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Old 02-26-2015, 07:25 PM   #1
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Dewott #Truvadawhore

Pre-exposure prophylaxis, or PrEP, has made a big splash in the gay community. Particularly, the specific drug Truvada. The base idea is that it reduces the risk significantly of HIV transmission to a HIV- person taking it. It's a once-daily drug that is meant to be used in conjunction with condoms, minimalising the risk of infection.

However, there is also significant controversy around this drug. Due to its excellent chances of preventing the spread of HIV to those taking it, many in the gay community who take Truvada use it not in addition to, but in lieu of, condoms, despite the recommendation being to use it in addition to other forms of prevention. Some call it sexual freedom. Some say it encourages risky behaviour that should be discouraged, not encouraged. Some say it's nobody else's business how they have sex so long as it's consensual. The term "truvada whore" has been used by opposing sides: one side uses it as an insult, citing it as an excuse for men to sleep around with minumal consequence. Others, often those who are on it, co-opted the term and wear it with pride. They "fuck without fear", as they say. It's a hashtag. I've seen shirts with it. I've even talked to my own doctor about wanting to be on it, as I am in a higher-risk group, being a sexually active gay man.

However, this is not only for promiscuous gay men. There are couples that involve a poz and neg individual in a loving relationship (both gay and straight and anything in-between), for which this is also a recommended treatment. A serodiscordant relationship, as they call it. There's also intravenous drug users, who, although they should not be encouraged to shoot up, should at least have the ability to do it safer. They're going to do it anyway, we might as well make sure they have the necessary precautions to help prevent the spread of disease (this is the same concept behind needle exchange programs).

And then there's the fact that if we're making headway into prevention, maybe, just maybe, this will push us closer to being able to cure it once and for all.

So, I present this to you, UPN. Is this overall a positive development? Is this just encouraging men to be sluts? Is that even a bad thing? Discuss.

(As a final note, I completely acknowledge that HIV/AIDS is in no way exclusively a gay problem, but a human problem in general. However, my knowledge of this largely comes from the gay community, as it is here that PrEP has been making a huge splash and I personally know more than one individual who is on it. Please do not feel you have to limit this discussion to only what applies to the gay community.)
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Old 02-26-2015, 07:57 PM   #2
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Seems like a pretty good thing to me, it reduces the amount of deadly/harmful disease we have in the world (if by a small margin) which, as you've not really noted any massive side effects of can only seem to be a good thing.

Not really sure what the problem with whoring oneself out is unless one is in a relationship, I mean there is the religious view, but no one has the right to nor should anyone shove their religious view points on others. Besides people who fuck anyway, this just makes it safer.

Only real problem is the people over relying on the ability of the drug and not using condoms as a back up I suppose. But that's a people being stupid problem not a problem with the product.

As an Asexual rock hermit I've never personally heard of this drug before, but I can most certainly say I approve of its existing. Here's to hoping they come up with a cure!
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Old 02-26-2015, 08:32 PM   #3
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One problem is the myopia. HIV is not the only sexually transmittable disease out there. An attitude that "We have an anti-AIDS drug, therefore I don't need to use protection!" is an unsafe one for both the individual who holds that belief as well as for the society with which he interacts. Gonorrhea is making a comeback, while other diseases like Hepatitis C never had a cure or vaccine to begin with. (Hepatitis C is noted specifically because of co-infection with HIV and because Hepatitis C, a life wrecker, is the leading cause of liver transplants.) Just because you're taking a drug that may or may not prevent you from infecting others with HIV does not mean that you're preventing transmission of any of the other diseases you might have. It's just plain irresponsible to have unprotected sex with strangers. It may be "fun" and "hot," but it puts yourself at risk for a lifetime of poor health and costly medical bills.

Another problem is the percentage. Truvada is not some miracle drug that 100% prevents the spread of HIV. According to some studies, "the use of PrEP reduced the risk of HIV infection by 96 percent." 96% is good. It's also on par with the accuracy of Air Slash and other 95%-accurate moves. Let's turn it into a fraction to make it a bit more obvious what danger you're placing people at if you think Truvada excuses protectionless sex: with odds of roughly 19 in 20 at preventing the transmission of HIV, you are going to spread the virus to your sex partner 1 out of every 20 times you have sex. Not just 1 out of every 20 sex partners: 1 out of every 20 sexual engagements. Those are scary enough odds even for individuals who only have sex once a month. But the young gay men who are contemplating the use of Truvada as a substitute for condoms are likelier to be having sex on the order of once every week to two weeks. Which means that, within a year, an HIV+ man who doesn't use protection but does use Truvada is going to spread HIV to some poor soul. Even if the efficacy could be shown to be "99.99% for men who use as directed," that'd still be on par with the rate at which babies with cerebral palsy are born in the US every hour. We've all met individuals with cerebral palsy, I'm sure. I've known multiple in my own life, including one who was born into the family several years ago. So it's not difficult for me to imagine someone using this "miracle anti-AIDS drug" that boasts 99.99% efficacy and then whoopsie daisy it doesn't work and they go and contract HIV from their HIV+ sex partner.
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Old 02-26-2015, 08:51 PM   #4
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I should note that Truvada is only to be used by HIV- individuals, and not by those who already have HIV

However, there's another counter point
According to this source:
Condoms used 100% of the time, though not necessarily 100% perfectly (i.e. with usual rates of breakage and slippage) provide protection of 80 to 85% against HIV (uncertainty range: 76 to 93%). In other words, for every 100 cases of HIV infection that would happen without condom use, about 15 (range: 7 to 24) would happen when condoms are used consistently.

CDC supports that condoms are not 100% effective, either.

"Consistent and correct use of male latex condoms can reduce (though not eliminate) the risk of STD transmission. To achieve the maximum protective effect, condoms must be used both consistently and correctly."

This is why we don't call it "safe sex", but "safer sex".

Condoms are always stated to be "highly effective". Well, Truvada is highly effective as well.

There's also the often-overlooked fact than many men who are HIV+ are on meds. I know many, many poz men, and almost all of them are on meds and almost all of them have an undetectable viral load, which means the risk of transmission is extremely low in those cases.

Just a couple counterpoints and factors you may not have considered

EDIT:
Actually, this source seems to report a 90-95% effectiveness of condoms preventing HIV transmission, which would actually make it less reliable than PrEP meds

And, to note, this is still a very early development and it's all too likely advances can be made to further reduce the risk
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Old 02-26-2015, 09:10 PM   #5
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Whoops, I was very confused about who is to take the drug. Apologies for that and any other misunderstandings about how the drug is to be used. That stated ...

It bears repeating that a drug that works well against one specific STD does not equate a drug that works well against all of them. Even if you could prove to me that Truvada worked 100% of the time at preventing the spread of HIV, it still wouldn't mean that gay men ought to go around having unprotected sex left and right. There are so many more diseases than just AIDS, and you're placing yourself at risk of contracting each and every one of them every time you decide to have sex with people that are not partners for life.
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Old 02-27-2015, 12:14 AM   #6
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Unless you believe HIV is God's little helper at wiping gays off the face of the Earth, and so to do anything to inhibit its course or spread is a sin, I see no issue with this drug. It'll help limit the spread and eventually help eradicate one of humanity's greatest nuisances.

I worry if it's really a risk-free drug, from a side-effect POV. I bet it causes infertility, ED or something. If that's the case, it's better not used especially in lieu of a condom, because the side effects (probably) outweigh the benefits.
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Old 02-27-2015, 12:30 AM   #7
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I think "nuisance" is a bit light a word, honestly.

Reported side effects seem to be limited to nausea and diarrhea. No reported ED (and given the demographic, no way that would go unreported), and the nausea and diarrhea tend to resolve themselves in a month or so, from my secondhand knowledge.

(EDIT: oh, and in rare cases liver problems, but I know of no-one directly who has had those creep up)

It's like people don't read links.

I'll wait for another person or two to weigh in before I give my full thing here.
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Old 02-27-2015, 12:32 AM   #8
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My idealogy about sex is that there is nothing wrong with it as long as its between two responsible, consensual parties. If Jack and Jill or Jack and Joe or Jill and Jane want to have sex as much as they'd like, as long as they are being responsible and safe, I have no issues with it. Same goes with people who have sex with multiple partners (why do we slut shame again this is not a bad thing). Truvada, for me, is just another step in giving safer, more responsible sex. If people want to not wear a condom, well while it is there choice its also not the responsible one. Truvada protects against HIV and nothing else and a condom protects more, that alone should be reasoning to not ditch the condom.

I think this is a positive development, absolutely. It's one step closer to finding a cure for one of humanity's gravest diseases.
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Old 02-27-2015, 12:34 PM   #9
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Okay, may as well crack my knuckles on this.

First of all, I want to play devil's advocate here when it comes to condoms. Put simply, comdoms are not nearly as reliable as people might like you to believe. The list of things that can compromise the effectiveness of condoms might be more significant than you might think, and, off the top of my head, here's just a few things that can make condoms ineffective: latex allergies, too much lube, not enough lube, girth of the penis in question (too thin and the chances of it slipping off increase, too thick and it can stretch the rubber a bit tightly, which combined with other factors can cause breakage), the wrong kind of lube (oil-based lubricants are known to break down latex, particularly notable is vaseline/petroleum jelly), not pinching the tip as you roll it on, air bubbles, using one that's too old (let's be honest here, who really checks condoms' expiration dates?), too much exposure to heat (which is a reason why it's not recommended to carry one in your wallet), too much exposure to cold, too much light exposure (both solar and fluorescent), sex a little too rough (particularly combined with some of the other factors), using condoms that are too thin (particularly in anal sex), using them inconsistently and/or incorrectly (which many, many do), and not putting on one right away. For those who actually do remember to pinch the tip, you also have to make sure your nail doesn't press into the condom as you do so, because that weakens the integrity as well. These are all just off the top of my head, and I'm certain there are some I'm missing. Truvada, on the other hand, seems relatively idiot proof. You take a pill once a day and a blood test every three months to check liver function to make sure it's all copacetic.

There's also the fact that a lot of men using PrEP but not condoms, probably were going to be barebacking anyway. Call them stupid or irresponsible all you'd like, but there are many, many men with multitudes of reasons why they go bare. At the very least, them doing it while on PrEP is much, much safer than them not taking it at all. An ounce of prevention, as they say.

While you do make a point on gonorrhea (which is, by the way, curable. Hep and herpes are among those that cannot be cured, however), Talon, that's not the fault of Truvada. As an insider in the gay community, HIV/AIDS resources are completely and utterly pushed on us, often to the exclusion of other STDs. A million places like LGBT centers and LGBT-friendly doctor's offices offer quick and free HIV testing, it's pushed on us to use condoms "to help prevent the spread of HIV", about a million advertisements (ironically, pretty much always targeted at a gay demographic) talking about how HIV is not a "gay disease", and, honestly, a lot of the gay adverts I end up seeing (such as on youtube and such) are HIV-centric. The gay community as a whole is downright obsessed with the disease. This drug cannot at all be held at fault for other STDs not getting the public attentions that they weren't getting anyway.

Now, if any of y'all know anything about me whatsoever, you'll know I am all about sexual freedom. As long as it's consensual and innocents are not being harmed, have at it. And the fact is, the only risk-free sex is having no sex at all. Every time you have sex, there are risks involved. I don't care if you use two condoms, spermicidal lube, and wrap yourself in bubble wrap, sex is a risky activity. Something that significantly decreases the chances of something that could go wrong actually happening, is never a bad thing in my book. Is PrEP when used with condoms safer? Of course it is. But I'm not going to judge people for their sexual practices (or for some, lack of) as long as it doesn't harm innocents. Nor do I want anyone to judge me on such, either.

And that's not even getting into PEP, anti-retroviral drugs that are designed to be taken within 3 days of possible exposure to try to prevent seroconversion. Rather than Pre-Exposure, Post-Exposure.
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Old 02-27-2015, 02:37 PM   #10
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I bring up gonorrhea because it's on the way to re-becoming incurable. (Source: medical report I can't locate right now from circa December 2014. You can find plenty of "It might do this soon" stories, but this one was specifically about an incurable case that forced the doctors to tell the patient there was nothing they could do for him aside from trying to treat the symptoms.)
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Old 02-27-2015, 10:24 PM   #11
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Using the drug seems like a sound plan to me. Using it in lieu of other protection like condoms1 - or willingly sleeping with someone who is - does not. I'm not going to stop them - by all means exercise all the freedom they want. But freedom to act doesn't mean freedom from the consequences nor does it mean they can expect much sympathy if they catch Hep C or something because they thought Truvada meant condomless was a good idea. Drug seems good, but it in no way makes it sensible to slacken off any other protective measure you'd otherwise be using.

1No, condoms are not 100% effective but unless you're a twit they're damn close. Pretty much all the issues Slash mentioned for me fall under "if it failed because of one of these reasons, the user is such an idiot that I have minimal sympathy."2 Can't speak for the reliability of condoms in anal sex in fairness.

2Or they've had really, really terrible sex ed. Like inexcusably so.
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Old 02-27-2015, 11:26 PM   #12
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On the sex ed front, I'll point out a lot of schools here teach mostly abstinence-only and spend little if any time on condoms, let alone proper use and the dos and don'ts. I've had to actively look up things like how and where to store them, what lubes are and are not compatible, etc. The "moral" right try to keep any and all sex ed as scare tactics and preaching that abstinence until marriage is the only option (not safest, but only), and limit or eliminate any kind of comprehensive sex ed. Think Mean Girls and Coach Carr. A lot of sex ed in the states is inexcusably terrible

(EDIT: also they spend even less time on gay sex which, trust me, takes more effort and knowledge and research to do properly)

And a lot of guys keep condoms in their wallets
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Old 02-28-2015, 07:45 AM   #13
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Even if someone is clueless at using condoms, it's still seriously reducing the chance of catching something nasty so using one is better than not. I approve of the use of Truvada in general, but does not provide protection against a hundred things that proper condom use will (and that even improper condom use will seriously help with) so it is not a replacement for them. It's really that simple.

And tbh if someone is too lazy to take five minutes and the internet to educate themselves on how to have sex safely, any consequences are entirely their own fault. Like I do rock climbing, and the community generally takes a very dim view of people who've skipped the "learn how to do this safely/properly use the safety equipment" bit before actually climbing. Sex, like rock climbing, carries risks. In the same vein I have a very dim view of anyone too lazy to educate themselves - it is not difficult and it does not take long.
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Old 02-28-2015, 10:03 AM   #14
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Reported side effects seem to be limited to nausea and diarrhea. No reported ED (and given the demographic, no way that would go unreported), and the nausea and diarrhea tend to resolve themselves in a month or so, from my secondhand knowledge.

(EDIT: oh, and in rare cases liver problems, but I know of no-one directly who has had those creep up)

It's like people don't read links.
The drug has been subjected to ten years of clinical trials (probably) and was approved for use in 2012. For comparison, 60% of people who develop lung cancer are older than age 65, so even if one continues to smoke the damage was already done in the teens and 20's.

Even if condoms are not 100% safe, barring the choking hazard and latex allergy they're going to be safer in the long run than introducing a biological substance into one's blood stream. The more complicated the biomolecule, and the more likely there are going to be side-effects down the road.
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Old 03-01-2015, 07:35 AM   #15
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Wow my grandpa just had a huge rw rant about this
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Old 03-05-2015, 08:18 AM   #16
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The existence of Truvada is undoubtedly a good thing. The fact that taking it tends to lead to reduced condom usage is very worrying to me however, especially because it doesn't seem that Truvada prevents the transmission of other STDs. Although greater condom use is something that the gay community is continuing to work towards in general, so I'm willing to bet that this is just a symptom of that.
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