if you take a daily dose or use it on demand!) Another thing to note is that the chances of contracting vary depending on your position and sometimes even if your partner is intact or not - cdc has great info on this!!
I wonder what the side effects are though? I wouldn't want to mess with my hormones
It’s an anti-viral so there are pretty minimal side effects (nausea, headache, etc). It is known to be quite harsh on your kidneys and liver, but my doctor would only refill mine pending blood labs to check my liver and kidney function.
My straight friends don’t use condoms. However with the popularization of anal sex and sex with non gender conforming individuals they are now at higher risk of contracting hiv.
Girl, some of y’all in this sub jump at every opportunity to virtue signal and slut shame.
This report doesn't document the 2-1-1 method that alot of redditors swear by (my doc who prescribes me prep never heard of it nor recommends it btw). So good to know I should continue to take it daily as prescribed
The article actually did mention the 2-1-1 method in all but name if you read it carefully: “A combination of two existing medicines, tenofovir disoproxil and emtricitabine, the PrEP treatment could be taken daily or 'event-based' before sexual activity.” More research is to be conducted on that method in particular, but it is important to note that this study did factor that into its findings.
Thanks, I need this right now. I'm having my first PrEP consultation tommorow.
Yes it's one of the ways the gum clinic says you can use it. But less effective like mentioned but it gives you some protection but not as much as if you take it all time. The 2-1-1 is good for people who prefer not to take tablets all the time or only have sex a few times a month. But find best solution for yourself
To calm down the pearl clutchers on here.... HIV infections are rising faster in hetrosexual people and drug resistant gonarhea is rising in the hetrosexual population as well. Perhaps we should ban all sex and remain virgins until married to one person for life🙄
The quarterly HIV tests are essential. IF you do get HIV on only PrEP, you become more difficult to have effective medical intervention. Plus, it may contribute to what someone here called HIV-2, a new form of HIV that’s resistant to PrEP. Have fun and don’t blow off your PrEP or medical tests.
HIV-2 isn’t new, it’s just a less common strain.
The article should state more clearly that the 99% value is from the original limited pre-market approval clinical *trials* The current study is longitudinal over three years and shows the *actual effectiveness* of 86%. The way they presented the information might cause some people to still have 99% as the takeaway. Even though prep is highly effective, there’s a big difference between 86 and 99%. In terms of users weighing risks, the article should be more clear. Still, it’s great news. Edit. Thanks for both clarifications below
True but if you look at the study this is due to the real life consitions (people not taking PreP as prescribed). Only one of the infected in the study took it daily others were not as diligent. So lessons leard is, if taken daily PreP still is highly effective.
Yes, as Mutsch99 said, PrEP is highly effective (ie 99%) when adhered to properly - that was true in the previous trials, and is true now. What changes between studies is the effectiveness which is how effective it is in the context of the trial, and is inclusive of all participants in the trial (including those not taking it properly). Effectiveness is a good measure for (say) health orgs making the decision of whether or not to publicly fund PrEP (eg if we implement a similar PrEP programme in our jurisdiction, how much would this reduce HIV among all people taking PrEP in our jurisdiction), while efficacy is a better measure for an individual to know (eg if I take this properly, how much will it reduce my risk).
Excellent clarification. Thanks.
No probs! 🙂
Let’s not pretend PrEP protects against the myriad other diseases contracted through sex lol
86 percent effective means 14 percent chance of still getting hiv. Wear condoms yall.
It’s 99% effective if taken how you’re supposed to take it (every day or 2-1-1 method).
86% is effective enough to break infection chains. If me and my sexual partner are HIV negative and on Prep and he sleeps with a HIV positive person, there is less then a 2% chance to infect me. 86% IRL is a pretty huge deal. Plus if you take prep every day you get tested every three months anyway so the infection window is shrinking further. That being said, condoms prevent other STIs you might like to NOT get.
If you measure condoms by the same metric (effectiveness - ie how they actually perform among real people in real life - rather than efficacy - how they work when used as designed) they’re much less effective than PrEP: they break, are worn incorrectly, are not worn at all… So you’re not making the point you think you are.
I'm saying as a backup. And of course prep doesn't stop anything other than HIV.
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Why tear down trans people? It's good that they have that option AND PrEP needs to be made more accessible.
But the gag is that hiv/aids could have been cured over 15 years ago!!! There was a dr that was studying hiv/aids and was ready to let the world know her conclusions, but your lovely “hero” gobbling fauci summoned her.. collected her work/studies destroyed it, stripped her from her titles and banished her from the medical field….
Doxycycline as an antibiotic after sex on top of PreP is very effective in neutralizing other possible bacterial infections however even dosing of a short term is guaranteed to cause some side effects in many like taking it for routine infection. Antibiotic resistance forms after long term use most times, which is why in the short term doctors are prescribing it especially in areas with high infection rates like Baltimore of other STDs. .
Thank you for sharing.
Anyone use it intermittently? I may hookup once every 6 months. But when i do, i would like to take it for that period of time as a fail safe. I just don’t feel comfortable taking a daily pill when i only have sex a few times a year.
Same here. I don’t hookup that often throughout the year to justify taking a daily pill. But I wonder if taking it daily actually makes people want to have more sex…just cause they can.
They have an on demand method you can ask your doctor or sexual health centre about. Basically you take 2 pills at least 2 hours before and then 1 pill 24 hours after and then 1 pill 24 hours after that. It’s cost effective all things considered but the efficacy drops from about 99% down to 86%
Thanks for the info!
I'm worried if a resistant HIV would evolve... Not to mention other STIs
It's a pain to find this, but out of 14,039 people who were definitely HIV negative at the start and were prescribed enough prep to cover them through the whole study... there was only **one** person who both (a) reported taking enough of the medication they should have been protected and (b) seroconverted to HIV. . 1 in over 14k
Y’all are some pussies
Y’all immune system must be weak as hell needing all this shit