Showing posts with label Prep. Show all posts
Showing posts with label Prep. Show all posts

February 21, 2017

Mr.Gay NZ Defends his View of Unprotected Sex with PrEp Partners

Charlie Tredway, 33, who was crowned Mr Gay New Zealand at Big Gay Out in Auckland on February 12, has received a backlash after being linked with websites about "barebacking".
Charlie Tredway, 33, who was crowned Mr Gay New Zealand at Big Gay Out in Auckland on February 12, has received a backlash after being linked with websites about "barebacking".
The new Mr Gay New Zealand, who is HIV positive, is defending having unprotected sex, saying he always informs sexual partners of his health status.
Charlie Tredway, 33, who was crowned Mr Gay New Zealand at Big Gay Out in Auckland on February 12, has received a backlash after being linked with websites about "barebacking" (a term used to describe anal sex without a condom).
Tredway, who works as a community outreach staffer for the New Zealand Aids Foundation, said he used condoms the majority of the time and always made sure that sex was informed, consensual and that he was looking after himself and his sexual partners.
He said he only had unprotected sex with HIV positive men or HIV negative men who he knew were on Pre-exposure prophylaxis (PrEP), which was a pill that reduced the risk of them getting HIV. 
He was also on anti-retroviral treatment which successfully lowers the level of HIV in the body to an undetectable viral load where the risk of passing HIV on was virtually non-existent.
An undetectable viral load is when there are less than 20 particles, called "copies", of HIV found in a person's blood.
"That combined with regular sexual health screening and monitoring my viral load is what safe sex looks like in 2017," Tredway told the Herald.
“We have lots of options to protect ourselves and others." Tredway, who contracted HIV from a partner he was entering a monogamous relationship with, said he was not endorsing sex without condoms, rather people's responsibility to look after themselves and use the tools available to them.
"We live in a time where there are scientifically proven and highly effective options and we need to be having these conversations without the scapegoating and misconceptions."
He said the only reason he entered Mr Gay NZ was to challenge the stigma that people living with HIV face regularly.
"That untrue notion that we are somehow less than the rest of the community. That we are unsafe to be around, or unclean and that we can't live our lives with transparency and dignity."
The online backlash was "difficult to take", but also validated his reasons for entering Mr Gay NZ, he said.
New Zealand Aids Foundation executive director Jason Myers said HIV prevention science had moved rapidly in the past two years and had shown that people with HIV and on treatment could reach an undetectable viral load which rendered them virtually non-infectious.
"And so, while in the good old days condoms are the only way to prevent the onwards transmission of HIV we are now in a space in 2017 where there are a number of tools that are equally as useful."
In addition to condoms, undetectable viral loads and Pre-exposure prophylaxis were also viable options to prevent HIV transmission.
The NZAF says it is legal to have sex without condoms if a person has disclosed their HIV status.
In an open letter, Mr Gay NZ producer Matt Fistonich said the organisation would continue to support Tredway as the 2017 Mr Gay New Zealand winner and his advocacy role for the community and HIV stigma and awareness.
"What Mr Tredway does in the privacy of is own home, is not an issue, and ironically any discussion around Mr Tredway's private life highlights and reinforces how as a community we need to continue to fight HIV-related stigma, and raise awareness of the damaging and hurtful attitudes of a vocal minority that need to change."

December 2, 2016

Sex Was Deadly-One Pill Changed That-Still Some Don’t see the Miracle Pill and Fall Overboard

 If where you live there is access to PrEp you have no excuse to put your self to becoming HIV positive, the health system thru the expense and your next partner that you might give it to.  If you forget to take a pill now if you are sexually active you will also forget to tell your partner about being  exposed and so the virus will live on.                                                                      

In late 2014 I received an email from one of New York City's largest sex parties for gay men. Usually, the email would have contained this: a time, an address, a dress code, the price. The party had long been condoms-only, but a new safe-sex provision had just been added: "If you do have condomless sex it is assumed that you are on PrEP/Truvada or undetectable."

I wouldn't have noticed this email if it hadn't been for a response from New York's one remaining condom-only party. This wasn't an invitation but a statement of policy, an email unlike any sent previously or since. Safe sex is an important project, it argued, and condoms are the only way to be safe. The second party remains condoms-only, and is still alone in this decision. It feels now like a holdover from a different time.

My generation of gay men came after the plague but before the pill. What I knew was that fifty thousand people died in the U.S. in 1995. I was thirteen. What I knew was that sex kills, that no pleasure is ever free of worry, of death. The first thing I learned about sex was Kaposi's sarcoma lesions, gaunt thirty-two-year-olds on TV. I became a gay man and a scientist with a background in microbiology and biochemistry. Viruses have always fascinated me for being so complex and yet so simple, for being so deadly with so few genes.

But HIV didn't just kill bodies. It killed a type of sex as well, a type of pleasure. It erased the possibility of my body and another meeting, one moment, without my mortality there too, watching. Sex is this: another body, my body, my mortality, all naked for me to see. I knew about HIV and death before I knew I was gay. I knew about death then, and that being gay might be deadly, and now I sleep with men.
HIV has never left me. I'm nostalgic for the pre-HIV era I never knew. Our image of those years is ambivalent: You could give head in abandoned buildings by the piers, but anything like a relationship seemed impossible to so many, the notion of gay marriage laughable. Gay people weren't often permitted relationships in a world so threatened by our bodies and how we use them. Now we can get married, but — thanks to HIV — we've lost the notion of pleasure without worry. I worry. I only have unprotected sex when in a monogamous relationship. Even then, who knows? Everyone cheats, even straight people.

Those who lived through or were born into the 1980s became a generation afraid of love and the sex it would bring. The writer Hilton Als, referencing the garbage bags that early AIDS victims were stuffed inside, wrote, "I did not say I loved him....If I did, wouldn't that end up in a garbage bag, too?" Even after HIV became less of a death sentence, I always viewed it fatalistically. Being positive would make it harder — I always felt — to find love and trust and sex. I had reservations about dating someone who was HIV-positive; I knew that if I were positive others would have the same reservations about me. If there were a pill for my worry, I would take it, a cure not for an infection of the body but for the traumatized mind. I would take this pill now, and I would never stop.

Some definitions: MSM: men who have sex with men, a term devoid of political or social overtones (unlike, say, "gay" or "queer"). MSM are the community most at risk for new HIV infection. PrEP: pre-exposure prophylaxis. PrEP is a pill taken by HIV-negative people to maintain their status. Truvada: The one pill approved for PrEP. It has been used as a component of HIV therapy since 2004, but was only approved for PrEP in the HIV-negative in 2012. In this article, "Truvada" refers to the drug used specifically by those who are HIV-negative, a shorthand that is almost universal in New York's gay community. Undetectable: An undetectable person is HIV-positive but controlling their infection with antiretrovirals. New research shows that their likelihood of communicating the virus is essentially zero.

Truvada came on the market four years ago, in 2012 , but prescriptions didn't start taking off until early 2014. Gilead Sciences, the company that makes and sells Truvada, reported earlier this year that eighty thousand to ninety thousand people were on PrEP. Twelve and a half thousand people in New York State have filled prescriptions, the overwhelming majority in the city. The number of individuals starting PrEP has increased exponentially, rising fivefold in two years, from the end of 2013 to the end of 2015. A survey by New York City's Department of Health estimates that 29 percent of MSM ages eighteen to forty in the city are already on PrEP.

For one week, those numbers included me. I wasn't having sex with a stranger. I was having sex with my ex. He'd been in and out of my life after he'd gone away for a month and I'd found evidence he was cheating. A part of me had always known.

We'd been having unprotected sex for a year. I've always had unprotected sex with my boyfriends, a sign that we cared for each other, that we had built something like trust. I insisted on couples trips to the free clinic after three months of monogamy. I loved this man in part because his sex seemed so free, so out of my control. I begged him not to put me at risk. I told him my body was in his hands. He looked me in the eye and said I could trust him. I did trust him. After I caught him cheating, we used condoms. I got tested. He said that he never had raw sex with anyone but me, that it was an intimacy I alone had earned. I believed he was telling the truth. I trusted that he only cheated safely.

My ex wanted another chance. He wanted to have raw sex again. So one of us — I don't remember who — suggested PrEP. This was in 2014, when hardly anyone knew about Truvada. PrEP and undetectable were not yet listed as safe-sex options in hookup apps. Gay activists still called it a poison, a party drug. This pill offered the promise of bringing us back together. Truvada was more certain than his word.

We both started swallowing that big, blue pill once a day.

A week later, without touching him much at all, I was on my way out of his life. PrEP made space for me to consider raw sex with him again, but I realized that it wasn't HIV that made him unsafe. Maybe for the first time in my life, I wasn't afraid of HIV. I was afraid of him. There was no cure for the damage we had done to each other. So I left, and I tried to stay gone.

Truvada is not one drug but two: emtricitabine and tenofovir disoproxil fumarate. HIV pills contain multiple (usually three) antiretroviral drugs. This is because HIV mutates rapidly to become resistant to any one therapy. The likelihood of a single virus simultaneously acquiring resistance to two or three drugs is the product of the individual probabilities, a number that approaches zero without ever reaching it.

People at high risk for HIV infection — sex workers, MSM, those with multiple partners — can take Truvada and have unprotected sex with little risk of contracting HIV. There is a 96 percent reduction in HIV transmission for those who take the drug four times a week. For daily use, the reduction is 99 percent. In one key study, none of the participants contracted HIV. Another option — post-exposure prophylaxis, or PEP — can be taken after a broken condom or risky sex. These drugs stop the virus from replicating before it manages to find and infect T cells. The virus never becomes a part of us.

In preventing the transmission of HIV, PrEP is at least as effective as condoms. Condoms reduce the risk of HIV transmission through anal sex by 70 percent with consistent and proper use. For men who don't use condoms consistently — and according to studies, most men don't — the difference in rates of HIV transmission between sex with and without condoms is not statistically significant.

Those who remain HIV-negative while on PrEP will have antiretroviral medicine consistently in their bloodstream and no virus in their blood. Undetectable people have antiretroviral medicine in their bloodstream and no virus in their blood. In terms of HIV transmission, there is no reasonable distinction between those who are HIV-negative and on PrEP and those who are HIV-positive and undetectable.

For many years there was a respectability politics of condoms. Truvada was vociferously opposed by traditional gay health organizations. Michael Weinstein, the head of the AIDS Healthcare Foundation, continues to campaign against it. The opposition to Truvada seems to have made Gilead cautious about marketing it. Though the drug has been available for four years, Gilead has started to underwrite advertising only in the past few weeks. Paranoia about PrEP remains, often driven by the idea that other infections (chlamydia, syphilis) will rise without condom use. Bacterial STIs did increase in 2015, though it's impossible to connect that increase to Truvada. In effect, much of the rhetoric about STIs continues a long history of pathologizing gay sex, particularly raw gay sex, now that we can no longer rely on HIV alone.

When single, I use condoms consistently. I believed this: Responsible, self-loving, caring, good gay men use them, always. I wanted to be that type of man. I was shocked, talking to my straight friends, to learn that they had unprotected casual sex. Gay men were considered unsanitary even before HIV. Our vice president–elect thinks us unfit to work because of our diseased bodies. We have to constantly prove to the world that we aren't, in fact, sexual monsters, deviants. Straight people don't carry the same burden of politics, the same history of HIV, into the bedroom.

In the era of HIV activism, gay sex was central to the conversation. HIV was a sexually transmitted disease; how we fucked was how we lived or died. In the fight for gay marriage, we willingly hid our sex. An ex-partner of mine worked at GLAAD, where he trained people to say "gay" and not "homosexual," because the latter puts the word sex in people's faces. The fight would be easier if people didn't imagine the icky things we do in the dark. We won the right to marriage by convincing straight nuclear families that our love is just like theirs. Our sex, too: three times a month, monogamous, missionary, seven minutes, safe.

But there's always been a tension. Queer people are a sexual and cultural vanguard. Anal sex is kind of our thing; now sitcoms joke about straight couples pegging. We had Grindr for years before Tinder popped up. We've been doing monogamish since basically forever.

Gay and HIV activists fought conservative institutions — public schools, the Catholic Church — to make condoms widely available and to train people how to use them. In a world where everyone was dying, condoms were the only way to stay alive. They worked. For decades, condom culture was a type of care among gay men. As we approach four years of a Trump administration, this fight against conservative institutions might be beginning anew. But condoms may have a cultural significance that now surpasses their usefulness in public health and public policy.

I bought into the politics that binds HIV and gay-marriage activism: that condoms matter, that sex must be contained, safe, respectable. I was raised Catholic and always had been a little afraid of my own sexuality. I thought myself better-than because I'd always used condoms. I looked down on my friends who didn't. Of course humans — of all sexualities — slip up. Of course people are going to find pleasure in doing the very thing they've always been told not to do. Sometimes we want things from love, from sex, precisely because they aren't safe. I wanted my ex; he wasn't safe. I always suspected he was cheating; we had unprotected sex anyway.

The conventional narrative of the past three decades is that we survived the plague. Then we got marriage, an assimilation into an institution that I always found too narrow for most relationships, even straight ones. What we lost was the freedom of queer sex, queer sluttiness, queer rage, raw sex, queer separatism, hedonism, and free queer love, which might not look like straight love at all. HIV gave gay men who believed in respectability, modesty, and monogamy the upper hand. Marriage used that respectability to gain legal rights. Truvada might be a step toward a new sexual liberation — sex parties, singles and swingers, threesomes even for committed couples — and away from the condoms that made our sex safer not just physically but culturally. No wonder it makes people, gay and straight alike, uncomfortable.

AIDS Taught Me Sex Was Deadly. A Pill Changed That 
Truvada is nothing special, nothing new. The antiretrovirals in it have been used for decades. The difference is the bodies the drugs are put inside, now HIV-negative, no virus in residence, now not ill but pre-ill, infected only by the type of sex we have.

The pill's out-of-pocket cost is roughly $18,000 a year. Truvada is made by only one company, Gilead. One common criticism of PrEP is that it requires HIV-negative people to take very expensive pills whose side effects are not insignificant. PrEP, the argument goes, turns gay sex into a profitable (and therefore palatable) enterprise in the age of late capitalism, where everything is moral if it's making someone rich. Gay sex parties aren't sinful debauchery; they're added value for Gilead shareholders.

The rebuttal is that PrEP works. It's most likely less expensive, and involves fewer years of dealing with side effects, than taking antiretrovirals for a lifetime, as those who are HIV-positive must. Yet $1,500 a month for the option of sex uncontaminated by fear of HIV is a high cost for an individual or society to pay.

Gilead has a program that provides free drugs to those without insurance, and there is a co-pay assistance program as well. Theoretically, anybody should be able to get Truvada at low cost. In practice, it's not that simple.

As I was writing this essay, I had dinner with a friend who had been on Truvada but who had recently had to stop taking the drug. He hit the yearly cap — $3,600 — for the Gilead co-pay assistance program and his co-pay, he said, was as high as $500 a month. With private insurance and a very high co-pay, he was — in terms of access to Truvada — in a worse position than those who have no insurance at all.

"I just want to be able to have sex again," my friend told me. He's single and mostly uses online apps for sex and dates, both. He was having a hard time finding men who would have sex with condoms. For my friend, in 2016, PrEP feels necessary to have sex. He wouldn't have unprotected sex without it, and hookup culture — according to him — has moved on. Condoms are no longer the norm. This does feel new.

I knew the city was building a program to help people with private insurance who max out the Gilead co-pay program. I had met with Dr. Demetre Daskalakis, the head of New York City's HIV prevention campaign, to talk about condoms and PrEP and the city's programs. We'd discussed people in my friend's situation. I spent the next two days on the phone with a full alphabet of agencies: first 311, then HASA (only for the HIV-positive) and ADAP (doesn't cover PrEP), then my city-associated HIV clinic. Nothing. Then state programs, PrEP-AP and the PrEP hotline; then PAN, then Xubex.

On hold listening to badly performed classical music I thought, This is how bureaucracy kills: to Bach. I'd spent months researching PrEP, and I couldn't help my friend. Once I'd exhausted all the options, I reached back to Dr. Daskalakis, hoping for a nudge in the right direction. Yes, the city knows about the PrEP donut hole for the underinsured. Yes, they are hoping to develop a solution. No, there is nothing yet. It's been months since my friend has taken Truvada and months, too, since he's had sex.

Truvada offers sex without worry for fifty dollars a pill. People live and die on the basis of a brief conversation at a clinic about whether and how to sign up. Fifty percent of black MSM are HIV-positive or are likely to be in their lifetimes. New York City is majority-nonwhite. In some places people are still — against medical and epidemiological evidence — going to jail for fucking while HIV-positive. Many still blame an HIV-positive person for their risk when both partners consent to unprotected sex. Even in New York, where the city government is committed to PrEP and stigma-free HIV policy, there are people who fall through the cracks. Outside of this city, those with the least access to PrEP will be people — queer people, poor people, people of color, people in prison, people in rural towns — who have always been excluded from healthcare.

And that is what HIV care looks like before Donald Trump starts running the federal government. Our vice president–elect has led the drive to defund Planned Parenthood — even as the closure of a Planned Parenthood testing center in his home state inflamed a major HIV outbreak.

The coming years could make geography matter even more than it already does — things like PrEP may be accessible in New York and entirely unavailable in rural Indiana. More than five hundred thousand people in America know they're HIV-positive but aren't on treatment. This is more than half of all people living with HIV. A friend of mine has a cousin in a deep-red state dying of AIDS, right now, today. He has KS lesions, he's unlikely to live much longer, he often can't get drugs, and when he does take medicine he tells his relatives only that he has "cancer." This isn't the story we're telling ourselves, and it's not one we often hear.

When PrEP was introduced, we all wanted to know: Would it change behavior? Would it lead to a world where condom use dwindled and raw sex became — again — the norm? Early research showed that PrEP users didn't decrease their condom usage. People on PrEP weren't more likely than they were before to have raw sex, they were just more protected in their actions.

More recent studies suggest otherwise. My experience and the experience of my friends also hints at a culture shift. Almost everyone I asked who still uses condoms has a story of someone backing out of a hookup if condoms were to be used. People are having more raw sex, and they're more open about it. They advertise it on apps. They talk about it with their friends. I see it now, and I didn't see it much before.

I've spoken to dozens of people, on and off the record, about PrEP. Sitting at my kitchen table with three gay writers, none of whom were taking PrEP, I realized that all the people I've talked to — whether they are taking the drug or not — are making a difficult and informed choice about their body, their pleasure, their risk, their sex. Some are using PrEP as a backup to condoms, others as a substitute. Many aren't using it at all; some use it on and off, when they are not in a monogamous relationship. Some want to start. At my kitchen table, one writer friend said that having lived through the 1990s, he'll never take the condom off. It'll never — for him — feel safe or sexy.

Me? When my boyfriend read an early draft of this piece, he asked if I wanted to get on PrEP. "No," I said, "I don't. Do you?" Reading this made him feel like HIV is inevitable, especially given the numbers concerning men of color. But this moment we're in makes me feel hopeful. Even if HIV happens, so what? I used to think that HIV would make it harder to find love and sex. Now we know that HIV-positive and undetectable is safe. It's sexy. I have friends who prefer to sleep with undetectable men. They know that most HIV transmission is by people who don't know they're infected or aren't on treatment. For an acquaintance who prefers not to use condoms for his hookups, people who know they're positive and are on drugs are the safest bet.

"Our story is about to change," Dr. Daskalakis told me. He meant the public health programs the city is about to enact. For me, it's true of our cultural moment: a disorienting pivot from everything we told ourselves to be true. The line between HIV-negative and -positive, between bodies safe and not safe to sleep with, is becoming porous.

The political moment we're in only amplifies this feeling. We might go back to 2012 — before Truvada, before we knew that undetectable means safe. We might go back further. I can imagine a future where only people with money can treat or prevent HIV. For many, that's still today's reality anyway, and it probably won't change under the Trump administration. Remember that more than half of the people with HIV aren't on treatment right now.

So yes, we now have good HIV medicine for both treatment and prevention. Pills don't cure us, but they might keep us alive. In 1996, people were so near to death, and then they weren't. Pills do beautiful, beautiful things. Pills can't do it all. Pills can't make us better at negotiating consent or understanding risk. Pills are not healthcare infrastructure in communities that need it. Pills don't erase stigma. Pills exist where people can afford them. Pills exist for people who can get to doctors, clinics, and hospitals.

In New York City, Truvada has become something like mainstream. All living is risky. All sex, too. I've slept with people I didn't love enough when they loved me deeply. I've slept with people I loved who didn't love me enough, who lied, who cheated. I've had joy, too, even with that ex: when we made love as midnight brought in my thirtieth birthday. Joy: the Grindr hookup I had whose body fit mine. Joy: the first kiss with my current boyfriend, a bundle of nerves, leaning forward on my couch, our glasses clinking at the nose. For decades, and still too often, these small moments of pleasure could bring death.

In the past three years, I've been able to imagine a new type of pleasure. Remarkably, this pleasure is one willing to inhabit my own body. I don't know if it's PrEP — even though I don't take it — or the idea that being undetectable is safe, healthy. I don't know if it's because I have a partner I trust with my life, but I suspect it's something more than that.

Even with boyfriends or girlfriends I trusted before, I could never have sex without feeling my life and death were at stake. Now, with my boyfriend, we strip each other naked, no Truvada in either of our blood. In these moments, my mortality is growing smaller and smaller. Sometimes I don’t think about it at all.

August 3, 2016

Ruling Indicates NHS Has the Responsibility To Gay Men to Roll Out Treatment of PrEp

Truvada Caps


The health and lives of gay men matter. That’s what the high court ruled on Tuesday morning. Last year, NHS England decided against rolling out a treatment called PrEP – which prevents the transmission of HIV. The wellbeing of gay men was overriden by other priorities. Given it costs substantially more money to treat HIV than to prevent it, even financial considerations weren’t a good reason.

 On Tuesday, NHS England was defeated in court and told it was responsible for funding the treatment, and that they have a “preventative role and power to commission preventative function”. Pressure must now be placed on the NHS to start rolling this drug out immediately. As the British Medical Journal pointed out, “delays by NHS England will cost lives”.
If you want to stop HIV spreading, then PrEP is one among many solutions. It works. As studies in the United States have shown, if taken every day, it has been shown to reduce the risk of HIV infection in high-risk individuals by up to 92%. The objections to PrEP, in truth, are based on moral objections. If you do not want the risk of HIV, goes the argument, then wear a condom. Those who get HIV are, by implication, morally condemned for bringing it on themselves.
Of course, safer sex messages must always emphasise the importance of condoms: after all, they protect against many other STIs. But – in the real world, rather than the non-existent world of the morally self-righteous – things are more complicated. People get carried away; people get drunk (yes, in the real world imperfect people sometimes drink more than the recommended daily amount); condoms break. The same moralising is used against the right of women to have control over their own bodies, whether it be the right to abortion or even the morning-after pill. The standards set by the “morally pure” cause harm – or even kill.
We have come so far with the treatment of HIV, once a disease that ravaged the gay world. But according to the Terence Higgins Trust, there are 45,000 men who have sex with men living with HIV; and thousands of them do not know they even have it. The annual rate of newly infected men in 2014 was higher than the decade before. If you genuinely want to send HIV infection rates hurtling into reverse, then PrEP is not the only solution – but it is a good one.
Gay people, their health and their lives, matter. That’s a court judgment. NHS England must now accept the defeat – and start doing its job: protecting health and saving lives.

May 21, 2016

What You Should Know About Gay Men that Take PrEp-Smart?Slutty?SuperSmart?

Image result for prep


Critics of PrEP, the daily pill that stops people getting HIV, say that gay men just need to change their behavior, not take a preventative medicine. Here is why that alone is not the answer

When the Pill was introduced, there was an immediate backlash, as people felt it would encourage promiscuity. We managed to overcome that stigma, and over 50 years later we are on the cusp of something similarly revolutionary in regards to HIV.
PrEP, a daily pill that stops people getting HIV, could soon be provided on the NHS. For gay men, the demographic most at risk, there is the very real possibility that they too will be able to have sex without life-changing consequences.
Yet like the Pill, PrEP is not without its critics – we are seeing many of the same arguments, often made by heterosexuals with a low HIV risk, being rolled out to deny gay men PrEP. 
It’s important to remember that it’s not just gay men who get HIV, but often the main arguments against it are based on judgements about their behavior.
 1. “Just stop sleeping around” 
Shaming anyone’s sex life isn’t an effective way to prevent HIV and whilst it stands to reason that the less people you sleep with the less chance you have of getting HIV. It’s not that simple. 
For gay men the odds are stacked against them from the off. One in 20 gay men in the UK has HIV. This compares to 1 in 1,000 straight people. 
If you are a sexually active gay man, you have a high chance of sleeping with someone with HIV.  If he is one of the 14 per cent of gay and bisexual men who aren’t aware that they have HIV, there is a real risk you will acquire it from them. People who have diagnosed HIV and are on effective treatment are essentially non-infectious. 
2. “Use condoms”
 People say that giving gay men PrEP will mean they are less likely to use condoms. The UK-based PROUD PrEP trial, which was designed to understand how PrEP would be used in the real world, showed that this wasn’t the case. 
Condoms used perfectly are 98 per cent effective, but this isn’t a realistic scenario. They can break or come off – this brings overall effectiveness to 85 per cent. This is without factoring in the times people are just too drunk or turned-on and decide to chance it. 
Let’s face it: people do make bad decisions in the heat of the moment.
 Clearly condoms have been, and will continue to be, vital to the fight against HIV.  Scientists have concluded that if gay men had given up on condom use entirely between the years 2000 – 2010, we would have had 400 per cent more new infections.  With around 2,500 gay and bisexual men acquiring HIV a year though, condoms have clearly not managed to crush the epidemic single-handedly.  
3. “Just pick a partner and stick with them” 
In reality, more men get HIV from their boyfriend or regular partner than from casual sex – promoting monogamy isn’t a catch all solution. Clearly, what we have been doing hasn’t stopped HIV or even slowed it down amongst gay men (each year a record number get diagnosed with HIV). 
But we have something that works – PrEP.
PrEP is at least as effective as condoms in preventing transmission. In the three major studies on PrEP, there were no instances of someone who was taking PrEP, in the correct manner, acquiring HIV.  By all means if condoms work for you, keep doing what you’re doing – but if that was enough, we would have stopped HIV in its tracks a long time ago. 
We need to keep the options open for everyone, and level the playing field for populations facing an unfair burden of HIV, meaning they can have the privileges that so many of us take for granted – the chance to have sex without fear.

January 16, 2016

Another Study Indicates PrEp to High Risk Guys/Girls Will Cut HIV Rates by 40%


"Without PrEP, HIV incidence in men who have sex with men in the UK is unlikely to decrease substantially by the end of this decade," the study states..

In the UK, HIV transmission in gay men has shown no sign of decreasing in the past decade, and in London alone, one in eight gay men is HIV positive.

PrEP is not yet available on the NHS, but some men are buying the drug privately from clinics in the UK and online.

HIV advocacy groups have hailed the new study as "important" and are calling for PrEP to be made available on the NHS.

"PrEP has been something we have [been] arguing for for a while," "PrEP has been something we have [been] arguing for for a while," Suzi Price, a spokesperson for the National AIDS Trust, told Mashable.

"It would be an important inclusion into the range of options people use for HIV prevention, condoms being a main element of this, as well as strategies such as partner reduction."

"We are hopeful with all the evidence of the success of PrEP that the NHS in the UK will start funding it soon as well," Price continued.

Michael Brady, medical director at the Terrence Higgins Trust, stressed the importance of the new study's findings.

“This study published in the Lancet is really important as it demonstrates that, in a relatively short space of time, PrEP could have a dramatic impact on reducing HIV transmissions," he told Mashable.

“PrEP has been shown, both in clinical trials and in real life settings, to be highly effective at preventing HIV transmissions. “PrEP has been shown, both in clinical trials and in real life settings, to be highly effective at preventing HIV transmissions. Despite the proven benefits of condom use and the impact of HIV therapy on reducing transmission, the number of gay men infected with HIV each year has remained relatively stable over the last decade," he continued.

Brady also warned that the UK is "lagging well behind other countries" in its approach to HIV prevention, and that investment in successful prevention techniques, such as PrEP, is urgently required.

"It is essential that PrEP is made available on the NHS as soon as possible for those most at risk. Every month we delay there are more people being unnecessarily infected with HIV,” he said.

This is not the first time PrEP has been found to be highly effective in preventing HIV transmission in high-risk men.

In February 2015, researchers from University College London and Public Health England found that PrEP reduced HIV transmission by at least 86% in men who have sex with men in England.

And a 32-month study at the Kaiser Permanente San Francisco Medical Center found that among sexually active gay men who were taking PrEP, no new HIV infections were reported.

September 9, 2015

Two and half Years Latter No one Contracts HIV on PrEp in 'Frisco

 Im clean and Im HIV

You gotta trust it in order to work for you. Read the facts and see if it’s right for you. 

Two and a half years into a large Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP) program in San Francisco, none of the more than 600 men who have sex with men (MSM) taking the HIV prevention medication have contracted the virus. At the same time, many of these inHIVdividuals are using condoms less since starting PrEP, and during their first year on Truvada half of them had contracted at least one sexually transmitted infection (STI). Those at higher risk of the virus were more likely to opt to start PrEP after their initial consultation.

Researchers at Kaiser Permanente published their findings in Clinical Infectious Diseases. The paper represents a powerful endorsement of PrEP’s ability, in a real-world setting, to prevent HIV infection among those at very high risk of contracting the virus. The lack of new HIV infections among these men challenges the stance of AIDS Healthcare Foundation president Michael Weinstein, who has vigorously campaigned that PrEP should not be used as a widescale public health intervention.

On the flip side, the Kaiser findings challenge the received wisdom from PrEP clinical trials that those taking Truvada as HIV prevention do not increase sexual risk-taking while on the medication.

“Our study is the first to extend the understanding of the use of PrEP in a real-world setting and suggests that the treatment may prevent new HIV infections even in a high-risk setting,” reports lead author Jonathan Volk, MD, MPH, a physician and epidemiologist at Kaiser Permanente San Francisco Medical Center. “Until now, evidence supporting the efficacy of PrEP to prevent HIV infection had come from clinical trials and a demonstration project.”

Kaiser released preliminary data about the PrEP-taking group in December 2014, stating at the time that two of them had contracted hepatitis C virus (HCV), most likely through sex. Since then there have been no new hep C infections.

Over a 32-month period, 1,045 individuals were referred to Kaiser Permanente San Francisco Medical Center’s PrEP program. A total of 835 (80 percent) of them had an in-person evaluation for PrEP at the clinic, and 657 of that group (82 percent) then began Truvada. Starting in September 2013, when media attention to PrEP suddenly surged, the Kaiser group saw interest in PrEP begin to rise.

The average age of those taking PrEP was 37 (they ranged between 20 and 68 years of age), and 99 percent of them were MSM. The group included three heterosexual women and one transgender man who has sex with men. Three reported injection drug use and 15 of them had taken post-exposure prophylaxis (PEP) during the three-month period before staring PrEP.

Those who ultimately went on PrEP were more likely to say that they had multiple sex partners than those who chose not to take Truvada (84 percent vs. 69 percent). Among those who did not start PrEP, 35 percent opted out because they felt they were at low risk for HIV, 15 percent were concerned about cost, 10 percent did not want to have make the required quarterly clinic visits, 6.3 percent preferred PEP as an HIV prevention method, 2.8 percent were worried about side effects, and 1.4 percent were concerned that PrEP might influence them to increase their sexual risk-taking.

Among the group taking Truvada, the average time on PrEP has been 7.2 months, which adds up to 388 person-years. (Person-years represent the cumulative time spent on Truvada among the group. So if one person took PrEP for one year and another for two years, that would represent three person years.)

After six months, the clinicians at Kaiser surveyed 143 of the cohort about their sexual risk-taking. At that time, 74 percent reported that their number of recent sexual partners had not changed since starting PrEP, while 15 percent said they had fewer sexual partners and 11 percent said they had more. Regarding condom use, 56 percent said they used them at the same rate after starting Truvada, 41 percent used them less and 3 percent used them more.

Because these individuals were not engaged in a clinical trial, there is no control group to measure the change in these men’s sexual risk-taking against. So there is no way to tell if the group would have changed their risk-taking in a similar pattern if they had not been taking PrEP.

One thing is clear, however: These men would have been at very high risk of contracting HIV had they not been taking PrEP while engaging in the same level of sexual risk-taking. The evidence is in their very high rate of STIs. Six months into taking PrEP, 30 percent of the PrEP users had been diagnosed with at least one STI. During their first year on PrEP (or partial first year), half of them contracted one or more STIs, with 33 percent diagnosed with a rectal STI, 33 percent with chlamydia, 28 percent with gonorrhea, and 5.5 percent with syphilis. As noted, two of them contracted hep C.

“Without a control group, we don’t know if these STI rates were higher than what we would have seen without PrEP,” stressed the paper’s co-author Julia Marcus, PhD, MPH, postdoctoral fellow at the Kaiser Permanente Division of Research. “Ongoing screening and treatments for STIs, including hepatitis C, are an essential component of a PrEP treatment program.”

No one in the group has been diagnosed with HIV.

In an accompanying editorial in Clinical Infectious Diseases, Kimberly A. Koester, MA, and Robert M. Grant, MD, MPH, of the University of California, San Francisco, called the lack of HIV infections among the group “tremendously good news.” They wrote that the paper’s findings demonstrate “meaningful progress towards the goal of halting infections” of HIV.

Koester and Grant also called for “a vigorous conversation about sexually transmitted infections, too long eclipsed by fear of HIV infection,” and stressed the need for routine STI testing in primary care practices. “If the STI burden in the context of PrEP use become[s] too great, communities can and will make course corrections,” they wrote, while noting that rising rates of STIs among MSM predates the advent of PrEP.

At this time Kaiser has no data to report about the group’s adherence to the daily Truvada regimen. Such information is forthcoming.

The researchers said that demand for PrEP is growing in San Francisco. They also pushed for increased outreach to offer Truvada to other high-risk individuals, including transgender women, heterosexual men and women, and injection drug users.

This story written by Benjamin Ryan and it first appeared on

To read the study abstract, click here.

June 15, 2015

Sex without Fear

Left: “I equate PrEP to the Pill. People had a backlash against it at first, thinking it would lead to promiscuity. I’m being a pioneer and a guinea pig, and why not?” —Nathan
Right: “I use condoms but not with one guy, a friend with benefits. I’m HIV-negative, and he is, too, to my knowledge, but I’d consider going on PrEP to be more cautious. I can get it through my mom’s insurance.” —Sherrod   

Gabriel and his friends like to go dancing at places in Chelsea and Hell’s Kitchen like Viva and Pacha. One night last winter, they ended up at a downtown club hosting a circuit party, a huge gay rave with throbbing, industrial house music. The theme was leather and S&M, and Gabriel* wore a singlet. He’s usually the least interested in drinking of the group­—he’s the responsible planner—but as the night wore on, he wound up becoming very drunk and very high and making out with lots of men. “I was feeling the fantasy of it all,” he says. A couple he vaguely knew grabbed him. They wanted to do more, insistently. Gabriel resisted at first and then, he says, decided to just give in to the spirit of the evening. It felt, at the time, freeing and hedonistic. 
But he hadn’t been wearing a condom when they had sex, and in the morning, he woke up wanting nothing more than to regain control over that moment. Gabriel is a 32-year-old real-estate broker. He had tested negative for HIV the last time he’d been to a clinic. Terrified that might change, he went to Callen-Lorde, a health clinic in Chelsea, where he was placed on a 28-day course of a full HIV-medication regimen. When taken within three days of exposure, it dramatically reduces the chances of infection—something like the morning-after pill for HIV. Gabriel didn’t react well to the course: He felt nauseous and drained the whole time. 
He never wanted to go through that again—neither the physical or the psychological anguish. So Gabriel got a prescription from his doctor for Truvada. Truvada is a ten-year-old HIV-treatment pill that, in 2012, quietly became the first drug to be approved by the FDA for a new use: to prevent HIV infection. The drug has the potential to dramatically alter the sexual behavior—and psychology—of a generation. When taken every day, it’s been shown in a major study to be up to 99 percent effective. For Gabriel, it was like switching to birth control instead of Plan B. 
Several months after starting the drug, Gabriel says it’s allowed him to be bolder and more unapologetic in his desires, to have the kind of joyfully promiscuous, liberated sex that men enjoyed with one another in the decade or so after the Stonewall riots brought gay life out from the shadows and before the AIDS crisis shrouded it in new, darker ones. 
For some men, Truvada’s new use seems just as revolutionary for sex as it is for medicine. “I’m not scared of sex for the first time in my life, ever. That’s been an adrenaline rush,” says Damon L. Jacobs, 43, a therapist who has chronicled his own experience with the drug on Facebook so enthusiastically that some assume Gilead, the drug’s manufacturer, must be paying him. (It’s not, say both he and Gilead.)
“I stayed the night with a guy I knew, whom I believe to be HIV-negative,” he tells me. “We passed out, too drunk to fuck.” In the morning, they tried again, without a condom. “He was getting close to coming,” Jacobs relates, “and he said, ‘Do you want me to pull out?’ and I said, ‘No.’ I thought, I want this experience. I deserve this.”

For the past several years, the conversation about gay life has been, to a large degree, a conversation about gay marriage. This summer—on social media, on Fire Island, at the Christopher Street pier, and in certain cohorts around the ­country—what many gay men are talking about among themselves is Truvada. And what’s surprising them is how fraught the conversation can be. For some, like Jacobs, the advent of this drug is nothing short of miraculous, freeing bodies and minds. For doctors, public-health officials, and politicians, it is a highly promising tool for stopping the spread of HIV.
But for others, a drug that can alleviate so much anxiety around sex is itself a source of concern. They worry that Truvada will invite men to have as much condom­less sex as they want, which could lead to a rise in diseases like syphilis. Or they fret that not everyone will take it as religiously as they ought to, reducing its effectiveness and maybe even creating resistance to the drug if those users later become HIV-positive and need it for treatment. And just as the birth-control pill caused single women in the sixties to wonder whether they’d be seen as “sluts” and to internalize that real and imagined shame, some gay men wonder how Truvada will play in the straight world; it sends a strikingly different message from the one in the “Sunday Styles” wedding announcements. Other gay men worry that the very existence of such a drug is a kind of betrayal: of those who’ve died in the epidemic; of fealty to the condom, an object alternately evoking fear and resilience, hot sex and safe-sex fatigue; and of a mind-set of sexual prudence that has governed gay-male life since the early ’80s. Even after treatments for HIV made it a manageable disease for many, gay men have absorbed the message that a latex sheath is all that stands between them and the abyss. Meaning not only HIV infection but everything it implies: loss of self-control and personal dignity, abdication of civic responsibility.

This is the Future a new Chapter

They ended up taking baths together all winter long. But it was only in March, when they were both in New Orleans for Mardi Gras, that they fell in love. “I realized,” says Herrera, who previously had found Beard a little dour, “that a New York winter is not the time to see the best in someone.”
When they got back to the city, Herrera was faced with a dilemma. He wanted them to sleep together without a condom, but Beard’s HIV undetectability wasn’t enough to ease his mind. Herrera started looking into going on PrEP. 
“I felt an incredible loss of control, constrained,” says Herrera. “I thought previously I’d go on PrEP for every slut in New York City, then I found myself thinking of going on it for just one guy. I felt like I was being pulled into a big public-health trend, not to mention Gilead’s coy indirect marketing. Was it really the best thing for me?”
Beard would say to Herrera only that it was his body and his decision to make, but says he wasn’t comfortable having condomless sex, as a top, unless Truvada was involved. 
Herrera went through the paperwork of getting on an Obamacare plan and going on PrEP. “I was a Latino immigrant who grew up without health care,” he says, “and finally I had a reason to be in a health structure and go to the doctor and get checked up every three months.” He took his first dose of PrEP with a huge can of Sixpoint beer and posted on Facebook a picture of the can alongside the Truvada bottle. One friend posted a frowny-face (perhaps thinking Herrera had HIV), but another wrote, “The future is now!” while yet another PrEP-taker said he liked to take his with a mimosa.
After ten days, once they were sure the Truvada had kicked in, Beard penetrated Herrera without a condom. “I was afraid I was going to hurt him,” says Beard. “I was dazed all day after,” Herrera replies. He smiles.
Homosexuality is separated from heterosexuality by the simple matter of whom one desires. And for 50 years, gay men have experienced an extreme series of turnabouts in their collective sexual psychology. The closets of the pre-Stonewall period gave way to the abandon of the ’70s, which was met with death and then shame and anxiety. And now? I ask Herrera how he felt about being on PrEP after what he called “the temper tantrum in my head” he’d experienced before starting the treatment—one in which it seemed like the various debates of the last half-century of gay sexuality were colliding, in miniature, as he made this one decision. 
He pauses. “It feels like the future, like a new chapter,” he says. Then Herrera surprises us by starting to cry. After all, a powerful history of desire and dread intertwined is not easily undone. “I feel very proud because a lot of men have died for me to be able to do this,” he says. 
Beard takes Herrera’s hand. “Leo thinks out loud,” he says. And then, to me, “Why should we continue punishing ourselves?”

 3 yrs after this picture was taken
at a Manager’s conference, I stopped smiling.
These two stories out of a six story appearing at with the same theme, sex without fear.
 I picked the first and the last because I believe it represents the point of where we are in the history of HIV and stopping the transmission without stopping the sex lives of people that are in nature very sensual and aware of the mental implications on gay sex. Yes all sex starts with the mind but it doesn’t end there. Gay sex because the stigma that was attached to it and still is in many minds, it becomes more important than just an orgasm. When you put your life on the line to accomplish something with another man it just doesn’t get more important or mind boggling than that. This is as personal as it gets, sex between two men.

We have beg, fought and marched to get science to catch up with this just like it has with other viral epidemics. With a late start and always a lack of funding we are at the point in which rate numbers in many places have stopped going up and in some down. New York City an example of how hard it can hit when you have so many subjects, it’s managed to control these rates on the sex equation of it and that alone is a message to those places in which the rates are going up which in many instances in places where there were little reporting and lots of denial. Still NYC serves as an example that they can get on top of it. I don’t want this piece to be an argument of numbers instead I want to bring forth something that we should be talking about sex without fear; Sex is good and it can be safe and condom-less. Condoms had their time but they were never made for gay sex and never 100% effective.
My fear my sex

The second time that I can remember having sex in a particular sexual position or way with another man and having both wear condoms, still I became HIV. My next relationship two years after that was with a man who was HIV-. Condoms had to be the answer and they had to work every time for my sanity and protection of my partner. This time they worked. My sex life was lacking and no matter how much intercourse I had with my partner it took so much control over my mind not to think of what if it breaks? question. 
What ever information about the safety in oral sex was not made public so there I was denying him something he wanted very badly and he was willing but I was not, he probably got it someplace else. I split up because he was a bad partner. No the one to grow old with. but the one that will make you old. There are other reasons but for his privacy’s sake I wont go into details. He had too many issues being the gay son of alcoholic, homophobic parents. Sadly enough his next partner was also HIV but there was no condoms and he ended up becoming HIV. 

Had Prep been available then, Im sure he would have not turn with his next partner and I would have broken up with him a lot sooner than sticking it out with a guy that was killing me without a gun. I stuck it out with him for 5 years because I didn’t think anyone else would want me. Those five years cost me so much in every way you can think. If I thought of the price I paid for this relationship I could not finish writing this piece, is that emotional with me still. I refused an HIV- partner after that and that shrunk the pool of decent kind of guys that could be available to me. Guys with the normal luggage and everyday problems.


I am so happy no guy particularly guys above 30 and single have to go through what I experienced. I think is time we put a tap on the fear and tapped it out. Wether you are negative today or positive, go for the man not the disease. Its better an HIV+ partner than a lier, obese, gym bunny,alcoholic, cheater, drug, computer, porno, Fb addict.  I’m open to an HIV- negative guy but one word out of place at the beginning makes me assume(yes assume) he might not be educated in this disease and I could not start from scratch again. The truth is and some people would want my hide for saying this but many HIV guys have a lot of issues they have not dealt with. They have made themselves damaged. They went for bad habits in order to survive and thinking they never had a future. I know it because I did. I never planned one day ahead never for the future because I thought I had none. I let life just pass me on by.  Didn’t become a full alcoholic nor a druggie but I was damaged in other ways. 
Not damaged anymore because I know the truths and you know the truth will set you free. I’m free of most of my fear. Im free of religion, gods, lies, etc. I try to be tuned to the earth and the spirit. These things you can do without posting false messages on Facebook or trying to feel better by selling snake oil.  It is wrong to be telling people their life will be good if they have faith or believe in this or that. Gays of all people you would expect to know better. But as an HIV person, some try to hold on into anything for help. You will never know what that is unless you became HIV, particularly from 10-30 yrs ago. Sex, Religion and politics are personal. But only sex and religion have to do with the heart, no one has the right to prescribe to you on those unless asked for particular help.

 My truth is mine because I found it. Your truth might be different and it might not be with loving Christ and the Pastor but surely it has to do with fear. Only you will know. One shoe size does not fits all.  You don’t dwell in what you don’t know today  you might figure out tomorrow. I get better everyday without the fear of tomorrow. Im starting to plan again. The problem is I have wasted much valuable time trying to find answers that only life was going to give me on its own time. 

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