scared of being cheated on and catching HIV

[hotatlboi]

The primary problem is cost- the annual cost for Truvada is over $12K per year. Even with group insurance plans, it's generally in the top tier for deductibles/copays.

Not all gay men are in the same socioeconomic group. The group of MSM who have the highest rate of HIV infections is black and hispanic men in urban areas, many of whom can't afford PrEP (which is ridiculously expensive).

More distortions and obfuscations. I recently started taking Prep (I've now stopped since I have a monogamous partner). The total cost to me was $0. My insurance covered it (almost all insurances have agreed to), and Gilead has distributed a copay assistance card to pretty much anyone who wants one that covers the copay. Apparently mbamike's experience was the same.

There's no study that supports "99% effective". The rates that are quoted in the media are studies of people having sex with partners of unknown status (the "russian roulette" method of public health studies).
http://www.healthline.com/health-news/studies-show-truvada-prevents-hiv-when-taken-as-needed-022415

Regardless of the true number, 86%, 99%, whatever, it has been shown that it is HIGHLY effective in reducing HIV transmission. This fact seems deeply disturbing to you.

What no one has really disclosed to you is that you are part of an informal study. We aren't sure that PrEP will work- the studies have been limited. So, now that it is available to the general public, those who are being monitored (at places like the VA that have electronic records) will be the way we find out if it works.

Sure a larger evaluation is ongoing. But we know it works. Some of the initial studies were halted for ethical reasons to provide the people in the control group access once it was found out that it did work. I'm sure you know this.

Because if you put someone with HIV on HAART, their viral load drops to near zero which the studies show means that they are very unlikely to transmit HIV to their partners- even when they have unprotected sex.

HAART has been available for 15 years. If the HIV rates for the past 15 years have remained constant this means people with HIV a) aren't on HAART and b) they're still having unprotected sex and c) they're still having sex with multiple partners.

A significant number of people with HIV don't know they have it because they do not seek out regular testing. Again, I'm sure you know this. Why are you feigning ignorance here?

The only success that we have had in the past was with limited behavior modification (e.g. safer sex practices). However, MSM return to their old practices when there's no peer pressure to practice safer sex. We haven't been able to "medicate away" the HIV epidemic in the past.

We know that safer sex/condoms usually work. We also know that global adherence to condom use has never been achieved, nor anything close to it. We also know that even among those who have used condoms, they have not always worked. Andrew Sullivan is a well known example. He has said that he was shocked when he tested positive because he had always used condoms.

Given that we now have a second powerful tool to prevent HIV in addition to condoms, we should be doing more to encourage its use, not discouraging it.

It's unlikely PrEP will make a difference either

Absurdly premature conclusion. Hardly a scientific perspective. As you said, we know condoms have worked (for people that use them). We also know (with a not certain but high degree of reliability) that prep works (for people that use it correctly). Given that, it stands to reason that it could very well work on a large scale with an efficacy rate similar to condoms. Neither have nor will be a silver bullet that eliminates HIV totally (that would take a vaccine) but they can both be powerful weapons against it, and we need more weapons against it being deployed.

assuming that it actually works and assuming that it doesn't just become an excuse to not use condoms (which was already happening before PrEP became available).

And there it is. Your reason for spreading doubt, denying the evidence, and linking up with the people who wish to publicly shame prep because of its potential to decrease condom use. This conveniently ignores the fact that according to the studies the FDA conducted before it was approved, most people who are taking/want to take it for protection against HIV during unsafe sex weren't using condoms anyway.

This is actually an old debate. In Larry Kramer's 1983 play "The Normal Heart", there's a discussion between Ned and his doctor about how to best stop the spread of HIV. We're still having the same debate 32 years later, only we know that there's no hope that gay men will change their behaviors in the long term:

My take is that we can best stop the spread of HIV by using ALL weapons against it that we have. That includes condoms, treatment as prevention, and prep.

 

[hotatlboi]

I take Truvada everyday as a prEP. I understand it is 99% effective in preventing HIV (even without the use of condoms) when it is taken daily. What is the significance of the infection rates remaining constant?

There isn't one. He's trying to sow doubt about prep by using an absurd comparison. The ARV treatments were never previously offered to a wide enough population to make any significant difference in infection rates from the portion of the populace that had HIV and was unknowingly spreading it (which has always been a significant percentage).

 

[hotatlboi]

Condoms, prEP (Truvada) and abstinence are the tools available to prevent one from contracting HIV. Pick which tools you want to use. Your health is YOUR responsibility.

There is one additional one, having sex with people known to be on ARV treatment (undetectable). This of course requires trust in the other person that they are adhering to their meds. It also means this method probably shouldn't be used outside of a very trusting relationship.

But I agree, there should be wide dissemination of ALL available methods of prevention to our entire community.

 

[hotatlboi]

So, it seems to me that if Truvada is made available for free to all sexually active MSM, a major HIV epidemic can be avoided.

It would, that's one of the reasons the FDA approved it, despite the objections from others that we are seeing similarly here that it should be avoided due to the potential to reduce condom usage.

 

[hotatlboi]

The gay community is losing the history of what happened in the 1980s and the current generation of young gay men are returning to some of the reckless behaviors that led to the events from 1980-1996.

I just wanted to say that I hope I didn't come across too harshly in my previous posts. I also want you to know that as a young gay man, I do understand the deep divide that many older men feel exists in the gay community with the younger generation's perceived lack of knowledge or empathy of the awful horrors you guys had to witness.

I also applaud your consistent and continued efforts to encourage condom use and am disturbed myself about the increased prevalence of other STDs in the gay community in recent years. I've had gonorrhea myself, it is not fun. It's not something you should put yourself in a position to easily get. So yeah, I understand your motivation here.

I just happen to fundamentally disagree with what seems to be your intention to suppress or obfuscate medical knowledge about the efficacy of prep. Ultimately people are going to do what they want to do. Hopefully more people realize that abandoning safe sex is not the answer and will lead to an unhealthy outcome of more disease. But if they don't, they should still be able to make a choice to protect themselves from the worst std if that's what they want.

 

[hotatlboi]

There are numerous studies ongoing but the decision to approve Truvada for PrEP was made on surprisingly few studies and it was specifically stated that it was for certain high risk groups (e.g. discordant couples) and was not a replacement for condoms.

People having sex with multiple partners who are not using a condom 100% of the time (and even some who are or think they are, i.e. Andrew Sullivan) are a high risk group for acquiring HIV. Again, you know this.

That group encompass a large number of gay men (maybe even the majority).

Hence, they should be offered prep or at least educated on its existence.

 

[kallipolis]

If a sexually active person elects not to use a condom, a simple, convenient protection against contracting sexually transmitted infections... it is also highly probable that he will not be bothered to use PrEP...as an after thought.

Prevention through condom usage is the ideal.....

 

[kallipolis]

People having sex with multiple partners who are not using a condom 100% of the time (and even some who are or think they are, i.e. Andrew Sullivan) are a high risk group for acquiring HIV. Again, you know this.

That group encompass a large number of gay men (maybe even the majority).

Hence, they should be offered prep or at least educated on its existence.

Agreed....and widely advertised....

 

[KaraBulut]

This has to be the most absurd comparison I have ever heard. Why would treatment of HIV with drugs be expected to reduce the overall rate of infections significantly when that treatment was only available to a small subset of the general population?

In epidemiology, "infection rates" is a measure of incidence (new infections) not prevalence (existing infections). Incidence and prevalence are indicators of risk to a population while incidence is an indicator of rate at which the infection is spreading in the population.

Incidence is also an indication of the effectiveness of measures taken to control the spread of infection, (in the case of the bar graph, safer sex practices and avoidance of needle-sharing).

 

[kallipolis]

Incidence is also an indication of the effectiveness of measures taken to control the spread of infection, (in the case of the bar graph, safer sex practices and avoidance of needle-sharing).

Well noted....

....and from my personal perspective it is also a matter of personal responsibility that one not only takes preventative measures to protect one self...but also to protect ones sexual partner, or partners...I appreciate that the moral dilemma is not one that features in the lives of everyone considering these issues.

 

[mbamike]

If a sexually active person elects not to use a condom, a simple, convenient protection against contracting sexually transmitted infections... it is also highly probable that he will not be bothered to use PrEP...as an after thought.

Prevention through condom usage is the ideal.....

I respectfully disagree. I consistently take my prEP daily. I do not consistently use a condom.

Well noted....

....and from my personal perspective it is also a matter of personal responsibility that one not only takes preventative measures to protect one self...but also to protect ones sexual partner, or partners...I appreciate that the moral dilemma is not one that features in the lives of everyone considering these issues.

I agree. Those "preventative measures" can be a daily dosage of prEP also.

Also, I want to reiterate another point. I get my prEP for FREE. There are programs available that provide prEP to those interested in protecting themselves from HIV.

 

[kallipolis]

^My grandfather taught me that an ounce of prevention is worth a pound of cure saying, it is better to stop something bad from happening than it is to deal with it after it has happened...for this, a condom is the ideal preventative measure....

Some one has to pay for PrEP treatments even, when the treatment is provided without charge, to those who refuse to use condoms....health insurance cover includes paying premiums...

A work colleague reminded me that driving with a seat belt buckled, is not about complying with traffic regulations...but of reducing the risk of serious injury, or death....the PrEP advocate will always reply, that hospitals provide treatment for accident victims...I'll choose the seat belt...buckled...