Prep questions

[Harker]

I apologize if this duplicates past threads, I couldn’t find anything quite like it in the search. I’ve recently started seeing someone and having anal sex, after not doing so for a long time. We’re both safe and talk about it, but I’ve wondered if Prep was something to look into.

I got a script from my doctor about two weeks ago but I haven’t started it yet, and mainly because I don’t trust either the extremely positive or extremely negative things I’ve read and watched about it. The side-effects, especially the long term ones have me worried, especially since this is so new (as a. Preventative med.) Also the idea of taking such a strong hiv drug makes me nervous. When I ask friends or people in the lgbt health care field, the concerns about side effects and long term use are laughed away as silly. And when I try to examine the horror stories you read, or the extreme opposition, some of it seems irrational when at th end of the day this pill can prevent some high risk people from contracting HIV.

I guess the absence of a seemingly and reassuringly objective middle ground that both takes the concerns and the benefits of Prep serisouly is something I’ve been looking for. Has anyone been in a similar situation or know of a resource I might be able to turn to that could help? Thanks!

 

[KaraBulut]

A couple of questions:

1. Are you or your boyfriend HIV positive?
2. Do you and your boyfriend intend to be monogamous and do you plan on using condoms consistently when having anal sex?

 

[Harker]

1. No.
2. We haven’t had The definitely monogamous talk yet, but we are headed in that direction. And yes on condoms although they’ve broken on us twice now.

 

[KaraBulut]

PrEP has a place in the tools for HIV prevention. It was originally recommended for couples where one person was HIV+ and the other was HIV- as a "just to be sure" mechanism in case of condom breaks or in cases where the HIV+ person's viral load was still detectable.

Since then, it's become increasingly prescribed for HIV- people who have sex with multiple partners in an attempt to prevent the spread of HIV.

If you and your partner have both been tested and you are both HIV- and you are using condoms, there's a very low risk. After all, PrEP is supposed to stop the spread of HIV but in the case of a monogamous HIV- couple using barrier protection- exactly who is it that the physician thinks is going to introduce HIV into the situation?

On the other hand, if you and your partner had an open relationship or there was the possibility that he was cheating, then PrEP would be an option for you to protect yourself. The forum has lots of stories about people who thought they were in a monogamous relationship with someone only to discover that the other person was cheating or had cheated; in this case PrEP would be an additional mechanism to prevent HIV infection, particularly if the couple wasn't consistent in using condoms for anal sex.

Based upon the information you provided about your situation, are you in the recommended risk group that would benefit from PrEP? No.

Do you have any particular risk factors? You've said that you use condoms and you and your partner are both HIV-, so you don't have the risk factors that would justify the expense for PrEP.

If any of these conditions change- i.e. your partner is found to be HIV+ or you can be sure that the relationship is not monogamous or you are going to stop using condoms, then you might want to reconsider because PrEP would be more appropriate for your situation.

Re the condom breaks: you might want to change condom brands if you've had two breaks. The major brand condoms, if properly sized and lubricated and kept away from heat, shouldn't break that often.

 

[Harker]

I get being at face value low risk. But I’ve been cheated on and it can happen anytime to anyone. I’d rather never be in that situation again of “well he lied about that, what else was he lying about.”

I just find it really troubling that there’s so little that seems a realistic evaluation of actually taking the pill. The provider I went to was basically “you want it- let’s test you- here you go.” I don’t know if it could give me an extra piece of mind or not and feel like there’s no where to go to actually be educated about it.

 

[KaraBulut]

I get being at face value low risk. But I’ve been cheated on and it can happen anytime to anyone. I’d rather never be in that situation again of “well he lied about that, what else was he lying about.”

It can. But there's that saying about "adding insult to injury". PrEP might help prevent the injury of getting HIV from a partner but it's not going to prevent the insult of being cheated on by that partner.

I just find it really troubling that there’s so little that seems a realistic evaluation of actually taking the pill. The provider I went to was basically “you want it- let’s test you- here you go.” I don’t know if it could give me an extra piece of mind or not and feel like there’s no where to go to actually be educated about it.

I can give you some insight into why physicians prescribe PrEP.

There is a group of nurses and physicians who are desperate to do whatever they can to stop the HIV epidemic. These same physicians and nurses were some of the same providers who were talking to their patients about safer sex and HIV testing back in the 1990s and 2000s and they were a critical piece of why HIV infection rates dropped between 1985 and 2010. The one thing that they lost the battle on was drugs and alcohol- the things that were tied to many HIV infections by otherwise rational educated LGBT people during that period.

Then came Grindr, PnP and barebacking.

So, now the only option many of these same healthcare providers feel they have is to get their patients on anti-retrovirals- for HIV+ patients, they want to get their viral loads as low as possible and HIV- people, they want to prevent HIV from replicating once an infection occurs.

It also doesn't hurt that Gilead pays some physicians to write prescriptions for PrEP. In 2016, Gilead made $43,416,802.98 in payments to physicians.

In your case, you asked your physician about PrEP and did what I would expect him to do- test you and give you a prescription. What I fault him on is not talking to you about risk, about pros/cons of taking an anti-retrovirals and referring you to someone who could talk you through that decision if you were unsure.

Part of the reason that your physician might not have told you about potential side effects or risks of taking a retroviral is that we don't have a lot of research about what happens to healthy people who take retrovirals. We have a lot of evidence about HIV+ people and what can happen when someone in on ART for long period of time. PrEP was not originally approved for the general public and there weren't the extensive studies required for trugs like Truvada because they were already on the market and they had been in use for many years.

From personal experience seeing patients taking PrEP, the side effects really run the gamut. Some people who go on PrEP say they had some mild nausea at first but it was temporary and they have tolerated PrEP well. A small number of people have had problems with gastrointestinal side effects and issues with their liver function tests. Another group of patients had issues with the costs- the retail price of Truvada is about $1,300 a month which many insurance plans will cover; for those without insurance or with high copays, the cost is an issue.

 

[Harker]

Thank you so much for the in depth and well reasoned and thought out reply. I filled my first script but never opened the bottle. The health risks the pill could bring were too much for me, and i realized i didn’t need it to have safe sex. On a very shallow note, the weight loss worrried me, as all my friends on PREP have lost so much weight and have that gaunt look to their faces. I get that this is a tool in helping contain HIV infections, but it’s just not for me.

 

[billybob109]

After long research and talks with my Doctor i decided to go on Truvada a month ago. I pay $0 for it as Gilead offers assistance for it even if one does not have insurance (which i do have) one can get it for free. Gilead will pick up over Please visit their website and apply for it. Again i have had no issues or side effects so far. This is not a replacement for unsafe sex nothing beats having safe sex. This is an extra measure of caution in case one comes in contact with HIV positive person. Again do not be afraid of the cost as it can be free for most people.

 

[mbamike]

I am not in a monogamous relationship and I have had condoms to malfunction on me. Then there are the frustrations that occur when you are hot and heavy with a guy, you stop for the Top to put on a condom, he loses his erection and can't get it back up! Also, I am a total Bottom which always makes me the high-risk partner. So, I decide that taking prEP was the best route for me.

I have been on Truvada since April 2015. There was some nausea at first, but that quickly subsided. Today, it's just like taking my medication for allergies or high cholesterol. I don't have any side effects. I don't think much about anymore.

Truvada is a combination drug of tenofovir disoproxil and emtricitabine. Tenofovir was patented in 1996 and approved for use in the United States in 2001. Emtricitabine was part of a triple combination drug that was approved by the FDA in 2006. So, neither of the drugs in Truvada are "new" as I often read.

I pay $11 for a 30-day supply. I am required to get tested every three months to continue getting my prescription renewed. In addition to testing for HIV and STI, I am tested for liver enzymes to ensure there are no side effects. To date, there have been no issues.

You can read more about prEP and HIV on The Body.

 

[ballcaphair]

I suggest you put the condom on him with a big smile. That should keep him hard. I'm a nurse, not a doctor. I do know that you mustn't miss a dose and it can interact with other meds, but does not affect effectiveness of either or all. Do keep your doctor in the loop. Stay hydrated, your kidneys and general organs will thank you. Thanks for the link too.