In a serodiscordant relationship. Should I start?

[sumboy]

Hi All,

So i've been diagnosed early this March. My CD4 last checked in June is 520 no viral load count because it is too expensive to be tested even in government hospitals. I will only know my VL when I start to be on meds which is CD4 below 350. I am in Malaysia.

Anyway, I recently met this amazing guy and I told him i'm poz from the first day we met. He laughed at me because I made such a big deal about it. He just came back from 15 years in Australia. We also recently went to get him tested again because he wasn't feeling well for awhile. We've been doing it safe and telling each other if theres a cut anywhere. The results came back negative and we were super relieved.

We've been talking about me starting meds or him starting on PrEP. I want to start meds because that will lower my viral load. PrEP lowers the risk of being infected but there are still chances right? Meds here costs about RM600 (roughly USD200) per month which is quite an amount for me, whereas he could get PrEP from OZ for free. He's got a PR there.

AM I stupid for wanting to start ARVs because of him and we've only been in a relationship for 2 months? He seems to be very determined to fight this with me. What you think?

[ad2san]

Hi there,

I want to start meds because that will lower my viral load.

this is correct and by the way it will prevent that you suffer from severe medical diseases ... some may tell that it will reduce the risk of "accidental" transmission.

  PrEP lowers the risk of being infected but there are still chances right?

hey, you know already a lot, this is correct too.

AM I stupid for wanting to start ARVs because of him and we've only been in a relationship for 2 months? He seems to be very determined to fight this with me. What you think?

You're certainly not stupid, you are also lucky that your friend takes it this way, I still see a lot of people running away from positive guys ... You should take advantage of having someone by your side to support you. In my eyes it also shows that he cares (a lot) about you already ... you must be a great guy ! By starting therapy now  you'll be a great guy a long long time.

Take good care of you and your BF.

Cheers

[newt]

AM I stupid for wanting to start ARVs because of him and we've only been in a relationship for 2 months? He seems to be very determined to fight this with me. What you think?

Not stupid. He would also be not stupid for starting PrEP. Since ARVs is usually a one-way street for people with HIV, ie stopping is not recommended, PrEP might be easier for now, see how things go eh? Me, personally, I'd want a discussion about condoms and where they fit, before PrEP (or ARVs). You don't want to be bounced into condomless sex that you didn not plan on.

Belt and braces keeps your trouser up nice and proper.

- matt

[mecch]

Personally I don't think a HIV- person should take PREP rather than the HIV+ person taking HAART.  There are advantages to the HIV+ person taking the HAART, besides diminishing risk to the negative partner.
What PREP does he get for free??
If cost is an issue, maybe you can take HIS PREP in combination with one more drug.  How much world the generic cost of the third drug, only???  I dunno, just throwing that out there.  Its an odd suggestion. I guess if you are on HAART but not HAART bought or supplied in your country, you still wouldn't get the right to viral loads???  Nor would it be a long term solution.

Another idea would be for him to get the PREP supply for a couple of months, not take it, and just keep it handy for PEP, if there was ever an accident.

[Souledout]

I'm going though this decision at the moment. We've been denied the option of PrEP which is a bummer, in my eyes the best solution would have been him on PrEP for a few years until my position becomes more clear. Recently evidence seems to be pointing towards earlier treatment, which means it'd be a good thing for both in a serodiscordant relationship.

I'm not going to lie, the prospect of starting lifelong treatment fills me with dread.

[mecch]

in my eyes the best solution would have been him on PrEP for a few years until my position becomes more clear.
.....

I'm not going to lie, the prospect of starting lifelong treatment fills me with dread.

Isn't the best solution using condoms and nobody going on HAART. And you coming to terms with being HIV+ and the eventuality of HAART, and starting at the appropriate time.

[Souledout]

Condoms seem to be breaking with alarming regularity (3 times in one year). He goes on PEP, freaks out, arguments happen.

[mecch]

Hmm, well that is disturbing.  Ann has a good lesson on condom use to avoid breaks...
I mean maybe you aren't using them correctly. Or maybe you have low quality stock?

[Souledout]

Coming to terms? Yes very much so. I'd rather not be obviously. HAART eventually yes, but it looks like I could be able to hold out for some time under good circumstances, and I'd rather not start sooner if I can avoid it.

[mecch]

But isn't it a bit odd the the one who DOESN'T have a viral infection goes on HAART because the one who DOES have a viral infection isn't ready yet?

Course, any means necessary to avoid another transmission, that's still a good motivation.

[Souledout]

Maybe we're a bit unlucky ad paying the price of him having about ten times the normal amount if ejaculate than normal. I've have one or two breaks in my entire life, then 3 in one year. The condoms come from a local hiv charity, you'd expect them to be ok.

[mecch]

He's the top? And the negative one and coming inside you in the condom? And the qty of seman is the suspect?  I guess possible. I dunno.
Why doesn't he pull out an come on you, that's exciting too. But I guess not a routine.
I wouldn't ASSUME that those condoms are quality... by the way. 

I'm starting to confuse you with the OP.  Sorry.

Which couple is in the poor country?

Get quality condoms - find clever ways if necessary.  If he has a big load, get the condoms with the reservoir tip.  Pinch the tip so there is no air, before rolling down. Don't put it on too tight.... Put it on when super erect, and with the head exposed, if he is uncut, so there is some give for the in and out...

When I was HIV -, I once had a HIV+ lover who was demanding and also hung. He'd only do me with femidoms. They were expensive, though. 

[buginme2]

But isn't it a bit odd the the one who DOESN'T have a viral infection goes on HAART because the one who DOES have a viral infection isn't ready yet?

It's more than odd.

If you have HIV and are with someone who is negative then YOU should be on meds.   I can't imagine telling my partner he has to take hiv meds because I wasn't emotionally ready yet.  Your kidding right?

By the way, my partner of six years is negative, I'm positive.  He's not on prep but I take my meds every day like a good boy.  Buck up Souldout. 

[Souledout]

Mecch, all these things are in discussion now. Just depends on how it goes. If I didn't have my low VL I'd be jumping at the chance if early treatment, but it seems a waste if I can fight the virus well.

[mecch]

I'm going though this decision at the moment. We've been denied the option of PrEP which is a bummer, in my eyes the best solution would have been him on PrEP for a few years until my position becomes more clear. Recently evidence seems to be pointing towards earlier treatment, which means it'd be a good thing for both in a serodiscordant relationship.

I'm not going to lie, the prospect of starting lifelong treatment fills me with dread.

What rationale was given to you for the denial of PREP.

I am guessing that it's because safesex / condoms are effective enough, time tested, and you are the one with HIV.

If your BF is going on PEP a few times a year, you need to talk to a very whip smart doctor or social worker because that's not a viable result.... 

Someone is overestimating the risk to him. (partner? doctors?)  Or you guys are making too many mistakes... Or you need to go on HAART just to make peace in the relationship.

Look out for doctors who are in general scandalised by sero-discordant relations, especially gay ones.... They don't necessarily practice the best medicine.  Maybe...

[EUINAU]

^^^i have to agree with what buginme2 said.... I am poz and on meds...

[Miss Philicia]

It's more than odd.

If you have HIV and are with someone who is negative then YOU should be on meds.   I can't imagine telling my partner he has to take hiv meds because I wasn't emotionally ready yet.  Your kidding right?

By the way, my partner of six years is negative, I'm positive.  He's not on prep but I take my meds every day like a good boy.  Buck up Souldout. 

Can't you elect to use condoms consistently?

[Joe K]

What rationale was given to you for the denial of PREP.

I am guessing that it's because safesex / condoms are effective enough, time tested, and you are the one with HIV.

If your BF is going on PEP a few times a year, you need to talk to a very whip smart doctor or social worker because that's not a viable result.... 

Someone is overestimating the risk to him. (partner? doctors?)  Or you guys are making too many mistakes... Or you need to go on HAART just to make peace in the relationship.

Look out for doctors who are in general scandalised by sero-discordant relations, especially gay ones.... They don't necessarily practice the best medicine.  Maybe...

The rationale for denying unwarranted treatment, may be that HIV meds, barring emergencies, should be for poz folks only.  Until all pozzies are treated, HIV meds should not go to negative people, solely for the purpose of sexual risk reduction.

Joe

[oksikoko]

Why doesn't he pull out an come on you, that's exciting too.

If you say.

To everyone: starting HAART is not the nightmare you may envision. Sure there are horror stories, but most people lately seem to be saying they have minimal if any side effects. And that is in exchange for an undetectable viral load and peace of mind regarding one's own health and infection of others.

Talk to your doctors, though. Everyone is an individual with individual circumstances.

[oksikoko]

The rationale for denying unwarranted treatment, may be that HIV meds, barring emergencies, should be for poz folks only.  Until all pozzies are treated, HIV meds should not go to negative people, solely for the purpose of sexual risk reduction.

Joe

That's a shame. I think PrEP should be available to anyone who feels he or she needs it. Better a few months or years of prevention (while needed) than a lifetime of HIV. And all to save the cost of a few pills.

One other problem is that the FDA needs to approve more than just Truvada (under patent) for PrEP. There's no non-money reason older, out-of-patent drugs couldn't serve the same purpose.

Lee

[newt]

The rationale for denying unwarranted treatment, may be that HIV meds, barring emergencies, should be for poz folks only.

Except the FDA approved Truvada for prevention for individuals. Issue of access to meds should not preculde Truvada as a preventative prescription for an individual.

I am guessing that it's because safesex / condoms are effective enough, time tested, and you are the one with HIV.

Except that meds scored better than condoms in studies, it is arguable, and there are issues here with condoms, which makes treatment of some sort a valid consideration (among other things, like a bespoke condom selection).

PrEP is not licensed in Oz, so there is a simple reason for the refusal. In the UK many HIV/sexual health docs would have done an off-label prescription, or suggested enrollment in the PROUD study of PrEP (which includes other helpful interventions re: reducing risk of transmission apart from Truvada) << or Oz equivalent.

Clearly, the big anxiety here is starting meds, and I recommend the previous comments on how this is not such a big deal these days. But it is a fair anxiety. You will have to address it sooner or later.

Also clearly, the residual risk of transmission from condom breaks is an issue here, and therefore the discussion on treatment as prevention valid in my mind (PEP is hell, to get, to take), but, I do note, any relationship worth it's salt considers the points of view of both people, and agrees actions that reflect the means available that suit both people. Going on treatment to prevent the small risk of transmission if a condom breaks is well and good, but there are other ways to resolve this, and if you don't need the pills yet maybe other options are better? Only you two can decide.

Feeling uninfectious is a great boost, and this is something to consider.

Guidelines always revise up the CD4 count for starting treatment, and this is also something to consider.

The people who have played the I'm-HIV-positive-I-must-use-condoms-goody-twoshoes card in this thread, I am unimpressed. Individuals have more options now, and the discussion on the options should be had by the people concerned. Indeed, the OP never said they didn't/wouldn't use condoms.

- matt

[sumboy]

Thanks for all the discussion guys. Am gonna get my VL tested some time next week and see how it goes. Will be my first VL test after being diagnosed in March. I don't understand why some people would not start medication given the chance, I would jump straight on the bandwagon and do everything I can to protect myself and my boyfriend. For now am looking at him to start on PrEP until my CD4 is low enough to get the free first line meds from the government. We're meeting a doctor next week, will tell you guys how it goes.

[friskyguy]

another suggestion. If you want to bypass the meds starting requirements in Malaysia just jump on a budget flight to Bangkok (1 hr flight) and access your labs including viral load and for meds that are much much cheaper than in Malaysia. Some great medical experts there....plus an exotic fun holiday too :-)))

[sumboy]

another suggestion. If you want to bypass the meds starting requirements in Malaysia just jump on a budget flight to Bangkok (1 hr flight) and access your labs including viral load and for meds that are much much cheaper than in Malaysia. Some great medical experts there....plus an exotic fun holiday too :-)))

sounds good, thought about it. do you have any recommendations? Which hospital or doctors? If not i'll just do a google search I suppose. Thanks a bunch

[friskyguy]

there is quite a bit of info on other threads about Bangkok.

You need a Thai prescription for your meds. Any hospital can provide. Bumrungrad Hospital is first class to find a doctor.....less than 800 baht. Just tell doctor you want to fill your prescription at Thai Red Cross. You may be able to get PrEPp for your bf too.

Labs and meds at the Thai Red Cross cause cheaper than hospital (Thai Red Cross near gay area of Silom and fantastic service). Can also do your HRA there for 1000 baht. I think from memory the viral load test is 1500 baht. Lab results sent to your email so don't need to stay in Bangkok.....convenient, efficient and they run a tight operation.

Meds cost depends on the meds but they have generic there.

Good luck