PREP / Truvada Discussion : All discussion on PrEP & it's side effects(Compiled)

[Guest meowth]

Public-health officials are pushing for much wider use of a drug that has proved effective at preventing HIV infection.

PrEP, or preexposure prophylaxis, is a daily medication that people at high risk for HIV can take to protect against acquiring the virus, which causes AIDS. The drug Truvada was approved by the Food and Drug Administration in 2012 for use as PrEP.  About 50,000 people a year in the U.S. become infected with HIV, according to the Centers for Disease Control and Prevention.

Still, fewer than 22,000 people are estimated to have taken PrEP for prevention, according to an analysis this year in the journal Current Opinion in HIV and AIDS. AIDS remains a significant cause of death in certain populations although treatments have made living with the syndrome a reality for many.

The CDC in November released a report suggesting some 1.2 million U.S. adults who are at substantial risk for acquiring HIV could benefit from PrEP. Among those are one in four gay and bisexual men; one in five people who inject drugs; and one in 200 sexually active heterosexuals.

Taking PrEP reduces the risk of HIV infection through sexual transmission by as much as 92% and by about 70% in people who inject drugs, the CDC says. Still, one in three primary care doctors haven’t heard of the medication, according to a 2015 CDC survey.

 

The agency has issued clinical guidelines with charts and checklists to assist health-care providers during patient evaluations, and offers a telephone hotline for people to get free expert clinical advice on PrEP. “As with any new health intervention, it will take time for people to learn about and become comfortable with PrEP,” a CDC spokeswoman said.

 

“More high-risk individuals need to know about the benefits of PrEP and more physicians need to know about it,” said Carlos del Rio, chairman of the Infectious Disease Society of America’s HIV Medicine Association and a professor at Emory University. “We can really decrease the number of new HIV infections if PrEP is used more.”

PrEP can cost between $8,000 and $14,000 a year, although it is covered by most private insurers and by Medicaid in many states. Assistance programs, including one from Gilead Sciences, the maker of Truvada, are available for those without insurance. The drug, which is also used in HIV treatment, has mostly minimal side effects, doctors say.

Some AIDS organizations don’t promote use of the drug, partly out of concern it could encourage more risky sexual behavior. “We are having an explosion of other sexually transmitted diseases impacting the gay community and PrEP offers no protection whatsoever for any other disease,” said Ged Kenslea, communications director for AIDS Healthcare Foundation, a Los Angeles-based global AIDS organization.

 

Mr. Kenslea said the group disagrees with the CDC’s goal of getting 1.2 million people on PrEP. “The patient must take the [PrEP] pill; we can’t even get people who are already HIV positive to take their pills every day,” he said. The foundation last week began a national ad campaign, entitled “PrEP: The Revolution That Didn’t Happen,” in gay and lesbian publications in major cities. It aims in part to encourage the CDC to focus on other prevention methods, such as condoms, and to devote its resources to HIV treatment.

 

Research has shown PrEP’s effectiveness. A continuing randomized controlled trial in England, which has been following more than 500 men at risk for contracting HIV, found that participants taking PrEP were 86% less likely to get infected than those not on the drug. The study, published in the journal the Lancet in September, also found that the people on PrEP reported more unprotected sex, but there was no evidence of an increase in sexually transmitted diseases.

Researchers at Kaiser Permanente in California followed 657 noninfected people taking PrEP for an average of seven months and found none of the participants contracted HIV, said Jonathan Volk, lead author of the study and a physician with Kaiser Permanente San Francisco Medical Center. “That’s really compelling data on how effective this medication is,” he said.

After one year on PrEP, however, about half of the users were diagnosed with at least one sexually transmitted disease. And nearly half the participants in a representative subset said they used condoms less frequently after starting PrEP, Dr. Volk said. The study was published in September in the journal Clinical Infectious Diseases.

 

Albert Liu, a clinical research director at the San Francisco Department of Public Health, said a study he led shows that most people will take PrEP as prescribed if they have access to the medication. San Francisco has made efforts to expand the availability of PrEP over the past year, including offering it in a number of clinics.

The study, published in November in JAMA Internal Medicine, followed 557 gay men and transgender women who were provided PrEP for a year in clinics in San Francisco and Miami and a community health center in Washington, D.C. More than 80% of the participants had protective levels of PrEP in their bloodstream, suggesting a high level of adherence to the medication regimen, Dr. Liu said.

The study also found that among the participants, “risky behavior either declined or remained the same,” Dr. Liu said.

“My belief is that PrEP doesn’t change people’s behavior,” said Paul Marcelin, a 41-year-old software engineer in Alameda, Calif., who has been taking the drug since July 2013.

 

Mr. Marcelin said more people in the gay community have begun advertising if they are on PrEP in online- and social-media-dating profiles. “Now, [PrEP] is much more commonplace, at least in San Francisco,” he said.

[Guest Sam]

AHF: New UCLA Study Shows Gay Men on PrEP Are 45 Times More Likely to Contract Syphilis; 25 Times More Likely To Be Infected With Gonorrhea

LOS ANGELES--(BUSINESS WIRE)--Researchers at the University of California Los Angeles (UCLA) issued a damning new report this week showing a dangerous link between the usage of pre-exposure prophylaxis (PrEP) by men who have sex with men (MSMs) and an astronomical increase in sexually transmitted infections (STIs).

In a research letter by Noah Kojima, Dvora Joseph Davey, and Dr. Jeffrey D. Klausner published in the September 10^th issue of AIDS, the official journal of the International AIDS Society, the authors report that a meta-analysis of 18 cohort studies of MSMs with incident STIs found that “incidence rate ratios showed that MSM using PrEP were 25.3 times more likely to acquire a Neisseria gonorrhoeae infection, 11.2 times more likely to acquire a Chlamydia trachomatisinfection, and 44.6 times more likely to acquire a syphilis infection versus MSM not using PrEP.” The studies included in the meta-analysis, including the PROUD and IPERGAY trial studies that PrEP supporters often reference to promote PrEP usage, covered a time period from 2010 to 2016 for MSM using PrEP and from 1998 to 2016 for MSM not using PrEP.

“These results by the UCLA researchers add timely, statistical evidence to the concerns AHF has long held and expressed regarding PrEP being widely promoted as a public health strategy,” said AHF President Michael Weinstein. “While we’ve often been mischaracterized and criticized for our position on PrEP, AHF’s mission and goal has always been to use scientific evidence to advocate for public policies that will inform and help protect the public from all STDs. This latest analysis should be a wakeup call for MSMs and other sexually active people that PrEP is not the magical panacea it’s often promoted to be.”

Heralded as a breakthrough medical advancement in the fight against HIV/AIDS, Gilead Sciences, Inc.’s antiretroviral HIV drug Truvada was approved for PrEP by the U.S. Food and Drug Administration (FDA) in July 2012. Following its FDA approval, the U.S. Centers for Disease Control and Prevention (CDC) threw its full support behind PrEP, championing PrEP coverage as one of its “key prevention strategies” and encouraging in May 2014 that 500,000 MSMs should go on PrEP. Last November, the CDC upped its support for PrEP by recommending that 1.2 million “high risk” Americans—including 25% of all sexually active gay and bisexual men, 20% of people who inject drugs, and 1 in 200 sexually active heterosexual adults—should be considered good candidates for PrEP.

Yet after four years of Truvada being available for PrEP prescriptions and millions of dollars spent to promote its benefits and usage, the number of PrEP prescriptions remains at a miniscule fraction of the recommended numbers, with Gilead releasing a report in June that declared that only 49,148 total cumulative PrEP prescriptions have been filled based on data reported by 82% of all pharmacies. In response, AHF issued an “Open Letter to the CDC on PrEP” that called on the federal agency to “rebalance your prevention efforts to align with what patients want and need so that we can achieve better success in preventing new infections.”

“Not only have gay and bisexual men largely rejected the relentless drumbeat for PrEP by the CDC and other agencies who have been dubiously shilling for Gilead, the men who are using PrEP are having increased condomless sex—contrary to the PrEP guidelines set by the CDC—and, as a result, are exposing themselves to dangerous sexually transmitted infections,” continued Weinstein.

The UCLA researchers’ report supports a 2014 study from Kaiser Permanente that revealed that the use of PrEP resulted in a 45% increase in condomless sex among certain study participants, leaving them vulnerable to disease.

Their findings come amid growing international concern about the rise of antibiotic resistant strains of gonorrhea and other STIs. In releasing its new guidelines for treating bacterial STIs last week, the World Health Organization (WHO) expressed concerns that “resistance of these STIs to the effect of antibiotics has increased rapidly in recent years and has reduced treatment options. Of the 3 STIs, gonorrhoea has developed the strongest resistance to antibiotics. Strains of multidrug-resistant gonorrhoea that do not respond to any available antibiotics have already been detected. Antibiotic resistance in chlamydia and syphilis, though less common, also exists, making prevention and prompt treatment critical.” Last December, Britain’s top doctor and pharmaceutical officer issued warnings about an antibiotic resistant “super-gonorrhea” that had been identified in the country.

“These global warnings about antibiotic resistant STDs must be taken very seriously, especially considering that using PrEP alone offers zero protection against infections like gonorrhea, syphilis, and chlamydia,” Weinstein added. “Despite some people’s desire to simply wish them away, these common STDs remain health risks that must be taken seriously and are best avoided by using condoms.”

According to the Centers for Disease Control and Prevention (CDC), gonorrhea is the second most commonly reported notifiable disease in the United States, with 350,062 gonorrhea cases being reported in 2014.

AHF’s Wellness Centers provide free testing for sexually transmitted diseases, including chlamydia, gonorrhea, syphilis, and HIV. To find the nearest location for STD screening and treatment, visit www.freestdcheck.org.

[bluefish20008]

Not strange. Truvada only eliminates the chance of HIV, but not other STDs (even Zika).

[lovehandle]

true!
https://www.newscientist.com/article/2117426-massive-drop-in-london-hiv-rates-may-be-due-to-internet-drugs

https://www.blowingwind.io/forum/topic/74377-prep-pep-hep-c-treatment-now-available/?do=findComment&comment=1636881

[wantonmee]

Sigh... its like i worry after my STD check and the minute i find out i am safe, i think i can fuck the whole world again... until the next check and repeat...

wtf is wrong with me..

[wintersnow]

truvada does cause some side effects as like other arv drugs and i dont see the point where some are using it on long term just to have unsafe sex when the use of arv drugs could potentially shorten your life span due to the strain it causes on your organs particularly the kidney and liver.

 

each tab is not cheap as well to begin with

 

that is also why, hiv+ are required to do routine blood test which includes kidney and liver function test

Edited January 14, 2017 by wintersnow

[Guest Guest]

I really hate such reports. The moment something good happens (eg PrEP preventing the rise in AIDS), someone must really point out the natural corresponding downside. If one day, the cure for AIDS is found, someone will definitely be publishing the corresponding rise in the number of death caused by other STDs.  

[Guest Wake up]

Just want to say any guys on prep please realise it's not 100% safe from HIV plus you have to think about all the other STD you can still catch

Don't be a fool 

Use a condom

[heliumduck]

what triggered this ?

[Guest Wake up]

6 hours ago, heliumduck said:

what triggered this ?

Some guy asking me 4 sex 

Wanted it raw 

Saying no problem as he is on prep

[whitedick]

17 hours ago, Guest Wake up said:

Just want to say any guys on prep please realise it's not 100% safe from HIV plus you have to think about all the other STD you can still catch

Don't be a fool 

Use a condom

 

right on dude.

Its never 100% safe.

https://www.cdc.gov/hiv/basics/prep.html

 

No, you should not stop using condoms because you are taking PrEP. PrEP doesn’t give you any protection against other STDs, like gonorrhea and chlamydia. Also, while PrEP can significantly reduce your risk of HIV infection if taken daily, you can combine additional strategies like condom use with PrEP to reduce your risk even further.

 

If used the right way every time you have sex, condoms are highly effective in preventing HIV and some STDs you can get through body fluids, like gonorrhea and chlamydia. However, they provide less protection against STDs spread through skin-to-skin contact, like human papillomavirus or HPV (genital warts), genital herpes, and syphilis. See How well do condoms prevent HIV? Learn the right way to use a male condom.

[Guest :-(]

My bf and I have never used any condoms before because we never have sex

 

How can people have sex with random strangers, not knowing if they're clean inside?

[chapapa]

I am worried about the trend that is happening.

People are buying Prep from non trusted source or misusing prep.

If you asked them was it prescribed, they have no idea or they just tested once neg and started prep without anymore follow up blood test.

The list goes on...

 

Guys no matter what, make sure you think with your head and not with the other "head".

If you get HIV and on prep, the HIV would likely be drug resistant or worse, aggressive.
Assume they are not on prep and still play it safe guys....

And yes I am on prep and seen a doc

[Guest Unsure]

Wanted to start on PrEP but read online about the various adverse effects and chicken out. 

Can someone who is current PrEP user comment?

[chapapa]

6 hours ago, Guest Unsure said:

Wanted to start on PrEP but read online about the various adverse effects and chicken out. 

Can someone who is current PrEP user comment?

 

i don't see why would the side effect affect u. its not major side effects at least I experienced nothing.

[Ben S]

I'm also on prep (acquired from trusted clinic), been a year or so.

 

it hasn't changed my lifestyle in sex, still option to play safe ... just consider prep as backup defense vs hiv.

there is option to play raw once there's trust happen between the parties.

there is an increase of sti around (chlamydia and GO) with all these barebacking trend ... so, best to play safe with strangers.

 

so far, no side effects that I know/feel of.

[Guest Yikes]

Noticed many grindr men are on prep, dangerous community there indeed. I bet there are more but they chose to stay quiet.

[fourth]

was on it for two months when my buddy was visiting. had vivid dreams at night, and that my cum tasted... bitter. XD

[Guest Idiot]

1 hour ago, fourth said:

was on it for two months when my buddy was visiting. had vivid dreams at night, and that my cum tasted... bitter. XD

Don't really think catching a life threatening disease or virus is something good to joke about? I could post you pictures of AIDS patients who are nearing their end, not something you would laugh at right?

 

Apparently you cant trust anyone until he goes to the clinic to test and shows you black and white that he is negative.

[Rhyn]

PreP is NOT 100%.

PreP is also NOT A REPLACEMENT FOR CONDOMS.

Here is some basic information about PreP.

 

That's the danger with this drug- people assume that's it's a safe alternative to preventing HIV because they're more afraid of the social stigma of HIV rather than the implications of STDs. That is an absolutely terrible reasoning.

 

Using PreP every single day accounts for close to 95-99% prevention of transmission of HIV. And that is provided the user consistently takes the pill. Everyday. As a routine that continues every 24 hours. Missing even a day of a pill drastically drops that protection below 95%. 

 

If you want to use PreP, there are a reasons that you should consider it.

 

1. Your partner is HIV positive. There was research on transmission rates of HIV between couples which you can read about here. Essentially, if your partner is HIV+ with an undetectable viral load, there is no chance of HIV spreading. But for further protection, condoms and PreP is an advisable way forward.

 

2. You have regular sex and you want another safeguard, on top of condoms.

 

If anyone is considering PreP as a replacement, don't. It is ill-advised, and you might just give yourself more issues.

[Guest Unsure]

I read that those on PrEP should go for regular check on their kidney and liver function. Another problem is the loss of bone density which makes one more prone to fracture. ANy comments?

[fourth]

20 hours ago, Guest Idiot said:

Don't really think catching a life threatening disease or virus is something good to joke about? I could post you pictures of AIDS patients who are nearing their end, not something you would laugh at right?

 

Apparently you cant trust anyone until he goes to the clinic to test and shows you black and white that he is negative.

how the fuck am i joking? it's all legit observations. picture of AIDS patients? really? i volunteered with Tzu Chi and was part of a large group of people gathering donations for PLHIV. The house visits and at CDC weren't pleasant but instead of pictures i've seen it with my own eyes and got to know some of them. why are you assuming so many things you do not know about? my buddy is poz and undetectable, and with me on Prep, we've been at it countless times and i'm negative for the longest time. Safe, or unsafe? get your facts right!

[lovehandle]

On ‎26‎/‎8‎/‎2017 at 1:16 PM, fourth said:

how the fuck am i joking? it's all legit observations. picture of AIDS patients? really? i volunteered with Tzu Chi and was part of a large group of people gathering donations for PLHIV. The house visits and at CDC weren't pleasant but instead of pictures i've seen it with my own eyes and got to know some of them. why are you assuming so many things you do not know about? my buddy is poz and undetectable, and with me on Prep, we've been at it countless times and i'm negative for the longest time. Safe, or unsafe? get your facts right!

can share more why is it not pleasant?

 

final stage of hiv patients must stay at cdc?

[doncoin]

AIDS is the final stage from being HIV+, when your body no longer produces enough defense to protect itself. When a person hits that stage, even a common cold may be fatale. PreP is designed to help those who are HIV- and I believe prescribed for some who are HIV+ too and are undetectable as a defense from the virus. 

 

Even if you are HIV-, and are on PreP, you should still use a condom, especially if you have multiple partners. 

[Guest Slut]

Just Google the internet.

 

Due to raw chemsex and PREP, HIV infection has dropped but syphilis and gonorrhoea rates have exploited.

 

These two "old" STDs have also mutated into new strands which are immune to existing antibiotics.

 

Be warned!

[Guest Slut]

America May Be Heading Into an STD Epidemic—and Gay and Bi Men Are Going to Be the Hardest Hit

By Mike Miksche

 

Time to get familiar with these guys.

jarun011/Thinkstock

Earlier this month, Poz magazine’s Benjamin Ryan drew attention to a concerning new study out of Northern California’s health system: Using data gathered from July 2012 through June 2015, researchers found that, among a cohort consisting mostly of same-sex–attracted men on the HIV-prevention regimen PrEP, “quarterly rates of rectal gonorrhea and urethral chlamydia increased steadily and about doubled after one year.” In other words, guys on the fantastically effective pill-a-day Truvada program were avoiding HIV infection—there were no new transmissions for regimen-adherent patients over the study period, in fact—but they seemed to be getting other sexually transmitted diseases relatively often. There are a few plausible explanations for the measured increase in this particular community, including the quarterly or at least semi-annual STD battery a PrEP prescription requires (more testing almost certainly means more diagnoses compared with men who infrequently or never get tested), and emerging evidence that many men, emboldened by PrEP, are engaging in more condomless sex. Either way, gay and bi men have reason to be alarmed.

This news came on the heels of a recent STD Surveillance Report from the Centers of Disease Control and Prevention which showed that the total combined cases of gonorrhea, chlamydia, and syphilis reported in the U.S. in 2015 reached record highs. Those most at risk were gay and bisexual men (regardless of their PrEP status), as well as the youth of America: Young adults aged 15 to 24 accounted for half the gonorrhea diagnoses and two-thirds of the chlamydia cases. Men who have sex with men (MSM) accounted for the majority of new gonorrhea and syphilis cases. And all this while strains of antibiotic-resistant gonorrhea were recently discovered to be on the rise among MSM.

As a journalist who covers sexual health and as a gay man who has sex, it seems to me that our community is on the cusp of a major STD epidemic. And although gonorrhea, chlamydia, and syphilis are certainly not the scourge HIV once was, I can’t help but feel a kind of old-fashioned, Larry Kramer–tinged guilt, like my community is to blame because of our more open relationship to sex. They say not to read comments sections online, but I couldn’t resist peeking at articles covering the CDC news. On a piece from USA Today, one person wrote: “Lot's of young whores out there today,” while another said, “looks like gays are determine[d] to do themselves harm.”

But is this accurate? Is “bad” sexual behavior among gays and other groups to blame for the trend? The answer is surely complicated, but if we want to better fight the rise in STD rates, we have to try to understand what’s driving it in the first place.

For the CDC’s part, the agency linked the national increase primarily to cuts to more than half of state and local STD screening programs’ budgets in recent years. This resulted in more than 20 health department clinic closures in one year, reducing access to testing and treatment for those who need it. It’s not hard to see how less testing and treatment would contribute to the spread of STDs across demographics.

But while the CDC’s explanation about budget cuts and clinic closures makes sense on a national scale, I have a sneaking suspicion that there had to be more to it than that for MSM. Within the gay and bi male community, I’ve recently noticed a lax attitude about contracting STDs on the part of some guys. The logic is something like: They’re treatable (for now), they’re not HIV, and they’re just kind of part of the sexual territory, so no biggie. Many gay men I know live in big cities that, for the moment, offer access to cheap or free testing and treatment—an unfortunately uncommon situation, as the CDC points out. To be honest, I personally don’t worry too much about STDs when I’m having sex. So perhaps we really are to blame for our own predicament?

“Yes, there are people who are less concerned about bacterial infections. We take antibiotics for a lot of reasons, and sexual health issues are one of them. I think there are some people who kind of anticipate, because of STI rates in certain communities, having an infection and they aren’t caught off guard when it happens,” Joshua O'Neal, the director of sexual health at San Francisco AIDS Foundation, told me over the phone.

O’Neal admitted, without qualms, that at the clinic they treat about 25 percent of the people on their PrEP program for STDs every three months—not necessarily because they have symptoms or tested positive for an STD, but because, in some instances, partners or a former lover may have informed them of a positive result.

This clinical insight jibes with the Northern California PrEP study. But O’Neal cautioned that the trend couldn’t only be attributed to behavior.

“It’s good to recognize that the people who are experiencing the most STI disparities aren’t just homos, but are young people between the ages of 15 to 24, are communities of color that also come from places where there’s not very good sex education,” he said. “We come from a very abstinence-only–based society. A lot of the numbers from the CDC are reflective of all the red states.”

And, when you dig down into the numbers, the CDC report validates exactly what O’Neal is saying. San Francisco has the highest number of LGBTQ residents per capita in the country; however, California ranked 17^th in the country for chlamydia, 14^th for gonorrhea, and third for syphilis. STDs are still a problem in California, but there are states with far worse situations. Louisiana, for example, ranked first for gonorrhea, with 221.1 people infected per 100,000, and first for syphilis with 15.0 people per 100,000. Alaska was ranked No. 1 for chlamydia, with 768.3 people infected per 100,000, followed by Louisiana and North Carolina.

I reached out to Patricia Kissinger to help contextualize these stats. She’s a professor with the Department of Epidemiology at the Tulane University School of Public Health and Tropical Medicine in Louisiana. “We’re in the Delta South, so a lot of the Southern states are very conservative, and one of the manifestations of that is they don’t agree with sex-ed,” she said. “They think that sex education should be done by the parents, and I think nobody would argue with that. But the problem is that the parents don’t do it—they don’t know how to do it, they don’t want to do it, so consequently the kids don’t get it.”

Kissinger explained how young people in the state don’t have the basic knowledge to protect themselves. They don’t know where to get a condom, how to use it, or even why they would need to use it. So maybe they aren’t just “young whores,” as that one commenter implied—they’re just undereducated.

Susan Jones, the HIV/STD program manager with the Alaska Department of Health and Social Services Section of Epidemiology, offered insight into the sex-ed question up north: “Alaska, traditionally, is very conservative state. … And has been a Republican state. The school districts in Alaska are individualized so each school district can decide how they’re going to address sexual health, and some are more conservative than others. There’s not a sexual health program that’s applied across the state in all school districts.”

In Alaska, HB 156 recently become law, which allows parents the right to direct the education of a child as it relates to sex education, human reproductive education, and human sexuality education, among other things. The bill doesn’t prevent the teaching of these subjects, but the curriculum, literature, or materials have to be approved by the district’s school board and available for parental review. I think it’s safe to assume that the resulting sex education wouldn’t be a liberal, sex-positive one.

In the Surveillance Report, the CDC highlights the necessity to mobilize, rebuild, and expand services to combat this epidemic and bolster prevention efforts. However, decisions about sex-ed curriculum are made by state and local school districts; the CDC doesn’t mandate specific sexual health education curricula. In some cases, they provide funding, tools, and technical assistance to state and local education agencies along with select NGOs for sex education activities, but the terms of how those are utilized vary state by state. Each state or local agency will decide what sort of programming they want to offer.

What’s more, with what little sex education that does occur in places like Louisiana, the law may preclude many of the most relevant things to teach. In that state, for example, instructors cannot use any sexually explicit materials depicting homosexual activity, nor can they hand out condoms. Which is somewhat irrelevant, since the students wouldn’t know how to properly use them—or why they might want to—anyway.

This lack of comprehensive sex education goes a long way to explaining why so many STDs aren't detected and go untreated. Some young people in Louisiana (or gay and bi people who used to be young in Louisiana) might not realize that you can get an STD from something like oral sex, whether giving or receiving. As a result, they won’t request a throat swab during testing, instead undergoing only a urine test, which says nothing about other potential sites of infection. Naturally, with a negative result added to the fact that many STDs can be asymptomatic, they'd conclude that everything is kosher, and transmission continues.

“Not everyone puts a penis in a vagina,” Jones points out, very matter-of-fact. “There are other places that become infected that haven’t been tested in the past and we’re finding that sex includes a lot of different body orifices, and all of those that have been exposed should be tested.” This means rectal swabs, too, but health providers may not test this area if they're unaware of their client’s sexuality or aren’t aware that even straight folks have anal sex. That, of course, would require one to be out and open about the type of sex they're having. And even then, in my experience, a nurse might not take a throat or rectal swab unless explicitly requested.

It’s a stark contrast to the sex-positive spaces found in a gay mecca like San Francisco, where people can talk openly about their sexual habits and get the appropriate tests and treatment that they need, shame free. “That’s what’s, again, unique about San Francisco: We’re so sex-positive, and we embrace it,” O'Neal told me, “where most places all over the United States don’t have that same approach.”

To be clear, this cultural explanation is not to downplay the CDC’s claim that, outside of unique cities like San Francisco and New York, the national increase is due to budget cuts and closures at state and local clinics. Such cuts result in reduced hours and staff at clinics that normally would provide treatment and prevention services. This could mean longer wait times, difficulty making appointments, and test results that take more time to get.

“You also have in Louisiana a heavy Baptist and Catholic tradition,” Kissinger told me. “They’re very anti-abortion so now they’re trying to close down any clinic that does any abortion.” It’s important to stress that while Planned Parenthood, which would be one such clinic, does perform abortions, that perfectly legitimate medical procedure accounts for only 3 percent of the work they do. Planned Parenthood also provides 4.2 million tests and treatments for STDs every year, which includes more than 650,000 HIV tests.

So when considering the STD uptick in the U.S. from a bird’s eye view, it isn’t really us urban gays, with our Grindr and PrEP and our sex-positivity/pleasure-first attitudes, that are driving the jump. Nor is it bored, rural youth purposefully being irresponsible with their sex lives. Not entirely, anyway. The real problem is the conservative legislators and parents in red states who are perpetuating this epidemic. And their fear and morality-based policy costs the health care system nearly $16 billion each year, according to the CDC, as STDs cause economic liabilities when undiagnosed and untreated.

As for the MSM community, it seems wise to continue to do what we do so well—which is also exactly what many conservative folks want us to stop doing: Talk about the sex we’re having, openly, so that we can eradicate stigma, educate one another, and normalize conversations and actions around sexual health. Each of these things encourage those in our community to get tested more frequently, and treated just as frequently without fear of being branded a “slut” for doing so. They can try to tell us that it’s behavior like this that drives STD rates up, but the evidence is quite clear: Sex positivity isn’t the problem. It’s part of the solution.

Mike Miksche is a regular contributor to Daily Xtra. He’s also written for The Advocate, Vice, Lambda Literary and The Gay and Lesbian Review.

[fourth]

16 hours ago, -Ignored- said:

can share more why is it not pleasant?

 

final stage of hiv patients must stay at cdc?

 

the skin infections in some can be very bad. and it's heartening to see them. what's even worse is, many of them, their families don't want to have anything to do with them.

[bigdanbeam]

22 minutes ago, fourth said:

 

the skin infections in some can be very bad. and it's heartening to see them. what's even worse is, many of them, their families don't want to have anything to do with them.

 

Heartening?

[lovehandle]

Disheartening 

[lovehandle]

3 hours ago, fourth said:

 

the skin infections in some can be very bad. and it's heartening to see them. what's even worse is, many of them, their families don't want to have anything to do with them.

Any of them are of younger age??

 

they just expose the skin infection?

 

Do u need to wear some gear before u visit them?

[wintersnow]

On 8/22/2017 at 8:40 PM, chapapa said:

I am worried about the trend that is happening.

People are buying Prep from non trusted source or misusing prep.

If you asked them was it prescribed, they have no idea or they just tested once neg and started prep without anymore follow up blood test.

The list goes on...

 

Guys no matter what, make sure you think with your head and not with the other "head".

If you get HIV and on prep, the HIV would likely be drug resistant or worse, aggressive.
Assume they are not on prep and still play it safe guys....

And yes I am on prep and seen a doc

 

the is a difference between prep and pep.

if you are on prep and get hiv, then u should be off prep, you should already be on the arv treatments which will include the use of truvada or its equiv as in prep and other arv drugs that will you contain that virus

 

the doc will be able to advise more

 

 

On 8/24/2017 at 5:29 PM, Guest Unsure said:

Wanted to start on PrEP but read online about the various adverse effects and chicken out. 

Can someone who is current PrEP user comment?

 

when i was first on truvada, i got such bad side effects. tiredness, lose of appetite, giddiness, nauseous etc...........

but after 2 weeks, i gradually overcome that 

 

 

On 8/25/2017 at 0:00 AM, chapapa said:

 

i don't see why would the side effect affect u. its not major side effects at least I experienced nothing.

 

not too major and u gradually overcome it.

 

point to note. everyone experience different side effects, some would have none to mild, some very servere 

 

On 8/25/2017 at 7:33 PM, Rhyn said:

PreP is NOT 100%.

PreP is also NOT A REPLACEMENT FOR CONDOMS.

Here is some basic information about PreP.

 

That's the danger with this drug- people assume that's it's a safe alternative to preventing HIV because they're more afraid of the social stigma of HIV rather than the implications of STDs. That is an absolutely terrible reasoning.

 

Using PreP every single day accounts for close to 95-99% prevention of transmission of HIV. And that is provided the user consistently takes the pill. Everyday. As a routine that continues every 24 hours. Missing even a day of a pill drastically drops that protection below 95%. 

 

If you want to use PreP, there are a reasons that you should consider it.

 

1. Your partner is HIV positive. There was research on transmission rates of HIV between couples which you can read about here. Essentially, if your partner is HIV+ with an undetectable viral load, there is no chance of HIV spreading. But for further protection, condoms and PreP is an advisable way forward.

 

2. You have regular sex and you want another safeguard, on top of condoms.

 

If anyone is considering PreP as a replacement, don't. It is ill-advised, and you might just give yourself more issues.

its not 100% yes and you are still able to catch other stds, the most common being genital warts

 

On 8/26/2017 at 0:14 AM, Guest Unsure said:

I read that those on PrEP should go for regular check on their kidney and liver function. Another problem is the loss of bone density which makes one more prone to fracture. ANy comments?

yes, kidney and liver functions

on the long run will hit the bone density also cos travada "removes" calcium from the bone

 

On 8/28/2017 at 0:05 AM, doncoin said:

AIDS is the final stage from being HIV+, when your body no longer produces enough defense to protect itself. When a person hits that stage, even a common cold may be fatale. PreP is designed to help those who are HIV- and I believe prescribed for some who are HIV+ too and are undetectable as a defense from the virus. 

 

Even if you are HIV-, and are on PreP, you should still use a condom, especially if you have multiple partners. 

yes given that the efficacy depends on how you take your medication

one thing to note, if im not wrong, you should take at least 28 days before any potential exposure cos your body needs some time to adjust and a certain level of medication to defend, so its not like Viagra, you take now in a few hours it works

 

23 hours ago, Guest Slut said:

Just Google the internet.

 

Due to raw chemsex and PREP, HIV infection has dropped but syphilis and gonorrhoea rates have exploited.

 

These two "old" STDs have also mutated into new strands which are immune to existing antibiotics.

 

Be warned!

not only that, genital warts, herpes as well and these can spread through with the use of condom as well

[Guest VHS]

The medical community should be screaming from the top of their lungs to nip this problem in the bud. Many guys are using PrEP as a condom substitute instead of a condom supplement.

 

PrEP should be thought of as the gay equivalent of the birth control pill in some regards. Condom + pill = best protection against pregnancy. Condom + PrEP = best protection against HIV.

[Summerbitch]

Many guys on PrEP always have the mindset that both their sex partner and themselves won't get HIV as either of them are on it.. 

This is bullshit. I hope they will wake up from this BS before anything serious happen to them.

[Guest Knock your heads]

Think twice before putting someone else dick in your mouth or ass.

[Clive]

PrEP is very effective in preventing  HIV,  probably comparable or even superior to condoms. But do use condoms to prevent other STIs! 

 

The US centre for communicable disease endorses it, and so does  WHO. AfA would recommend it too! 

 

https://www.cdc.gov/hiv/basics/prep.html

 

 

Edited October 29, 2017 by Clive
Pic

[Guest condoms or not]

Recently told by ons that people on prep are totally safe from hiv

Is this true?

[cutejack]

Someone told me tat too.is tat ssme guy?lol 

[Guest Be Wise]

I saw somebody post this idea a few months ago: Think of PrEP as a birth control pill for gays ...... PrEP + No Condom = probably won't get HIV ...... PrEP + Condom = almost definitely won't get HIV.

 

But, PrEP can only prevent HIV, not other STDs. That means if you use PrEP and have sex with no condoms, you can still get other diseases such as gonorrhea, syphilis, herpes, HPV, and chlamydia.

[tic-toc]

First it is the cost.  It is not like you take one pill and then you will be protected. You need to take it everyday for it to be effective. 

There are side effects too. 

check out the website : https://www.cdc.gov/hiv/basics/prep.html

 

 

[Rhyn]

6 hours ago, Guest condoms or not said:

Recently told by ons that people on prep are totally safe from hiv

Is this true?

 

This statement is too general on whether it's a hard TRUE or FALSE for a very simple reason.

 

If you want to be safe from HIV using ONLY PREP, you have to consume PREP . every, single, dayAnd that may guarantee a high protection rate of about 90%+. Only if it's every single day. 

 

If you miss just one day, the protection drops drastically- enough that you might get HIV from unprotected sex. 

 

If you want the highest form of protection against STDs and HIV, use condoms and PREP.

[lovehandle]

16 hours ago, tic-toc said:

First it is the cost.  It is not like you take one pill and then you will be protected. You need to take it everyday for it to be effective. 

There are side effects too. 

check out the website : https://www.cdc.gov/hiv/basics/prep.html

 

 

but the weblink u provide claimed there isnt

Does taking PrEP long-term have harmful health effects?

In people who are HIV-negative and have taken PrEP for up to 5 years, no significant health effects have been seen.

 

 

 

or are u ref to pep, tictoc?

PEP is safe but may cause side effects like nausea in some people. These side effects can be treated and aren’t life-threatening.

[lovehandle]

18 hours ago, Guest Be Wise said:

I saw somebody post this idea a few months ago: Think of PrEP as a birth control pill for gays ...... PrEP + No Condom = probably won't get HIV ...... PrEP + Condom = almost definitely won't get HIV.

 

But, PrEP can only prevent HIV, not other STDs. That means if you use PrEP and have sex with no condoms, you can still get other diseases such as gonorrhea, syphilis, herpes, HPV, and chlamydia.

yes, I rem u shared that but I m not sure those consuming prep is following this good concept and educating the rest he has dealings w correctly?

[Balestier]

Can't imagine poking anal without a cover.

[lovehandle]

18 minutes ago, Balestier said:

Can't imagine poking anal without a cover.

many

many done that and requested (nt the tops)

[Guest Whitec]

I fk my bf raw cause he said he don't like condom. Now I can't go back using condom. Luckily my fren cleans thoroughly before a session.

[Guest PoorGay]

How much does one need to pay to be on PrEP in Singapore?

 

For someone who fuck once a day (in average la), is it cheaper to take PrEP or pay for 30 condoms a month?

[Magicerife]

4 hours ago, Guest PoorGay said:

How much does one need to pay to be on PrEP in Singapore?

 

For someone who fuck once a day (in average la), is it cheaper to take PrEP or pay for 30 condoms a month?

Condom’s the cheaper option if you ain’t using those expensive special condoms lo. You can easily get like a hundred for only 20 bucks from AFA I think? But Wah. Fuck once a day. So much time and energy. 

[Guest Tanner]

Without foreplay...i can fuck my bf every night if the intention is just to cum

[Guest cummy]

8 hours ago, Guest Tanner said:

Without foreplay...i can fuck my bf every night if the intention is just to cum

 

U mean with foreplay then u cannot cum?

[Guest OH???]

According to the four studies under the United States' Centers of Disease Control & Prevention's Interim Guidelines, PrEP has a wide range of 50%–84% of HIV protection.