PEP & PrEP - facts, fantasies, delusions, and getting the sex you want.

[mecch]

I was chatting with a 20 something on the gay chat.  He contacted me and I told him I wasnt interested. Anyway he was persistent and he was telling me he wanted bare sex and it was "no problem" because tomorrow he would go to the hospital and get the "sachet" (packet) for an unprotected sex act.

He seemed so cool and nonchalant about it, and deluded, or misinformed, so I bothered to scratch the surface to see.. 

I explained that PEP that I know is for 4 weeks, 4 weeks of tritherapy - I explained a few times.  And wasn't that a bad deal for one night of bareback sex?  I tried to explain that PEP exists more for people who make a mistake, a safety mechanism for a regrettable risk. Not really something you plan on in arranging your weekend bareback risks, for the Monday afterwards.

He got angry and defensive, and wouldn't examine his statement that it was 1 dose.  Yep one day of drugs...  And a test a month later.  !!

He also seemed to have confused PREP with PEP.  I don't think Prep is common here in Switzerland...

I figured he is one or several of these: 1) lying that he has informed himself. 2) HIV+ already and lying. 3) Really stupid. 4) Never informed himself, takes risks, but has never reported to the hospital for PEP, some sort of denial..  The hospital would let serial PEP requests be so uninformed about their behavior???

Plus he couldn't discuss his info and his risks as soon as he heard I am on HAART he didn't want to discuss the topic in general, and quickly concluded there was no risk with me so why was I talking about it, and not screwing him.

It was a bit disturbing, but I guess you all involved in education see this sort of stuff all the time...

[LM]

I think he was just stupid, but in my honest opinion, I believe this will become somewhat common to see.

[jkinatl2]

I'm all for PreP - and for easy access to Truvada for it. Easier to make it possible to prevent HIV than to treat it - easier to take PreP than to combat eons of human psycho-sexual development.

[mecch]

Oh I agree with you on that.

This jh (jeune homme - young man) really couldnt be bothered to understand the difference between PrEP and PEP and he specifically thought there was a morning after type pill - and that was the extent of PEP. And, he he said you can take the sachet up to 72 hours after, so he got that figure, but none of the other info....   zzzz

tmi it seems results in confusion

[Hellraiser]

Pep isn't necessarily a three drug combo but it is for like 4 weeks.  I've heard of Truvada alone as prevention

[tednlou2]

Even if there was a morning-after pill, I don't understand the mindset of taking the risk that it may not work.  I suppose it would be different, if it was shown to be highly effective.  But, this is all hypothetical. 

A morning-after pill would be nice, obviously.  My partner's fellow firefighters are having to decide whether to start a 28-day course of PEP.  It was advised, after they got covered in blood from a man who committed suicide by gunshot.  Only having to take one pill would make that decision much easier, especially in a case like this where there is no evidence the man had HIV.       

   

[Ann]

PEP is indeed taken for 28 days. It is usually either Truvada alone, or Truvada plus Kaletra. Not only do you have to take if for 28 days, but it also extends the testing window period by one month (four months past the risk, three months past the last dose of PEP for a conclusive negative result).

The only thing this guy had right was the 72 hour window period for initiating PEP - although the sooner it's started, the better.

PrEP is NOT a "morning before" type solution. While there are not yet any "official" guidelines for its usage, it is not a "one off" pill to be taken before a risk is taken. It is to be taken DAILY. One pill, every day. EVERY DAY, not just before a barebacking session.

Read more on PrEP here.

Also see Community knowledge of PrEP and underground use.

One of the most recent articles I found (from November 2011) is Pre-Exposure Prophylaxis: The Great Confusion.

Mecch, this 20-something guy is a fool. If he isn't already poz, he probably will be soon. There just aren't any short-cuts when it comes to hiv. Not for prevention, not for testing, not for treatment. It's a shame when society's quest for instant solutions compromises the health of individuals.

[mecch]

Thanks Ann for all the perfect info and wisdom.

I didn't even know how PrEP would be dispensed, because I thought it hadn't been started anywhere yet as an the doctors or clinics would discuss generally and offer. 
Well I learned something at least - that PrEP will be a daily regimen.   


Yes I realised he was a fool, so then I tried to give information. The disturbing part was that the information made him angry.  (Among the other disturbing possibilities - such as maybe he is HIV+ now, or will be, and not know it.)

[mecch]

I changed the title of the thread, now that Ann has confirmed that PEP hasn't changed...

And see the theme I was hoping to dicuss.

This reminds me of another ONLINE GAY CRUISING exchange I had. Last week.

I was in NYC and went on Manhunt.  Two different positive guys, in their forties, hotties still - if we trust their pics - of course - but certainly attractive guys a lot of people might want to fuck...

Each one told me they get more and more action recently because - their explanation - people who want to bareback realize an HIV+ guy is a safe bet.

So I got impression, if these guys are NOT full of shit, there may be a new "it guy" -- he knows his status, takes his HAART, is undetectable, and says it all publicly -- to any guy looking for bb hook ups.  So the thrill of the bare (for an HIV- guy) is achieved within a reasonable, calculated risk.

The two manhunt guys said HIV- people and lots of twinks especially regularly ask them for bareback because the asker "knows an HIV+ guy who's undetectable won't transmit".

I couldn't judge if this is a trend, or not. I couldn't judge if they were faking their reported popularity.  Also I wonder if some of the HIV- guys pursing the bareback they want by doing "poz treated guys" -- are delusional about their supposed reasonableness, or their own status.   

That was a theme in the conversation with the jh on the Swiss chat. As soon as he know I was on HAART and undetectable, he really didn't want to discuss any of his other areas of misinformation.  He went in hard for - "you can't give it to me why are we still talking about this shit."   

____

Just some reports then about recent observations in online cruising and how this disclosure and safer-sex-discussions and "getting the sex you want" is always in evolution.

________

I was think about some of these things in general, and time passing, on the plane between my American roots, past and present, and my Euro roots now.

I read that post here about the18 yo boy who came out soon after leaving home. His mom tried to banish him from the family for that, but he simple elegantly refuses the banishment.
http://forums.poz.com/index.php?topic=41467.0

I think that's partly explained by his character but his character and how he lives his sexuality surely has been formed by all the positive changes in the last 20 years about bias towards gays, lesbians, and so on... Due to visibility, and accurate information from multiple sources that its normal, not scary, and a civil right to boot to be gay.

When I was in HS, my parents actively did NOT want to know I was gay or questioning. And I certainly didnt get any messages from my suburban surroundings that I could be gay and what that might mean.  I came out to my family a few years after I came out on campus.  I did it when a bf had AIDS and his family couldn't deal, and I need love and financial help to help me to help my bf.  The family did as they were told. It took another few years for it to become mundane.  Now, this xmas, everyone in the extended family is so matter of fact about any gay issue, gay person, gay anything.  Totally mundane and normal life.  Its been that way all through 2000's, it seems.

Bias against HIV+ people will surely decrease if everyone knows someone positive and has the basic good information about HIV the virus, and living with HIV.
http://forums.poz.com/index.php?topic=41460.0

[buginme2]

Mathematically speaking, they may be correct.

[newt]

Indeed they may, or perhaps they will be unlucky, or perhaps reading the maths poorly if they's shagging around given the prevalence of undiagnosed STIs, of which having one will increase the risk of transmission significantly, and/or really going for it, eg causing microscopic trauma to their arse, which will also increase the risk of transmission.

Viral load is a major factor, but not the only factor, in HIV transmission.

- matt

[tednlou2]

This is an interesting topic.  If someone is just going to bareback no matter what, it would seem the calculated risk would swing in favor of the openly poz guy who can show you their last several ud viral loads.  If I had to choose between this guy and a guy whose status was unknown, I would have to go with the poz guy.  Again, we're talking about someone who is never going to wear a condom. 

 

[mecch]

This is an interesting topic.  If someone is just going to bareback no matter what, it would seem the calculated risk would swing in favor of the openly poz guy who can show you their last several ud viral loads.  If I had to choose between this guy and a guy whose status was unknown, I would have to go with the poz guy.  Again, we're talking about someone who is never going to wear a condom.

I guess so. That is their thinking, at least. That is what these two HIV+ guys were trying to sell to me as a "trend" with their Manhunt cruising.
But I think its shot full of hopes and delusions. Clearly the HIV- guy will meet up with HIV+ guys who lie about being undetectable.
Also this thing about showing papers, it just seems as silly and misplaced as negative guys who used to offer and demand to see other negative guys tests results.  This seemed like such folly.

[leatherman]

in favor of the openly poz guy who can show you their last several ud viral loads.

LOL  like all pozzies carry around copies of their last year's worth of UD viral load tests to prove that to some hot, albeit stupid, trick that wants to BB. 

anyone that relies simply on the word of some stranger about their status or some piece of paper claiming something (with my PC I could whip up some of those documents saying I was UD or even not poz ) is just asking for trouble - ie asking to be infected with HIV.

[mecch]

Yes, it seems to be a "performance of responsibility" masking either the knowledge, or the denial, that its rather reckless.

Still, I can imagine MOST hiv+ gay guys are just honest about their health if they are also telling potential tricks they are HIV+. 

And I do think its slightly more plausible that a HIV- guy who loves barebacking and decides to seek out HIV+ guys who are undetectable, well thats somewhat a step to self protection, versus just doing who ever with no questions asked.  (This would be a good candidate for that proposed PrEP, me thinks...)

Manhunt is pretty warped universe onto its own rules, I must say...

I did meet one perfectly nice guy, though.