Health officials in Washington State say that a local man has contracted HIV while taking PrEP. It is believed he was infected with a rare strain of HIV that is resistant to both of the medications in Truvada.
According to Outbreak News Today:
Director of Public Health’s STD/HIV program, Matthew Golden, MD said the patient likely became HIV infected while taking PrEP. The man reported sex only with other men, and both he and his medical provider indicated that he had consistently taken daily PrEP in the months since his last HIV negative test and prior to testing HIV positive.
Related: Insurance provider denies Truvada coverage to patient for being a “high risk” homosexual
If taken correctly, PrEP can reduce the risk of HIV by 90%, although some studies have reported numbers as low as 86% and as high as 99%. Of the hundreds of thousands of people taking PrEP the world over, there have been only five reported cases of a positive test result for HIV.
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In 2015, the CDC recommended that 1.2 million gay and bisexual men, or about one in four, consider taking Truvada. As of early 2017, about 136,000 Americans were taking the drug.
Blackceo
Mmmm hmmm…this is why I’m not raw doggin and take chances with my life. While rates of contracting HIV while taking this are still rare, someone has to be one of the few who gets it. I’m not taking that kind of risk while shoving a drug in my system that I don’t need when I can just use a condom.
Vince
Statistically PrEP is a safer bet then even condoms. You just prefer one risk over the other.
Godabed
@Vince, lets be very real here, because this conversation becomes 1 sided real quickly. the studies before the drug was release recommended the use of PREP with condom and so do doctors. The last study showed that 50% of the people on PREP do not use condoms. and in direct correlation of them not using condom, STDs also went up 50%. In every study of reported STD cases outside of HIV, all of them have gone up. New reported cases have gone down among PREP users. There has been CDC alerts about incurable syphilis, Gonorrhea, and chlamydia. So this idea that you can just go to the clinic and not worry about those STD, is completely false. I got one of these STD’s the curable version from someone on PREP.
The fact is PREP is suppose to be used with condoms, the Reality is it isn’t being used with condoms, the myth that it’s for people in loving relationships who want to have sex with each other with different statuses…. Sorry I haven’t seen that. I’ve seen tons of people in relationships hooking up with other people outside of their relationships bareback, I’ve seen ads for monthly bareback parties with strangers, and tons of ads for prep cumdumps, and bareback only. That’s the reality. So if people want to be safer while having sex, use a condom, with PREP. period end of story.
Jody
@Godabed, that didn’t happen.
STI rates were on the rise well before PrEP. There were only 76,000 people on PrEP in 2016, far too few to drive STI rates. At no point has the CDC ever indicated that people on PrEP were driving STI rates.
There are no incurable STIs presently. The CDC has expressed concern about bacterial STIs being resistant to all available antibiotics. That day isn’t here yet.
PrEP isn’t “supposed” to be used with condoms. PrEP is only about preventing HIV infection. It does that better than condoms. A condom is useful in preventing other STIs, but only on the areas covered by a condom.
Blackceo
@Godabed thanks for putting that in a professorial way. I did a poor job of pointing out that the big point of my comment was the raw dogging. Many people are substituting condoms for PrEP because they want to bareback, thinking of only HIV and not all the other shit you can contract. The condom should be seen as the seatbelt and PrEP is the airbag. Its an added layer of protection because as was pointed out, not even condoms are 100%.
Erik
Jody: “STI rates were on the rise well before PrEP. ”
Bare-backing was on the rise, increasing in popularity, well before PrEP. STD rates were in decline while Safer Sex was the norm, and bare-backing was rejected as risky and selfish. And before the rising popularity of bare-backing and the normalization of it, the rate of new infections among gay men was around 2%.
As many of us knew from the start, PrEP was destined to become an excuse for unsafe sex. This isn’t the first case of someone on PrEP sero-converting, it won’t be the last. Reported is the key word, and odds are excellent that there are a lot more people out there who have already sero-converted while on PrEP – they’re just avoiding being tested.
“PrEP isn’t “supposed” to be used with condoms. ”
Yes, it is. And in part because Truvada resistant strains were already showing up. Further, HIV cannot develop a resistance to condoms. And the kidney damage from Truvada is not something sane people are dismissive about.
Sam6969
Completing what others above have written:
Jodi: « There are no incurable STIs presently »
Presently, there is no cure for chronic hepatitis B. It may be in the future, but it is not the case right now. Tell what you wrote to the 257 million people worldwide, who suffer from chronic hepatitis B and also to the family of those who have died (1 million each year), because many of them did not use a condom (and were not or could not be vaccinated). You belittle the use of condoms, but see the potential consequences of not using it.
Source: http://www.hepb.org/
Tell that also to the 500 million people, who have genital infection with herpes simplex virus (HSV or herpes) and the hundreds of millions, who caught the human papillomavirus (HPV). These viruses are currently incurable and they increase the risk of getting HIV.
Source: http://www.who.int/mediacentre/factsheets/fs110/en/
I’d like to add this study, released a few months ago by the CDC, entitled: “STDs at record high, threatening the health of millions of Americans”
Source: https://www.cdc.gov/nchhstp/newsroom/2017/2016-STD-Surveillance-Report.html
Antibiotic resistance to gonorrhoeae, published on the CDC: https://www.cdc.gov/std/gisp/
Syphilis showing growing signs of drug resistance, as reported in this article:
https://invisiverse.wonderhowto.com/news/syphilis-has-returned-with-new-drug-resistance-0175505/
“Syphilis displays resistance to azithromycin, the antibiotic that is the second drug of choice for treating its infection.” Even if the bacteria causing Syphilis seems not resistant to penicillin (first choice of treatment), yet.
Tobi
@Jody — “There are no incurable STIs presently. The CDC has expressed concern about bacterial STIs being resistant to all available antibiotics. That day isn’t here yet.”
Wrong.
Dr Teodora Wi, from the WHO, said there had even been three cases – in Japan, France and Spain – where the infection [ Gonorrhoea ] was completely untreatable.
http://www.bbc.co.uk/news/health-40520125
Jody
@Erik, not that facts will dissuade you from your Firmly Held Belief™, but I’ll put them here anyway.
In 2015, the CDC issued a warning about rising STI/STD rates. Media, including many gay sites, attributed this to PrEP, something the CDC didn’t say.
The CDC noted that the increase was mainly in 15-24 year old men and women, was attributable to a drop in health care funding and in other political issues. They also noted that since 2007 syphilis cases had been rising, which was on -top- of a prior, decade long rise in HIV and other STI cases in MSM, corresponding with a decline in condom use and increase in ARV therapy. (See the CDC’s “Reported STDs in the United States 2014 National Data for Chlamydia, Gonorrhea, and Syphilis” and MMWR November 29, 2013). The same trend was also occurring at the same time in Europe (Aidsmap, November 2015).
There were 20,000 people on PrEP in the US in 2012, and 75,000 on PrEP in 2015, and about 300,000 globally today. The adoption of PrEP and the numbers of people on PrEP don’t correlate with the rise of STIs in the US or Europe.
Jody
@Erik
Oh brother.
“As many of us knew from the start, PrEP was destined to become an excuse for unsafe sex. ”
Then many of you were wrong. The CDC considers condomless sex on PrEP to be safer sex, just like it considers condomless sex with an HIV+ partner who is virally suppressed to be safer sex too.
>This isn’t the first case of someone on PrEP sero-converting, it won’t be the last.
Ding! We have winner! Yes, true! It won’t be. There will continue to be people on PrEP who are infected with HIV while on PrEP, just like there are people who use condoms who still wind up infected with HIV. There will just be way less, because PrEP is better at protecting against infection than condoms are.
“Reported is the key word, and odds are excellent that there are a lot more people out there who have already sero-converted while on PrEP – they’re just avoiding being tested.”
Nope. That’s not how PrEP works. People on PrEP are tested quarterly for HIV. It’s part of the procedure lain out by the CDC. Regular testing is what’s required to get a Truvada Rx renewed. You don’t know what you are talking about.
“And in part because Truvada resistant strains were already showing up.”
HIV strains with a resistance to medications have always been there, about 1% of HIV floating around in the West. Truvada resistant HIV is out there, too. But that resistant HIV isn’t all primary resistance — transmittable — but resistance archived in cells over time. For HIV to develop a resistance to one or the other medications in Truvada makes it more difficult to replicate, and therefore more difficult to transmit. For resistance to both, more difficult still. Everyday HIV outcompetes resistant versions day in and day out.
How likely is it to transmit HIV with a primary resistance to Truvada? It’s happened 3 times in five years…. and you have to look at three different countries to find those numbers.
Again, you don’t understand what you are talking about.
“And the kidney damage from Truvada is not something sane people are dismissive about.”
Truvada for PrEP doesn’t damage kidneys. Again, you don’t understand what you are talking about.
Jody
@Tobi
Then he was wrong.
“…Separately, and for the first time in the United States, health officials identified a cluster of gonorrhea infections in Hawaii that are showing potential emerging resistance to ceftriaxone and very high-level resistance to azithromycin. All patients were successfully treated using the recommended dual regimen; however, both the resistance pattern and the fact that it was a cluster of cases (which means the strain was able to spread) are causes for concern.”
–Dr Gail Bolan, director for the Division of STD Prevention at the Centers for Disease Control and Prevention
https://www.medscape.com/viewarticle/876378
Sam6969
[I commented earlier, but my comment did not pass]
Jodi: « There are no incurable STIs presently »
Presently, there is no cure for chronic hepatitis B. It may be in the future, but it is not the case right now. Tell what you wrote to the 257 million people worldwide, who suffer from chronic hepatitis B and also to the family of those who have died (1 million each year), because many of them did not use a condom (and were not or could not be vaccinated). You belittle the use of condoms, but see the potential consequences of not using it.
Source: http://www.hepb.org/
Tell that also to the 500 million people, who have genital infection with herpes simplex virus (HSV or herpes) and the hundreds of millions, who caught the human papillomavirus (HPV). These viruses are currently incurable and they increase the risk of getting HIV.
Source: http://www.who.int/mediacentre/factsheets/fs110/en/
Sam6969
I’d like to add this study, released a few months ago by the CDC, entitled: “STDs at record high, threatening the health of millions of Americans”
Source: https://www.cdc.gov/nchhstp/newsroom/2017/2016-STD-Surveillance-Report.html
Antibiotic resistance to gonorrhoeae, published on the CDC: https://www.cdc.gov/std/gisp/
Syphilis showing growing signs of drug resistance, as reported in this article:
https://invisiverse.wonderhowto.com/news/syphilis-has-returned-with-new-drug-resistance-0175505/
“Syphilis displays resistance to azithromycin, the antibiotic that is the second drug of choice for treating its infection.” Even if the bacteria causing Syphilis seems not resistant to penicillin (first choice of treatment), yet.
Sam6969
Jodi, if you want to be taken seriously, quote your sources. For instance, here:
Jodi:“The CDC considers condomless sex on PrEP to be safer sex, just like it considers condomless sex with an HIV+ partner who is virally suppressed to be safer sex too.”
I would be very interested to understand the rationale behind such a statement. I am always open to learn more.
Jody
@Sam6969
>re: Hep B
We were talking bacterias that are treated with antibiotics — gonorrhea, chlamydia, and syphilis — not viruses. The fear in this context was antibiotics no longer working to cure bacterial infections.
Remarkably, we have medications that greatly reduce the possibility of viral infections now. There are vaccines against Hep A, Hep B, and the forms of HPV that cause cancers. PrEP, which isn’t a vaccine, is the most effective medication we have at preventing HIV infection. It also reduces the odds of herpes / HSV2 infection by 33% (Celum, 2014.)
Regular testing, vaccination, and treatment is key to preventing further infections.
Jody
@Sam6969
There’s no disagreement from me that STIs are an issue, nor that there is a danger of antibiotics being unable to treat them.
However, the discussion here, the alarmism here, is that PrEP caused the STI outbreak, PrEP is driving the STI numbers, and that bacterial STIs are incurable. None of that is true.
Jody
@Sam6969
In 2014, the CDC stopped referring to condomless sex as unprotected sex in regards to HIV transmission because it was no longer accurate.
“…Though we know everyone hasn’t followed this advice, the idea became so ingrained in our conversations about safer sex that it was clear protected sex equaled sex with a condom, while unprotected sex equaled sex without one. Some HIV advocates argue, however, that in this day and age of HIV treatment, pre-exposure prophylaxis (PrEP), and behavior changes that can decrease risk, this language is no longer accurate or precise.
In January, the CDC announced on a call with more than 80 advocates that it would indeed change the decades-old language. Now, instead of referring to “unprotected sex” to mean sex without a condom, the CDC will refer simply refer to it as “condomless sex.”
The advocates’ argument hinges on the fact that there are now multiple ways to have safer sex when the goal is preventing HIV transmission. Condoms obviously still play an important role, but there are other ways individuals can protect themselves as well. Many HIV experts, for example, talk about treatment as prevention. Individuals who are on antiretroviral therapy (ART), which suppresses the replication of HIV, often have an undetectable viral load (a measure of the number of copies of HIV in a given blood sample). ”
https://rewire.news/article/2014/02/24/cdc-stopped-calling-sex-without-condom-unprotected-sex/
Sam6969
Jodi,
You did not address my previous questioning on your source. I think this is crucial for the debate:
Jodi:“The CDC considers condomless sex on PrEP to be safer sex, just like it considers condomless sex with an HIV+ partner who is virally suppressed to be safer sex too.”
Where does that come from?
Also, I quote you again: “The adoption of PrEP and the numbers of people on PrEP don’t correlate with the rise of STIs in the US or Europe.”
Could you give me a source backing up this statement?
Jody
@Sam6969
I linked to the change in CDC messaging on the topic. Here’s another article from the BAR about the change:
http://ebar.com/news/article.php?article=69482&sec=news
As for the rise in STI rates in Europe, here’s 2015 report noting the troubles they were having:
https://ecdc.europa.eu/en/news-events/sti-trends-europe-chlamydia-rates-stabilise-while-gonorrhoea-numbers-go
As for PrEP in Europe, EMA didn’t approve PrEP until 2016. France allowed HIV specialist physicians to prescribe it in January 2016. The Netherlands allows private purchase of PrEP. Belgium reimburses as of June 2017. Stats from PrEP Watch show that as of 2018 reporting only 1,000-1,500 people in France use PrEP and 300-400 people in The Netherlands use it. That’s it.
https://www.prepwatch.org/scaling-up/country-updates/
Sam6969
Jody, I will read that tomorrow (I am in Europe).
Tobi
@Jody. “Then he was wrong.
No, she wasn’t wrong. You are.
WHO reports widespread resistance to older and cheaper antibiotics. Some countries – particularly high-income ones, where surveillance is best – are finding cases of the infection that are untreatable by all known antibiotics.
http://www.who.int/mediacentre/news/releases/2017/Antibiotic-resistant-gonorrhoea/en/
Apolodorus
Best thread on queerty i have ever seen. Fact based discussions and disagreement siz
Sam6969
Jodi,
In my opinion, you should be more cautious, when writing things such as “condom-less sex on PrEP is safer” (safer than what, for whom and against what?), as people not knowing the statistical rationale, protective and risk factors behind such a claim, may get the wrong message:
-They may think they can mess around on PrEP without condom, since condom-only is statistically less safe. Yes, some people can make wrong inferences.
-They may think they, now, can go to cruising places (where you do not talk and the risks are higher), only on PrEP, and have condom-less sex like they do with someone they know. Some people just do not master fully the concept of “risk factors”.
-They may forget they can get other STIs and then contribute to the development and reinforcement of drug-resistant strains that affect the whole community and may backfire to them later.
To put it lightly, although instructive on one hand, I think the way you presented things have a potential for misguiding people, on the other hand. CDC is very clear on that matter, when you “ask” them the question:
“If I take PrEP, can I stop using condoms when I have sex?
[CDC answer:] 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.”
Source: https://www.cdc.gov/hiv/basics/prep.html
I think it is clear. In particular the fact a condom is very effective against gonorrhea and Chlamydia. Aside from abstinence and having a strictly monogamous relationship, I do not currently see a better way to protect against those STIs than using a condom. PrEP extension to quarterly STIs tests is not implemented everywhere, yet, is it? Plus, it may just turn out to be a stopgap solution.
Again, do not send the wrong message and contribute next studies on the relation between PrEP and risks compensation show people get lax. (You seem to refer to this single study: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00056-2/abstract, which is quite risky in itself)
Thinking in terms of short-term individual risks only is quite selfish and it will get back at the risk-taker through the community. A MSM can underestimate his risks, while having sex on PrEP without condom, because you suggest loosely “it is safer”, but it may get back at him in many ways, such as in the “unexpected” form of a surge of drug-resistant strains in the community later. Actually, as shown by several people here, Gonorrhea resistant strains already exist and it is likely just a matter of time they (or others) spread everywhere.
PS: vaccines against HPV strains causing cancer exist for people younger than 26. Too bad for the others.
https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet#q5
Jody
@Sam6969
Sam, you give me far more power to influence the hearts, minds, and penises of men than I, in my most free and boundless imagination, do. People have been choosing to use or not use condoms long before I was here. They’ll do so long after.
This discussion, on this topic, has been about HIV. It’s not required that I couch my comments in this thread in the context of all risk management. If there’s a question regarding something I’ve said, then yes, we can talk about that. However, I reject your assertion that because we’re talking about a subset of an issue, every response must be framed in the context of the full set.
We’ve been dealing with HIV for a number of decades. Dealing with HIV means dealing with human behavior. Human behavior is only motivated by fear based messaging for so long. During the worst of the HIV crisis, people were motivated to use condoms. Even then, we never got anything approaching 100% use 100% of the time. Were we to move to a day when antibiotics no longer worked, we’d still not get 100%/100%, though I’m quite sure we’d have many comments blaming people for their infections — and condemning anyone who doesn’t continue to repeat a thirty year old mantra.
We know from Smith’s 2015 research that less than 1 in 5 MSM use condoms consistently every time for two years running. Condoms break. People forget. People have that one friend they’ve always forgone condoms with. People enter into a relationship, then break up. Condoms are great when they are used. But there’s the rub. That’s always been the rub.
And when I refer to PrEP, testing, and treatment as being the best way to manage even -STIs-, I’m doing so in light of Jenness 2017 paper, not McCormack’s concerns in 2015. Even with various levels of RC (risk compensation), expanded PrEP/STItesting/treatment would not only reduce the amount of bacterial STIs in PrEP users but would halo to the general population as well. Pharmacological interventions typically have larger payoffs than behavior based interventions.
Lastly, people older than 26 can take the HPV vaccine. The recommendation for those younger than that is that they are both less likely to have encountered a large number of HPV types and younger bodies create more antibodies. But studies by Catellsaque (2009), Skinner (2014), and others show that even after 26, HPV vaccinations still provide benefits, though not as strongly.
Again, science.
I care about human flourishing. Some humans are great to use condoms for both STI and HIV prevention. But now with years of data behind us, we know that this doesn’t work for everyone. People do lots of different things sexually. The goal here is to provide ways to minimize risk and maximize pleasure, be that for a person who wants only one sexual partner in their life, as many sexual partners as they can, or anywhere in between.
Sam6969
I care about human flourishing too 🙂 I am just inclined to think it is better to encourage people using condoms to increase their chance of not getting infected (whatever the STI)…which happens to be the CDC position, as well. No blame involved. People make their own choice and there is no moral judgment there.
Science is great and being cautious about a single promising study (or even a couple of them in a short period of time) is also the ground of a scientific mind, as others may contradict them later.
I really hope STIs will decrease on a long-term basis, thanks to this expected PrEP generalization and that those scientists took into account all variables in their conclusions.
seaguy
Well not everyone likes using condoms, some were probably just raw doggin as you call it before PrEP so at least they are on it now.
CastleSF
Clearly if this guy had practiced safe condom sex in addition to taking PrEP, he would still be HIV free. A cautionary tale for all, esp. those who can’t afford the HIV meds or have no health insurance.
Vince
I’ve yet to meet the magical unicorn you speak of.
ChrisK
I agree Vince. I’ve not met anyone that uses them together. Maybe a married guys afraid to bring back something to his wife. The whole point of PreP for most is to be free of condoms. F*ck like it’s 1970s, etc. Finger pointing and shaming is not going to change that fact.
Umoja
Not clearly – condoms fail (tear and roll off) more often than PrEP fails to protect.
Jody
Just curious, @CastleSF. Is the cautionary tale for people who use condoms and still wind up infected, that they should have used PrEP too, regardless of if they had insurance or not?
Me2
There are risks associated with every prophylactic in the market. I believe most people who are on PrEP are on it because they don’t always use condoms. In my opinion, only five reported cases of HIV transmission among worldwide PrEP users is an extremely low risk.
Vince
It reminds me of all the warnings the pharmaceutical makers put on their drugs. Unfortunately people have had health disasters taking the same drug that most of the times should be perfectly safe. There is no such thing as no risk in life.
Erik
There was a day when only ten people had been diagnosed with HIV/AIDS.
Truvada also causes permanent damage to one’s kidney’s – not a minor issue.
Vince
Truvada PrEP Not Linked with Major, Lasting Kidney Problems
http://betablog.org/truvada-prep-kidney-health/
seaguy
I agree, many were barebacking prior to PrEP, so at least they are taking some measure to prevent themselves from getting HIV.
Kangol
It’s a fluke but nevertheless, in the absence of a cure for HIV, you are still taking a risk of HIV seroconverting even with PrEP.
Couple PrEP with a condom or dental dam, and your risk of HIV seroconversion or any other STI transmission is pretty close to zero. Not absolutely, but close.
CastleSF
It just makes you wonder how many men this guy must have slept with or how kind of promiscuous lifestyle he must have lived to the extent that even the best med can’t keep him HIV clean?
ChrisK
It only takes once hon.
Paco
No discussions took place with his sexual partners about their status or if their virus was suppressed with no resistance to the drug he was taking?
These conversations still need to happen before sex if you are truly concerned for your health.
Juanjo
Not everyone tells the truth which is why I would never go raw in this day and age. One of my younger friends, a 23-year-old financial wiz had a hard lesson on this earlier this year when he did his regularly scheduled test and it came back inconclusive/lightly positive [whatever the hell that means]. Scared the hell out of him since he has been using PrEP for two years. They ran the confirming test and it came back negative but that scared him into deciding he was not going raw with anyone. Not to mention they ran a full panel of all STDs on him as well. That brought home to him the cold light of reality.
CastleSF
A 23-year-old smart young man with a good job should know better. I bet it must be the older guys he had befriended seduced and corrupted him.
Tête Carrée
@CastleSF
“seduced and corrupted him”. Wow, you sound so much like the Church Lady here. I’m guessing “smart young man” doesn’t apply to you. What does a “good job” have to do with it?
CastleSF
He is a smart young financial wiz, not some street kid or drug addict. He understands the risks and he knows his stuff. So the only logical conclusion is that someone else coaxed him into having unprotected sex.
Brian
OK, if I ever had my doubts that Castle and his pearl clutching, church lady posts weren’t really an intentional troll, this removes all doubt. He was obviously seduced and corrupted because he’s 23 with a good job? That is hysterical.
Ummmm Yeah
So this is what at least the third time it’s failed and no where near the majority are on it. However the drug maker will keep on pushing it as a bareback drug to sell more.
Kieru
In order to fail Truvada would have to proclaim to work in this scenario. Truvada only protects against HIV-1 and only against HIV-1 strains that present no resistance to Emtricitabine or Tenofovir.
Considering every hand-out from the manufacturer advocates PrEP in combination with condoms I think it’s hard to argue the manufacturer is promoting PrEP as a condom-replacement, though you’ll get no argument from me that that is a common application by the consumer.
DonW
Please cite where the drug maker is “pushing it as a bareback drug.”
Gilead has barely even advertised PrEP, and when it has, the ads are so packed with scary warnings that anyone reading them without knowing better would run screaming from the medication.
They go on for pages about mandatory condom use, the fact that you can still get HIV on PrEP, and dangerous side effects. These warnings are hyper-cautious because they’re written by lawyers — the company wants to avoid any liability.
Maybe there’s someone “pushing it as a bareback drug,” but I’ve never seen it, and it’s certainly not coming from the drug maker.
ChrisK
CastleSF aka Danny595 or the promiscuity is wrong troll we all know. I imagine Danny will be coming along anytime to disagree with you in a minor way to throw everyone off.
Umoja
The average risk of contracting HIV when you’re an HIV-negative bottom and the top is HIV-positive (and is not undetectable) is 1.43% or one-in-70 (from CDC). If taking PrEP reduces this risk by about 95% then the actual average risk becomes 0.071 or one-in-1408 encounters. So an average risk of almost 2% becomes significantly reduced.
While a 95% risk reduction sounds sorta-almost like a 5% average risk, the practical risk is that you have to bottom an average of 1408 times with an HIV-positive partner for the average seroconversion. But these numbers are still affected by studies that can’t guarantee perfect adherence to the PrEP programme.
In addition PrEP resistant HIV is weaker than regular HIV and 1) infects less frequently, and 2) often becomes reduced in proportion of viral load over time
Sam6969
PrEP is not effective for other STIs, such as syphilis, gonorrhea, hepatitis B and Chlamydia, but a condom is. It is a reason why PrEP and a condom should be used together.
Plus, as shown in the article, PrEP lowers the risk of getting HIV by approximately 90%, so using a condom improves the odds.
A condom lowers the risk of getting HIV by about 80% (not 100%, because people may not use it properly and it may break during the intercourse). However, used properly, a condom is very effective (up to 94%, see sources below).
Sources:
https://health.howstuffworks.com/sexual-health/contraception/10-wrong-ways-to-use-condom.htm
http://www.thebody.com/Forums/AIDS/SafeSex/Q192159.html
Odds of getting HIV in different scenario: https://www.poz.com/article/HIV-risk-25382-5829
Jody
CDC puts condom protection at 72% (Smith, 2015) and PrEP at 92% (Grant, 2010).
See here: https://wwwn.cdc.gov/hivrisk/about_the_data.html
Sam6969
Are you diverting people’s attention from the rest of my comment? If not, then just complete your statement, because your whole rhetoric, belittling condom use in this comment section looks quite suspect…and potentially hazardous for your readers.
Now, to address your rectification, it is true this study found 72% of condom effectiveness for receptive anal sex (with the top partner being HIV positive) and 70% in the case of any receptive and insertive anal sex with HIV-discordant couples, in the US.
However, they also mitigate their statement mentioning tests of statistical significance in their study. Here is what they write:
“The point estimate in our analysis of condom effectiveness when “always” used by MSM during anal sex with any HIV-positive male partners is 70%, modestly less than the 80% estimate for condoms when “always” used by heterosexual HIV-discordant couples. Although these point estimates do not differ by tests of statistical significance, it is more appropriate to use the MSM-specific point estimate of 70% effectiveness for discussions and models involving anal sex among MSM than to continue use of the heterosexual 80% effectiveness point estimate for MSM.”
Source of the complete study is here: https://journals.lww.com/jaids/Fulltext/2015/03010/Condom_Effectiveness_for_HIV_Prevention_by.14.aspx
Note the use of: “condom effectiveness” and not: “condom efficacy” all along the study, as the authors did not estimate if the condoms were properly used, but rather were consistently used, as Susan C Weller and Karen David-Beaty (referred to in the Smith’s article) put it in their own study for heterosexual serodiscordant couples:
“This review indicates that consistent use of condoms results in 80% reduction in HIV incidence. Consistent use is defined as using a condom for all acts of penetrative vaginal intercourse. Because the studies used in this review did not report on the “correctness” of use, namely whether condoms were used correctly and perfectly for each and every act of intercourse, effectiveness and not efficacy is estimated.[…]”
Source: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003255/full
This suggests the closer you are of a correct use and perfect conditions, the higher is effectiveness.
Jody
@Sam6969
No, I’m noting there are two different scenarios here: 1) HIV prevention 2) STI prevention.
While HIV is an STI, it’s in a different class of impact than others.
As you mention, the closer you are to perfection in using condoms, the better they work. But that’s the rub, isn’t it? Smith’s other 2015 study noted that only 16% of MSM report consistent condom use over a two year period. Between accidents, forgetfulness, and partners they agree not to use them with, less than 1 in 5 people use rubbers during every encounter.
That’s why all the strum un drag anytime anyone points out how condoms aren’t the best overall strategy for prevention of HIV -and- other STIs isn’t all that great.
Daily PrEP has a higher effectiveness against HIV infection because it’s both untethered from sex and very forgiving in protection. Statistically, as few as two doses in a week provides a 76% reduction in the chance of infection. While not as good as 7 days a week, that’s better than the 0% reduction when a condom isn’t used — which happens quite often.
Condoms -do- reduce other STI acquisitions. They only work for areas covered, though. And there’s a range of effectiveness depending on the study cited. People don’t use condoms for oral sex. Gonorrhea in the throat is much more difficult to treat than in the ass. Condoms don’t prevent HPV acquisition. Condoms don’t prevent syphilis infections when the infected area is outside that covered by a condom.
Circling this back around to PrEP, Jenness 2017 paper on PrEP use and the STI testing that accompanies it notes that despite what people here continue to assert, increasing the numbers of people on PrEP will actually decrease STI infection rates, not increase them, even with a significant percentage no longer used condoms. As this number scales up, the greater the reduction in STIs becomes, not just in the PrEP group but also in the wider community itself.
Condoms currently remain a great way to prevent various STIs, but they aren’t the only way. In the case of HIV, PrEP is clearly superior to condoms. Regardless, testing is key. Vaccination is key. There are multiple ways of dealing with this problem, other that shouting “Just use condoms” repeatedly or slut shaming anyone who winds up with an infection.
Smith’s study on condom usage:
https://www.ncbi.nlm.nih.gov/pubmed/25469526
Jenness on STIs and PrEP:
https://www.ncbi.nlm.nih.gov/pubmed/28505240
Tobi
@Jody. “CDC puts condom protection at 72% (Smith, 2015)”
You forgot to mention the caveat:
“The results are based on self-reported use, which may not be accurate. Condom effectiveness is likely to be higher when condoms are used the right way every time during anal sex.”
Jody
@Tobi
No, I actually rejected that editorializing by the CDC, when Smith’s 2015 study noted that “…Only 16% of MSM reported consistent condom use during anal sex with male partners of any HIV status over the entire observation period.”
We have little data that people do -better- than what they self report. We have data that they are accurate. We have data that self reports are inaccurate. We have data that self-report may be inaccurate based on how and who asks questions.
Condoms work exceedingly well when used. People don’t consistently use condoms. PrEP works exceedingly well when used — even when people forget to take a pill or two.
tnguy222
I have never allowed anyone to finish inside me, and have only bareback topped serious boyfriends.
I do not want to get any STDs, and I am deathly afraid of getting herpes, as it becomes a scarlet letter practically.
Over time, anonymous sex steals your soul. Prep might be the safest way to do it, but psychologically it will destroy you.
Umoja
You realise you can get herpes from just a kiss, right? HSV I and HSV II can both be transmitted orally. It’s just a kind of infection where a herpes sore is not always present. The virus hides out in a part of your spine and then travels back to the place where it was originally introduced in a process called viral shedding. All of this can occur in asymptomatic individuals.
Stop fearing herpes.
Jody
As of 2018, The World Health Organization estimates there are 300,000+ people on PrEP around the world. In the 5 years PrEP has been in use, there have been three infections.
WHO estimates there are about 1.8m HIV infections a year, almost 10 million people since 2012. Those people were using condoms, serosorting, or not using any protection at all.
PrEP is the best tool currently available to prevent HIV infections. We need greater access to it to prevent further infections.
CastleSF
What are your real agendas here, Jody? You posted some seemingly scientific data here (which can be easily discredited by other equally credible sources) to support your bias and ignorance. You are in denial of the alarming new STD infections and how some new infections are seriously resistant to ALL antibiotics. Are you a salesman for the big pharmaceutical company pushing for more sales of this PrEP drug so that more people will use condoms less and in return more sales for the drug? You can’t fool the smart people here. You dubious motive to push the drug sales is just shameful.
Vince
Yes. Using facts and science. Such an agenda. Go ahead though. Show the links that disprove what Jody just said. Should be easy.
Erik
There have been a small number ‘reported’ infections. There is a difference. An important one, but it takes honesty to recognize that. That trait is seriously deficient in your posts on this matter.
CastleSF
The moment this Jody, a wolf in sheep’s clothing, said that “PrEP isn’t “supposed” to be used with condoms”, he made his hidden motive known in no uncertain terms. This guy posing as a health advocate for gay men, is advocating this dangerous notion that condoms are optional. It’s not hard to see which side he really is on – the drug company side.
Jody
@Castle SF
My agenda here is clearing up the numerous bits of misinformation being in this thread.
I noted that STI rates were rising well before PrEP came along, both in the queer community and the non-queer one.
I noted that there is a concern about antibiotics being unable to treat bacterial STIs, but that we aren’t there yet.
I also noted the vast array of tools we currently have at our disposal to prevent HIV and STI infections, tools far broader than trilling “JUST USE CONDOMS” in response to evidence reality is far more nuanced than you think it is.
I’d love it if we went to a national health care system in the States, took Truvada off patent, dropped hundreds of millions into opening STI testing and treatment centers in every city and rural area, especially those with a predominantly young, poor white, or POC population, the populations most in need of testing, PrEP, and STI treatment. That’s not in the cards anytime soon.
So instead, I’ll point out the misinformation being spread in both clickbait, alarmist articles and comment thread like this one here.
Tobi
@Jody. “My agenda here is clearing up the numerous bits of misinformation being in this thread.”
No, you’re spreading misinformation, including the lie that there are no incurable STIs, when the World Health Organization reports very differently.
WHO reports widespread resistance to older and cheaper antibiotics. Some countries – particularly high-income ones, where surveillance is best – are finding cases of the infection that are untreatable by all known antibiotics.
http://www.who.int/mediacentre/news/releases/2017/Antibiotic-resistant-gonorrhoea/en/
Jody
@Tobi
What’s hilarious is the press release — which you’ve listed — makes a claim that isn’t supported by the papers / commentary linked within it. Again, there are no incurable bacterial STIs. -There is a danger- this might happen, though. There’s research being conducted into new treatments for gonorrhea, some of it is pretty good actually. But none of those medications have been approved for use.
From the two linked articles in the press release:
“Widespread antimicrobial resistance (AMR) in highly variable strains of N. gonorrhoeae has continuously compromised the management and control of gonorrhea. Because of widespread AMR, the persistence of AMR determinants in gonococci, and the unavailability of diagnostic tests that provide AMR results at the time of treatment, clinicians resort to empiric treatment for gonorrhea. Since the introduction of antimicrobial treatment, resistance has rapidly emerged to sulphonamides, penicillins, tetracyclines, macrolides, fluoroquinolones, and early-generation cephalosporins. Currently, in most countries, the injectable extended-spectrum cephalosporin (ESC) ceftriaxone is the only remaining empiric monotherapy for gonorrhea. However, gonococcal in vitro resistance and/or treatment failures to the last-line oral ESC cefixime—and, more rarely, to ceftriaxone—have been verified in many countries [5–8]. Consequently, dual antimicrobial therapy, mainly ceftriaxone plus azithromycin, is recommended [9–13].”
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002344
“The number of gonorrhea cases is rising in many settings worldwide, and an increasing proportion are multidrug-resistant. The choice of antimicrobials that can be used for treatment of gonorrhea is very limited, and resistance has even been reported to extended-spectrum cephalosporins which are the mainstay of currently recommended antimicrobial therapy. Currently only three new chemical entities are in different stages of clinical development for treatment of gonorrhea.”
https://www.gardp.org/wp-content/uploads/2017/07/Alirol_PLOS_multidrug-resistant_gonorrhea_2017.pdf
Jody
As an aside, one of the primary vectors for multi-drug resistant gonorrhea to be created and spread is oral sex. It’s more difficult for antibiotics to kill all of the bacteria living in throat tissues than anal or vaginal tissues. It takes much more work and much closer monitoring to remove that. The Hawaii cases that were part of alarmist headlines a while back were oral gonorrhea in straight women.
So if you are concerned about treatment resistant / “incurable” gonorrhea, then use a condom for oral sex.
“…Effective treatment of pharyngeal infections (regardless of resistance) is more difficult than treatment of uro-genital infections; while the average cure rate for urogenital infection is 96%, outcomes drop to 79 and 84% (males and females) for oropharyngeal infections [58, 59]. This may relate to insufficient drug exposure in the latter site. Worryingly, these infections most probably act as a reservoir and persistence of pathogens at these sites jeopardize global efforts to slow the spread of resistant gonorrhea.”
https://www.gardp.org/wp-content/uploads/2017/07/Alirol_PLOS_multidrug-resistant_gonorrhea_2017.pdf
Tobi
@Jody.
OK, put up, or shut up, and link to any reputable evidence that refutes the WHO’s statement that:
“Some countries – particularly high-income ones, where surveillance is best – are finding cases of the infection that are untreatable by all known antibiotics.”
http://www.who.int/mediacentre/news/releases/2017/Antibiotic-resistant-gonorrhoea/en/
I think the majority reading your posts have long since worked out you’re a paid shill for a drug co. and hopefully won’t take your word, that of an anonymous poster with an obvious agenda, over an unequivocal statement by the World Health Organization.
Jaxton
PrEP is for buffoons.
Vince
Pulease girl. That takes a willing sex partner. Something we all know you lack.
mrjeremito
Guys, learn the facts about Prep. The CDC DOES recommend using it with condoms. There are no long term health effects, like kidney issues according to th CDC.
https://www.cdc.gov/hiv/basics/prep.html
JoshGL
So let’s recap: consistent use of both PrEP and condoms reduces risk of HIV and STI transmission to a minimum.
The rest is just a discussion of what is acceptable risk above and beyond that baseline. Those are personal decisions.
OK…next subject?
PinkoOfTheGange
yup
DarkZephyr
The thing that kind of worries me about those who use PrEP without condoms is that this rare and resistant strain of HIV could ultimately become NOT so rare because fewer people are protecting themselves against it. In my HUMBLE opinion, condoms WITH PrEP are the way to go. This is the third time I’ve heard of someone contracting HIV while on PrEP.
innernetsurfer
Despite, or even because of the well-refuted troll/misinformed comments, this is an excellent discussion and should be archived! Bravo guys. Personally I am a unicorn I guess – I would never consider sex outside of closed relationship/monagamous marriage without Prep AND a condom these days – not just because of AIDS but because of all the other pesky STDs which are on the verge of becoming not so pesky! AIDS started the same way, trickles of odd reports and various speculations about causes. I read Christopher Street magazine a lot at the time – and it was spreading all along. These warning signs should not be ignored and we must hope the CDC is going above and beyond to protect all of us! You can’t fool Mother Nature and she/he has no political/moral agenda, just is. Viruses and bacteria inherently try to adapt and evade our drugs, shits gonna happen! I totally agree we all have the right to choose our odds on the roulette wheel of life. And if married/in a relationship, doesn’t matter gay or straight, you’re not on the roulette wheel alone. In fact we’re all on it together and that ought to guide our behavior too! (OK I’m a novice practicing Bhuddist) Promiscious barebacking is unfortunately a bad idea. I loved the 70s. I was also young and foolish and lucky for the most part. They’re not coming back literally, though we can still learn to have more and better sex! We’re hella smart animals, sometimes… Personally I gave up oral sex without a condom (if not in a closed relationship) in the mid 80s as less was known about AIDS, but also because of all the other pesky STDs. Who needs them? Worry spoils the fun! There is no zero risk, especially given Mother Nature’s infinite tricks, but I choose as close as possible without giving up the possibility of going a little bit wild once in a while. While all these numbers and statistics are great, they are by definition yesterday. It Truvada resistant strains of HIV have been discovered, no matter how rare, and azithromycin etc. resistant gonorrhea, you can bet your ‘bottom’ dollar that’s probably the tip of an iceberg (like AIDs was), or could be. Who needs that? We’re hella smart. As gay/bi men we don’t really want to be the guinea pigs for humanity, but maybe that’s our function too(!?), and what some people are (again) unwittingly choosing. In the meantime, I feel a little less like a unicorn than when I first insisted on covered blows, and now Prep with condoms. Sure I miss the alternatives, they are awesome! And still possible safely in monogamy, dare I say. Though not the smorgasbord of flavors !
Umoja
The good news is that this resistant form of HIV is less fit than regular HIV. It transmits less often (in disease clusters of >15 and >30 seroconversions it was present in only one infected person). And as part of a person’s total viral load, it is expected that the resistant strain reduces its proportion of total viral load over time.
Yes, it is possible that it could spread further, but we’re lucky that at the moment it seems poorly suited to become its own epidemic.
Daniel-Reader
Whenever drug people say no bad effects, just remember they said the same of Fen-Phen before it started doing people in.
PRINCE OF SNARKNESS aka DIVKID
There you are! Shills in damage control
drosemudiamwenherbalcenter
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Vince
Ooga booga. Oooga booga. There’s a name for what you do. Snake oil salesman. Go back under your rock.
Brian
Damn, I’m diabetic and my mom has cancer, but if it’s going to also stop masturbation I want no part of it.
seaguy
Spam/Fake News. Queerty should have a way of reporting these ads.
QJ201
So his partner clearly was not undetectable and may or may not have know his drug resistance profile and may not even have known that he is HIV positive.
Many guys are opening sharing “undetectable” or “on PrEP” openly hook up apps.
We all know status/meds is not discussed in places guys hookup, e.g, bars, baths, booths.
So I gather status was not discussed or partner lied about being undetectable or “on Prep too?”
JoshGL
Serostatus disclosure is a joke.
As for judging someone by their intelligence, how they look, etc….many of the sociopaths on Wall Street fit the bill perfectly. And they have zero problem lying about their status – in most cases, they don’t even know.
People are even more apt to lie when they are drunk and horny.
But, hey, free will and all. Go for it.
Rick
I’ve been saying FOR YEARS PREP is a. toxic b. not tested for long enough under numerous enough conditions c. not fullproof. Yet every fucking gay dude with an agenda claims up and down that PREP is the magic antiHIV drug (despite the fact it blocks nothing else and is only 95 or 98% effective, so you can still catch all manner of horrible STIs and be passing them onto everyone else, and it’s not even 100% foolproof against HIV, so if you are enabled to act EXTRA slutty because you think you got the miracle drug and you fuck 100 randos off craigslist and every other hookup site in a year, with every single one you got a 1 or 2% or 4% or whatever of catching it. On top of that, the ACTUAL transmission rates for unprotected bareback cum in your ass twice deep dirty sex is only 2% for bottoms and less than 1% for tops so.. why even use the drug if you’re just going to be risky and slutty anyways, it’s only adding 1% or 2% extra protection and a FORESKIN alone adds about 16-18% resistance to HIV (AND ALL OTHER STIs) due to lagerhan’s cells (which consume and destroy HIV and other stds/viruses/bacteria)
DonW
Good Lord, @Rick. What a scary world you live in. I presume you’re not having sex at all. You’d be a hell of a drag in bed, anyway.
voyagerB
Untreatable gonorrhoea is already a reality in Sydney, Australia where Prep has been rolled out and it’s been massively used. We will never experience safe sex without condom and that’s a fact no one can argue against. The problem is much bigger than Prep and barebacking. More gay men have died of depression/ suicide than AIDS but no one talks about it. Wild sex life, orgies, open relationships will never cure emptiness that remains stuck inside of us.
Jody
No, it actually isn’t.
There’s one case of failure with 500mg ceftriaxone to eliminate oral gonorrhea reported in Australia in 2013. An additional 2g of axithrdomycin was given, and 41 days after diagnosis, he was negative for gonorrhea. His partner was treated with cefalexin, doxycycline and amoxicillin which cleared it as well.
There is a -concern- that gonorrhea will develop a resistance to every antibiotic we have. This is a valid concern, as antibacterials we have to use against it have significantly narrowed and new ones aren’t out of the pipeline.
PrEP has not been massively used in Australia. Truvada as PrEP was approved by the TGA in may of 2016. Clinical guidelines for the use of PrEP was only approved for in 2017. In February, the federal health minister stated that it was likely Truvada for PrEP would be available as part of general benefits, which would bring the cost down from $10k a year. I don’t believe that’s been finalized yet. Outside of a few studies, PrEP remains out of reach for most Australians.
Neither of your claims then are factual. As for the rest, that’s editorializing. I’ve met people for whom orgies caused emptiness and others who found happiness in such freedom. Sex is an important part of life. It plays out differently for different people, though.
JohnnyCockets
FACT: Truvada reports that it does damage kidneys in the long term.
FACT: They same company has reformulated it which allegedly performs the same as far as its percentage of prevention to contract HIV. But without the harmless kidney effects. It’s called
DESCOVY
Truvada is old news and most doctors are switching their patients rapidly
Kieru
Truvada’s potential for kidney damage has more to do with HIV+ patients on Truvada than HIV- patients. Most ART medications have this risk, and since most HIV+ patients are on either a combination pill or more than one pill their risk for kidney damage is more severe.
Doctors are probably switching their HIV+ patients to Descovy as you said – but no one is switching any PrEP patient to Descovy for a very simple reason: Descoby is not currently FDA approved to function as PrEP.
Since this entire article is about PrEP that seems worth mentioning.
Jody
It also doesn’t matter about gonorrhea. It isn’t life-threatening. HIV is. Every gay and bisexual man should join the Truvada for PrEP Medication Assistance Program.
nerfherder1990
Super gonorrhea would say otherwise, do some research before you assume what is and isn’t life-threatening
nil44
Medications are consumer products designed to generate profit, and like any other consumer product, the people who stand to make money off it don’t care why you’re buying it. Consumption is fantasy fulfillment, which is why all marketing plays on fantasies. If you want to have lots of unprotected sex with no consequences, you’ll be inclined to believe that these are magic pills that will make that fantasy become reality. Of course, that doesn’t mean the belief is actually valid.
surreal33
Prep is ONE tool to prevent HIV. Prep is NOT an excuse to go hog wild and engage in random, unprotected sex!
Rebeccauj7
I was about to take Cruise Ship Management in school last year. But unfortunately, when I received the result in hepatitis b test, it was positive. I don’t know where I got this. I’ve never experienced having sex with any man or boyfriend. I was so disappointed at that time. But then again, it is never the end of the world. I repeated the test in a well-known hospital. But, it came back positive again. Early this year i purchase Hepatitis B herbal remedy online from BEST HEALTH HERBAL CENTRE. They told me i will be negative after 4-5 weeks of usage of their Hepatitis B herbal remedy, which i believed and have faith. After 5 weeks of usage, I did another test my HBsAg came negative in routine checkup, so I have done all investigations for hepatitis B. My test reports are HBsAg negative 0.04 on 22/02/2018. I will never stop telling the world about BEST HEALTH HERBAL CENTRE good work in human life .
nerfherder1990
My comment is probably going to get buried with all the bickering and fighting, but is this the 3rd person to get HIV while on PrEP?
seaguy
The King County case cannot be considered a confirmed case of PrEP failure, since we have only the patient’s self-report that he was taking the medication as prescribed. In the three documented PrEP failure cases to date, the patient’s adherence was independently confirmed through blood levels of the drug tracked over time. In PrEP trials, subjects frequently exaggerated their adherence in comparison to their measured blood levels.