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Author Topic: We all forgot the condom.  (Read 5254 times)

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Online Dachshund

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We all forgot the condom.
« on: August 22, 2008, 05:25:14 PM »
An interesting and lengthy piece about condom fatigue and serosorting. Sean Strub is quoted discussing pre-exposure prophylaxis, something I've never even heard of. It's a fascinating read.

http://men.style.com/gq/features/full?id=content_7437&pageNum=1

Offline BlueMoon

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Re: We all forgot the condom.
« Reply #1 on: August 22, 2008, 08:54:51 PM »
Even if PrEP does turn out to be effective, it's too late to do me much good.  And then there was no mention in the article of the horrendous expense of the drugs, nor the deleterious side effects.  The big question I have is who would pay for it?  I can't see the insurance companies picking up the tab, and at retail prices it's as bad as a cocaine habit.

Offhand about the only benefit that I can see for myself is that my HAART minimizes the risk of superinfection.

...................VL.....CD4.....%
-----------------------------------------
08/10-- ......<40.....290.....42
05/10-- ......<48.....290.....46
02/10-- ......<48.....481.....44
10/09-- ......<48.....277.....46
07/09-- ......<48.....300.....38
05/09-- ........51.....449.....39
03/09-- Added Isentress
02/09-- ........65.....299.....34
11/08-- ........62.....242.....40
08/08-- ........66.....212.....29
05/08-- ......202.....217.....27
03/08-- ....5210.....187.....21
02/08-- Began Truvada/Reyataz/Norvir
12/07-- 273,000.....157.....22
11/07-- 229,000.....209.....22
10/07-- Diagnosis

It's a complex world.

Offline Oceanbeach

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Re: We all forgot the condom.
« Reply #2 on: August 22, 2008, 09:06:47 PM »
I guy I knew once forgot the condom, I was fast asleep when we started.  Hello, My name is Michael and I have been living with HIV for 14 years.

(crowd says), "Hi Michael"

 ;D   Have the best day
Michael

Offline GSOgymrat

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Re: We all forgot the condom.
« Reply #3 on: August 23, 2008, 12:34:21 AM »
Even if PrEP does turn out to be effective, it's too late to do me much good.  And then there was no mention in the article of the horrendous expense of the drugs, nor the deleterious side effects.  The big question I have is who would pay for it?  I can't see the insurance companies picking up the tab, and at retail prices it's as bad as a cocaine habit.

So the arguement will be the government needs to give Gay Bob $100 of dollars a month for antiviral medications so he can be sodomized without getting infected because a 50 cent condom just "feels so clinical." Yeah, that will fly.

Online Dachshund

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Re: We all forgot the condom.
« Reply #4 on: August 23, 2008, 08:21:10 AM »
Even if PrEP does turn out to be effective, it's too late to do me much good.  And then there was no mention in the article of the horrendous expense of the drugs, nor the deleterious side effects.  The big question I have is who would pay for it?  I can't see the insurance companies picking up the tab, and at retail prices it's as bad as a cocaine habit.

Offhand about the only benefit that I can see for myself is that my HAART minimizes the risk of superinfection.



If it doesn't do you any good then by all means forget about it. If you read the article you would know the author wasn't advocating, just reporting. PEP wouldn't help you now either, do you suggest we not offer that as an effective way to stop the spread of the virus? Offhand if the only benefit you can see is for yourself, oh, never mind.

But one careful study done on PEP among gay men in Rio de Janeiro found just the opposite, he says. Once a patient has spent a month on the very strong AIDS medications, he is considerably less likely to put himself in that situation again, the study showed. “PEP can be the educable moment,”
« Last Edit: August 23, 2008, 08:22:57 AM by Dachshund »

Online Dachshund

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Re: We all forgot the condom.
« Reply #5 on: August 23, 2008, 08:34:17 AM »
So the arguement will be the government needs to give Gay Bob $100 of dollars a month for antiviral medications so he can be sodomized without getting infected because a 50 cent condom just "feels so clinical." Yeah, that will fly.

No Ford that's not the argument, and wouldn't you have liked that option when you weren't feeling so clinical?

I wish you would take the time to read the article first Ford before offering up lame Log Cabin logic. We know if done correctly Ford, PEP is highly effective. What do you think, just talking dollars and sense, would be more cost effective? One month of PEP, or a lifetime on HAART?

You do the article a disservice by not reading it first before commenting. Sorry it was over a paragraph.

edited to add:

I find your description of gay sex as being "sodomized" highly offensive.
« Last Edit: August 23, 2008, 09:01:00 AM by Dachshund »

Offline woodshere

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Re: We all forgot the condom.
« Reply #6 on: August 23, 2008, 11:09:57 AM »
But one careful study done on PEP among gay men in Rio de Janeiro found just the opposite, he says. Once a patient has spent a month on the very strong AIDS medications, he is considerably less likely to put himself in that situation again, the study showed. “PEP can be the educable moment,”

However, if like me, you have no problems with your meds the first month, would the person actually learn anything.  I am by no means saying don't educate people about PEP and making it widely available, but we need to realize that there will be many that don't suffer any side effects.

I think people taking PEP prior to sexual encounters, could lead to something like "THE PILL".  I definitely don't think that those of us infected should knock any type of research or program that might prevent others from joining our special group.
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Offline BlueMoon

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Re: We all forgot the condom.
« Reply #7 on: August 23, 2008, 01:02:09 PM »
Well alrighty then, let's don't discuss what we think of the article and how it affects those of us who are "Living With HIV".
...................VL.....CD4.....%
-----------------------------------------
08/10-- ......<40.....290.....42
05/10-- ......<48.....290.....46
02/10-- ......<48.....481.....44
10/09-- ......<48.....277.....46
07/09-- ......<48.....300.....38
05/09-- ........51.....449.....39
03/09-- Added Isentress
02/09-- ........65.....299.....34
11/08-- ........62.....242.....40
08/08-- ........66.....212.....29
05/08-- ......202.....217.....27
03/08-- ....5210.....187.....21
02/08-- Began Truvada/Reyataz/Norvir
12/07-- 273,000.....157.....22
11/07-- 229,000.....209.....22
10/07-- Diagnosis

It's a complex world.

Offline thunter34

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Re: We all forgot the condom.
« Reply #8 on: August 23, 2008, 01:13:26 PM »
No Ford that's not the argument, and wouldn't you have liked that option when you weren't feeling so clinical?

I wish you would take the time to read the article first Ford before offering up lame Log Cabin logic. We know if done correctly Ford, PEP is highly effective. What do you think, just talking dollars and sense, would be more cost effective? One month of PEP, or a lifetime on HAART?

You do the article a disservice by not reading it first before commenting. Sorry it was over a paragraph.

edited to add:

I find your description of gay sex as being "sodomized" highly offensive.

Actually, based on the use of the "feels so clinical" line, it looks like he did read the article (that very line comes from way deep in the article).  Also, as for cost effectiveness...the use of PrEP actually IS "a lifetime of HAART".  PEP is a one month deal based on a possible exposure, whereas PrEP is constant use of ARV therapy so that one is armed in case an exposure situation occurs.  That little "r" makes a huge difference.  It's one thing to take short term meds to fight off one instance of known exposure, but quite another to stay consistantly and properly dosed full time to prevent ongoing "possible" exposures.  And the financial question is a valid one - just where the hell are we supposed to get the money to keep everybody dosed up on meds full time?  Hell, there are waiting lists NOW for some people who already really NEED the meds to stay alive.  And if people can't be counted on to use condoms reliably, can we expect them to adhere to these meds diligently enough for them to work effectively?  To me, it has too many huge IF's hanging off of it.
AIDS isn't for sissies.

Online Dachshund

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Re: We all forgot the condom.
« Reply #9 on: August 23, 2008, 01:17:48 PM »
Well alrighty then, let's don't discuss what we think of the article and how it affects those of us who are "Living With HIV".

Actually each new infection does impact those of us "Living With HIV". Well those of us unlucky enough to have to rely on Ryan White to stay alive.

Each new infection brings us closer to a tipping point in funding.

 

Offline woodshere

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Re: We all forgot the condom.
« Reply #10 on: August 23, 2008, 01:27:37 PM »
Well alrighty then, let's don't discuss what we think of the article and how it affects those of us who are "Living With HIV".

part of discussion is having an exchange of ideas that are different and questioning of statements by various individuals
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Online Dachshund

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Re: We all forgot the condom.
« Reply #11 on: August 23, 2008, 01:38:11 PM »
Actually, based on the use of the "feels so clinical" line, it looks like he did read the article (that very line comes from way deep in the article).  Also, as for cost effectiveness...the use of PrEP actually IS "a lifetime of HAART".  PEP is a one month deal based on a possible exposure, whereas PrEP is constant use of ARV therapy so that one is armed in case an exposure situation occurs.  That little "r" makes a huge difference.  It's one thing to take short term meds to fight off one instance of known exposure, but quite another to stay consistantly and properly dosed full time to prevent ongoing "possible" exposures.  And the financial question is a valid one - just where the hell are we supposed to get the money to keep everybody dosed up on meds full time?  Hell, there are waiting lists NOW for some people who already really NEED the meds to stay alive.  And if people can't be counted on to use condoms reliably, can we expect them to adhere to these meds diligently enough for them to work effectively?  To me, it has too many huge IF's hanging off of it.

Once again the author advocated nothing. He talks about research, serosorting, PEP, condom use and PrEP. He also pointed out the risks involved in each. He points out that PrEP is not even being used at this time, but that researchers have tested it on mice to try and determine it's effectiveness. No where in the article was there a suggestion that we need to put "gay Bob" on that prophylactic.

As for funding, the reason we're on waiting lists now is the ever increasing rates of infection clogging the system, not imaginary expenses from PrEP that isn't even being used.


Offline woodshere

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Re: We all forgot the condom.
« Reply #12 on: August 23, 2008, 01:41:46 PM »
 It's one thing to take short term meds to fight off one instance of known exposure, but quite another to stay consistantly and properly dosed full time to prevent ongoing "possible" exposures.  And the financial question is a valid one - just where the hell are we supposed to get the money to keep everybody dosed up on meds full time?  Hell, there are waiting lists NOW for some people who already really NEED the meds to stay alive.  And if people can't be counted on to use condoms reliably, can we expect them to adhere to these meds diligently enough for them to work effectively?  To me, it has too many huge IF's hanging off of it.

Valid points, however the way I read it is that PrEP is in a very early research stage.  And who knows where it might lead.  My thinking is that in some research you are trying to find out the answers to the IF's.  IF this and this occurs then maybe this might work.  If it is found that PrEP is an effective way to prevent HIV infection then you move on to how to  make it readily available to the masses.  Of course your point of personal responsibility in using condoms is perhaps the most important.  The human factor enters into everything.  I didn't use one and became infected, had I had pills to take would I have used them, guess I will never know.
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Online Dachshund

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Re: We all forgot the condom.
« Reply #13 on: August 23, 2008, 01:47:12 PM »
Gay men, meanwhile, have extrapolated from another body of data to conclude that taking the same drugs before exposure might block a potential infection. Does it work? Maybe. But it’s difficult to test in humans. Ethically, you can’t ask somebody to take an experimental pill before sexual exposure to a seriously debilitating virus. So instead, a half-dozen studies around the world have given various drug combinations to people at high risk for infection to take every day while also using other precautions to protect against transmission. If after several years there are fewer new HIV cases on the experimental arm of the trial compared to the placebo group, this will be an indication the drugs are working. Results aren’t expected for some time, and researchers aren’t supposed to talk about findings until they’re reviewed by peers, but the excitement around pre-exposure prophylaxis, or PrEP, is palpable.
“PrEP right now is probably the hottest and most immediate approach available to us,” says Myron S. Cohen, M.D., of the University of North Carolina. “I’m very optimistic about it.” Sally Blower, Ph.D., a biomathematician at UCLA, has created a computer model that shows that if it were just partially effective, it would still lower infection rates considerably. “People who aren’t infected, if they can just take a pill and have sex and protect themselves—like women do with oral contraceptives—I would think everybody would jump up and down and do that,” she says.

That’s why some in the gay community are deciding not to wait and taking purloined pills in advance of unsafe sex. They’re doing this in “party packs” mixing tenofovir, a powerful antiretroviral, with methamphetamines and Viagra—sometimes called MTV. “For years in New York it’s been known as ‘taking a T,’ ” says Jeffrey Laurence, M.D., an AIDS expert at Cornell’s Weill Medical College. “Soldiers in World War II used to pop a penicillin and go out to have a good time. Back then, it seemed to work.” But he says there’s no evidence one dose of tenofovir is a reliable safety shield.

On the contrary, it turns out there are results showing it does nothing at all. That data comes not from a human study but from the half-human mice in Dallas.
*****

Offline Iggy

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Re: We all forgot the condom.
« Reply #14 on: August 23, 2008, 02:13:10 PM »

It looks like an interesting article and I plan to read.  I guess it will be intriguing how GQ magazine discusses HIV related issues since that is not the primary focus of the publication.  Thanks for posting it.

Sean Strub is quoted discussing pre-exposure prophylaxis, something I've never even heard of.

I am surprised that this is the first you have heard of this though as it has been discussed on the board before and was a major topic at the International AIDS Conference.  As a way of balance on the issue from the IAC perspective, you might want to look at Peter's thread where he lists all the subject covered at the event including a video interview with David Evans and Ian McGowan of the University of Pittsburgh in Pennsylvania about this very subject.

http://forums.poz.com/index.php?topic=22643.0

I think it's a worthy conversation though and will provide my thoughts on the GQ article after I have a chance to fully read.

Offline thunter34

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Re: We all forgot the condom.
« Reply #15 on: August 23, 2008, 02:19:32 PM »
Once again the author advocated nothing. He talks about research, serosorting, PEP, condom use and PrEP. He also pointed out the risks involved in each. He points out that PrEP is not even being used at this time, but that researchers have tested it on mice to try and determine it's effectiveness. No where in the article was there a suggestion that we need to put "gay Bob" on that prophylactic.

As for funding, the reason we're on waiting lists now is the ever increasing rates of infection clogging the system, not imaginary expenses from PrEP that isn't even being used.



I'm capable of reading.  I know the author isn't "advocating" anything, but what is the point of researching it if there isn't at least some thought toward using it?  Whether you're taking ARV's every day out of necessity or simply as part of some preventative measure, the cost for the meds is still the same.   The difference might be in the associated medical costs (labs, etc).  It still seems like a very unwieldy option, and I won't apologize for saying so.  I'm not necessarily "dis-advocating" (is that a word?) the option either, but discussing what I think are the potential problems with it.  And if you don't want people to do that, what's the point in posting it in the first place?

Whether you like Ford's terminology or not, there's something to what he says...in that this very sentiment could (and most likely would) be echoed by a lot of people:  "Why should we (government / taxpayers) spend this emormous amount of money on preventative meds so people can have sex with abandon when the same end could be reached if people just exercised a little restraint?"  That's already the basis of the so-called "abstainence only" message now, right?
AIDS isn't for sissies.

Online Dachshund

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Re: We all forgot the condom.
« Reply #16 on: August 23, 2008, 02:32:00 PM »
I hope everyone does read the article, it's quite interesting.

Hopefully, the small part of the article that discusses PrEP and again hopefully, research being done in that direction would result in something that decreases or halts the ever rising rates of infection. Hopefully.

Anything, research, needle exchange, condoms, PEP, PrEP, poodle balling or whatever it takes to decrease the rate of infection, in my book is a good thing. Personally, I'm not ready to discount something that's not even in use. I am willing to try and find out more about it.

Offline bocker3

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Re: We all forgot the condom.
« Reply #17 on: August 23, 2008, 03:09:10 PM »
So research is good and getting answers is very important -- even if a potential result is all that "practical" to the masses.

Some things to ponder:

1 - Would an increase in demand lower the costs, thus benefiting both infected and uninfected?
2 - Would be develop "pill fatigue" just like "condom fatigue"?
3 - Eventually these drugs will come off patent -- again making them a more affordable option
4 - Would PrEP be 100% effective (I'm guessing not, not much is in the realm of biology)?
5 - Would reliance on this and abandoning condoms actually cause an increase in infections, assuming that PrEP would not be 100% effective?

Now I raise these points not denounce anything in the article -- I am simply raising questions to be considered - so, please no personal attacks.

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline Ann

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Re: We all forgot the condom.
« Reply #18 on: August 23, 2008, 03:57:07 PM »
I wasn't going to say anything, but considering the way this thread has at times threatened to go off topic with the ... (what to call it?  eh, call a spade a spade I say...) bitchy asides, I decided to speak up.

One of the editors at GQ got in touch with Tim Horn to ask permission to post a thread to find out what our members thought of the article. Tim politely turned her down (because we all know how outsiders can be received here sometimes, and with good reason). I replied to the email to alert this editor that one of our members independently started a thread on the article and linked her so she could follow the posts.

This thread is your chance to speak up and let the Conde Nast publishing house know how you feel about their coverage of this issue. We, as positive people, often moan (I've done it myself) about the lack of mainstream media attention to the cause of hiv/aids. Let's take advantage of this opportunity to speak our minds.

What did you think of the article? Not just the PrEP issue, but the whole article. Was it biased and if so, how? Did it state the facts clearly enough? Do you feel more should have been included on the facts of transmission and prevention? What did you think of the tone? Let's not get bogged down in the semantic of any one poster's reply. Let's let the publishing world know what we think - from the gut - about this type of article.

They clearly think this article was very important. Do you agree? Do you want to see more of the same, not just in GQ, but across the board? Let's not forget that Conde Nast holds quite a few titles.

Speak up folks, now is your chance.

Ann
Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline GSOgymrat

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Re: We all forgot the condom.
« Reply #19 on: August 23, 2008, 04:30:59 PM »
I enjoyed reading the article (yes, I did read it) and think the research is very interesting. My previous comment was concerning the application of the research. I purposely used provocative language because that is what the critics of PrEP are going say. Frankly I don't know a good response to that criticism. I'm all for reducing HIV infection but we already have a pretty good way to do that: condoms. Most Americans are not going to want to spend one dime so that gay men can have sex without condoms-- many don't want us having sex at all. The article focuses on gay men but what about protecting heterosexuals or other at risk groups? PrEP needs to be MUCH less expensive, proven not to have serious side effects and shown to be effective on a large scale. Also if people can't use condoms regularly are they really going to take a daily multi-medication regimen just to reduce the chance of acquiring HIV? An implantable rod that dispensed medication for several months, like birth control, might be more effective.

As far as the article as a whole, I did a double take when I saw this article was from GQ. I didn't expect this subject matter from a big glossy ad mag. It had a good balance of the personal and the political. The science was particularly interesting. I'd like to see more articles like this.

« Last Edit: August 23, 2008, 05:03:39 PM by GSOgymrat »

Online Dachshund

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Re: We all forgot the condom.
« Reply #20 on: August 23, 2008, 05:07:07 PM »
As Ann suggested I hope everyone reads the article in totality. To me the author was suggesting that researchers, after gay men extrapolated, "well if PEP works then why shouldn't PrEP?" was a viable avenue to be researched. He wasn't getting into the morals or the money and that's what I liked about the entire article. No lectures, just a bit of thought provoking writing.

Let's face it folks, no matter what "solutions" we come up with mainstream America will find it distasteful if it involves sex, and especially gay sex. That doesn't meant you don't forge ahead. Man, do you you remember the outrage the first time someone suggested needle exchange?

There is one thing I do know, we don't reduce the rate of infections at our own peril.
« Last Edit: August 23, 2008, 05:55:03 PM by Dachshund »

Offline BlueMoon

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Re: We all forgot the condom.
« Reply #21 on: August 23, 2008, 07:50:10 PM »
Quote
What did you think of the article? Not just the PrEP issue, but the whole article.

Back to the article then.  I did indeed read the whole thing before commenting and found it to be unfocussed, jumping from mutant lab mice to condom fatigue to pre-exposure prophylaxis. 

Anyone unfamiliar with HIV medication who reads it might think that PrEP is a simple matter of popping a pill, but as I said there's more to it than that.  According to the Medco website, a month's supply of tenofovir, the drug used in the study, retails for $563.  That's equal to a hefty car payment plus insurance, and is a big nut to crack for a young person just starting out in the working world.  Then there's the expense of monitoring for side effects.  According to the AidsMeds drug lesson, those include  lactic acidosis, severe liver problems, kidney problems, bone problems, elevated cholesterol and triglycerides, lipodystrophy, and diabetes. 

If I could turn back the clock to pre-infection and was given a choice of condoms or meds to prevent infection, I would opt for condoms even if the meds were free.       
...................VL.....CD4.....%
-----------------------------------------
08/10-- ......<40.....290.....42
05/10-- ......<48.....290.....46
02/10-- ......<48.....481.....44
10/09-- ......<48.....277.....46
07/09-- ......<48.....300.....38
05/09-- ........51.....449.....39
03/09-- Added Isentress
02/09-- ........65.....299.....34
11/08-- ........62.....242.....40
08/08-- ........66.....212.....29
05/08-- ......202.....217.....27
03/08-- ....5210.....187.....21
02/08-- Began Truvada/Reyataz/Norvir
12/07-- 273,000.....157.....22
11/07-- 229,000.....209.....22
10/07-- Diagnosis

It's a complex world.

Offline Assurbanipal

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Re: We all forgot the condom.
« Reply #22 on: August 23, 2008, 08:07:01 PM »
This is a really interesting article, especially the discussion of the transgenic mouse research.  The format was a little hard to read on the web, but maybe that means I should buy the mag?

Thanks for posting it
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline bocker3

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Re: We all forgot the condom.
« Reply #23 on: August 23, 2008, 11:04:41 PM »
It is an interesting article and I do think that the media should do more to cover HIV in the US, but I did find some things a bit disturbing.  Like reporting this:  "and people whose viral load has been undetectable for a minimum of six months have no active virus in semen or circulating blood."  I've NOT seen this before and it is stated with such surety -- It scares me.  I'd like to see where that comes from -- what studies have shown this and even if there are studies that found this -- it is NOT likely to be true for every individual. 
Also, this seemed utterly shocking to me:  "In one recent national study, 77 percent of young gay male subjects who thought they were negative were shocked to learn they were wrong."  77%??  Really??  If that's true we may be way too late in trying to stop this epidemic in the US gay population.

So, yes - research is needed and it is always better to have options and more importantly, to KNOW what options you have.  Yes, we need the media to do a better job at letting America know that HIV/AIDS is not just a problem in Africa, but right here in the good ol' US of A, so I applaud GQ for their article, however, it can be very dangerous to simply report scientific findings to the general public -- especially when it is done in an absolute way.  Scientific research gives findings about populations, not individuals.

that's my 2 cents.

Mike
Atripla - Started 12/05
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Offline edfu

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Re: We all forgot the condom.
« Reply #24 on: August 24, 2008, 08:50:46 AM »
I thought the article was fascinating and well done, but with some major caveats.  That it appeared in "GQ" is amazing in itself.  David France documented pioneering HIV doctor Gabriel Torres's downward spiral into meth addiction and homelessness in "New York" magazine and now this.  France is asking--and trying hard to find answers to--some of the most pressing questions of our time, and his work is being published in non-gay media, who are to be praised.

One thing I learned--to my horror and dismay, and I live in NYC--is the phenomenon of "party packs," or "taking a T":  gay men taking a tenofovir, a Viagra, and methamphetamine--a combination also known as MTV--before embarking for an evening (or days) of partying.  This I found utterly shocking and something I had never heard about.  Is this what the possible efficacy of PrEP would degenerate into?  I know I'm being judgmental here, but so be it.

My major problem with the article is that David France did not discuss the real reasons why the notorious Swiss study was so roundly condemned. It's not because it went against the "condom always" advice, which is egregiously disingenuous on his part. France writes as if those opposed to the study were just old-fashioned dinosaurs who would never give up condom advice, regardless of any new research.

As has been discussed on this board already, the study is easily misinterpreted, for one thing, because all its subjects were heterosexual and engaged only in vaginal intercourse. Compared to unprotected vaginal intercourse, unprotected anal intercourse is 10 to 100 times more likely to transmit HIV. The lining of the rectum is far more fragile than that of the vagina, and the cells that are open to infection are much closer to the surface. During anal intercourse this lining may rupture, allowing HIV to break through and infect cells.

Furthermore, it is simply not true that "undetectable" = "noninfectious." HIV is found to be "undetectable" ONLY in the circulating peripheral blood, but only 2% of CD4 cells in the body, the cells infected by HIV, are found in the peripheral blood. The other 98% of CD4 cells are found elsewhere, and the viral-load test is not testing "elsewhere." HIV is present in the gut, the lymph nodes, the brain, the testes.

Did the Swiss scientists look for HIV in semen? Did they prove that HAART made HIV undetectable in all these other places in which HIV "hides"?  They did not.

If a viral-load test is undetectable in the peripheral blood, and HIV is therefore, according to the Swiss, incapable of being transmitted, why haven't they also declared that such "undetectables" are cured?

From the Associated Press:  "Not only is [the Swiss proposal] dangerous, it's misleading and it is not considering the implications of the biological facts involved with HIV transmission," said Jay Levy, director of the Laboratory for Tumor and AIDS Virus Research at the University of California in San Francisco. Levy said there was no safe way of knowing whether a patient with HIV who has no detectable virus in the blood will not transmit the virus. More research into the links between viral load in the blood and the presence of the virus in genital fluid was needed, he said.

Men who are treated with anti-HIV therapy can develop drug-resistant virus in their semen, and there is evidence of multi-drug resistant strains of HIV developing in the genital tract but not blood. Furthermore, semen that has an undetectable viral load is still potentially infectious, and cells in semen can contain HIV proviral DNA and can act as vehicles for sexual transmission of HIV.

THAT is why responsible prevention advocates recommend that HIV prevention messages targeted to both infected and uninfected persons communicate the importance of condoms and other risk-reduction strategies regardless of HIV treatment status and at all stages of HIV disease.  For France not to discuss this response to the Swiss study is a major fault with the article. 

« Last Edit: August 24, 2008, 08:53:48 AM by edfu »
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

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Offline Iggy

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Re: We all forgot the condom.
« Reply #25 on: August 24, 2008, 09:54:56 AM »
Read the article and have some thoughts:

First, the good:

I applaud GQ for taking on this subject and recognizing that they need to speak of gay issues and HIV issues (though I hope they don't always have to go hand in hand for the mag to cover them) if they want to try to be relevant in this diverse society (which is growing more vocal about it's right to be diverse)

Very glad that the writer discussed the problems (even if he took a circuitous route to get there) with serosorting among neg parties particularly in relation to people not knowing they are already infected.  THAT is a message that needs to get out there.

I also enjoyed the writer's overall style in that he made the subject matter approachable to the general reader, and I found he raised some interesting points. 

I agree with ANN that we do need to be appreciative of mainstream publications giving attention to HIV issues and for that I am grateful that GQ did such a serious piece. 

Knowing that they are reading this thread, I also want to thank them for inquiring about our opinion to the piece - Frankly I wish more publications  would be so willing to seek feedback for how they cover our issues.  They deserve credit for this.

The bad or problematic:

However with taking on issues that are outside of their normal scope of writing, I think extreme care should be taken in how they represent such issues to their audience - particularly since their audience is not one that is not known as being attuned to the details of HIV and they may take GQ's word or image as fact or final truth on issues - an unfortunate scenario in places where the article misses the mark.

First a quibble and a regret:  The very headline is misleading and seems countered right in the opening glimpse paragraph (in italics) if not the entire article itself.   It seems the condom (and its benefits) is far from forgotten for gay men so much as not liked.  That is a (missing?) common thread in all of this and what I wished was better examined.  Actually I think the writer completely missed the opportunity here to really offer an in-depth exploration of condom fatigue and dislike, an issue that affects not only gay men, but certainly heterosexuals. 

The section on the mice was unnecessary, gratuitous, and really presented an immediate obstacle to my appreciating the writer's intent to examine the psychological  and sociological issues of gay men and condom usage.

I think the writer took a few too many literary licences in his summation of researchers reports and gay men thinking. I also had issue with his use of phrase like "many researchers" without more details of who those many are (sans the occasional interview with a single doctor/researcher)

Also many of the statements he made (and no, this is NOT objective reporting, but feature writing with a point of view) were bothersome to me.  Some were trivial exaggerations or simplification of issues and others were just outright wrong in it's conclusions.  Some key examples:

  • Quote
    And yet the news from the research community has never been bleaker.
    - Really?  Did the author do any research on recent findings or is he just consumed with a CURE mentality?  Where is the notice of recent reports of increased life span for those with HIV?  Where is the reports of the increases in effectiveness of ARV therapy? This was a gross fallacy in my opinion.

    Quote
    Gay men are no longer abiding by the one commandment that dominated gay life for decades: “Use a condom every time."
      - The use of commandment and decades seems to be a little bit off and minimizing of the issues in getting people to use condoms in the first place even back in the "golden age" of safe sex and exactly how long it was.  Perhaps a small quibble, though taken in context of how I feel the writer missed the overall mark on why gay men (and heteros too) often forgo condoms, I think such a glossing over of the issue is problematic.

    Quote
    "Condoms are about 90 percent effective as HIV barriers,"
       What an irresponsible statement to place in this story (particularly in the context of the headline and article) Where is the context of proper use of condoms and effectiveness.  The writer just generalized and mislead his readers that there is a certain 10% probability they will catch HIV even if they use a condom!

    Quote
    "But AIDS agencies are even more to blame. Even the Bush administration set a goal for cutting transmissions in half, yet the AIDS establishment watched passively as those goals were missed year after year, but offered no effective alternative solution and saying little about the staggering consequences.
    Setting goals but offering no (or cutting) resources to help agencies meet those goals seem a strange thing to omit from this statement.  While the writer does mention in the previous paragraph the  Bush Administration opposition to safe sex and needle exchange outreach programs in general versus an abstinence focus, he seems to miss the connection between that strategy and the AIDS orgs ability to perform effective and large scale outreach campaigns.  Frankly I'm disgusted at the flippancy with which the writer summarize the AIDS agency's performance in this context.  I think the AIDS agencies are to blame for ignoring many young communities of color for too long into this epidemic and for assuming that "always use a condom" was enough, but giving the Bush admin a free pass in this particular paragraph is beyond sloppy journalism.
     
    Quote
    And condoms are as rare today as they once were ubiquitous—no longer abundant in gay spaces, barely visible in gay porn, and almost never mentioned in online hookup ads.
      Pure hyperbole and misleading stereotype of gay men today.

    Quote
    Did this good news touch off celebrations here in the United States? Hardly. The Swiss study went largely ignored in the media
    What media does he refer to outside of perhaps GQ?  This study made all the major papers in the United States.

I could go on with such items that bothered me as they are numerous - some worse, some more trivial.  The overall importance to me in these examples by the way goes back to the image that GQ is painting for their reader, which as I already mentioned, is not a population known for being focused on HIV related issues. The false impressions made by the article may last a long time in the reader's understanding of many points.

The San Francisco comparisons of syphilis and HIV rates is misleading as well and in consideration of it's featured argument in the article about Serosorting could also be irresponsible.   I think the writer made a mistake in not notating the already high HIV infection rate in SF when he made the comparison and to not explain the context of the explosion of Syphilis in general across the whole country.  It's a very misleading comparison indeed.

Finally, I'm going to tie in my first post in this thread, with my opening here in this post as a final observation of the article.  I read nothing new in this piece that I have not already seen discussed (well, maybe the mice) in other publications, on blogs and on this very board.  What I see is a lot of items that have been discussed often along with a lot of misrepresentations and mistakes that often accompany such issues.   

The fact remains though that overall I though GQ did an honorable job of trying to be part of the conversation and engage it's readers in HIV issues.  That it comes as such a surprise that such an article appears in GQ is I think a wonderful thing and I hope to see the magazine continue to take on such non-traditional (for their readership) issues and impress on them that HIV is in fact something that affects them as well.  I do have issues, as detailed above, on many of the missed marks in the article and I hope the editorial board will be willing to offer some clarifications on such points in a follow-up piece - especially since I know they are reading this.
« Last Edit: August 24, 2008, 10:01:50 AM by Iggy »

Offline Buckmark

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Re: We all forgot the condom.
« Reply #26 on: August 24, 2008, 01:45:49 PM »
The first that strikes me is that the title of the article (We All Forgot The Condom) doesn't seem to reflect the content of the article.  It is provocative and eye-catching, however, so I'm sure that's at least part of why it was chosen.

As BlueMoon stated, the article seems a bit unfocused.  It started with with the evidently secretive and controversial research lab and research methodologies involving mice.  Then it goes on to discuss "condom fatigue" among gay men.  Finally it gets around to the research into pre-exposure prophylaxis.  Any of these could have made a great article on their own.  I interpret the intent here to be that PreP has promising potential for HIV prevention, since gay men (for a host of reasons) don't / can't / won't use condoms.

That's a fair enough subject for research and investigation.  But I do think that lots of people are going to have opinions about the practical application of PreP -- the cost, effectiveness, as well as our society's view on the morality of doing so.  The following quote from the article about the "party packs" draws attention to this pretty well.  And I think Ford's initial response above is a pretty realistic interpretation of how many Americans would view PreP.

Quote
That’s why some in the gay community are deciding not to wait and taking purloined pills in advance of unsafe sex. They’re doing this in “party packs” mixing tenofovir, a powerful antiretroviral, with methamphetamines and Viagra—sometimes called MTV. “For years in New York it’s been known as ‘taking a T,’ ” says Jeffrey Laurence, M.D., an AIDS expert at Cornell’s Weill Medical College. “Soldiers in World War II used to pop a penicillin and go out to have a good time. Back then, it seemed to work.” But he says there’s no evidence one dose of tenofovir is a reliable safety shield.

Also, I do think the article tilts towards advocating PreP as "a good thing".  The following quote seems to make that pretty obvious to me:

Quote
"PrEP right now is probably the hottest and most immediate approach available to us,” says Myron S. Cohen, M.D., of the University of North Carolina. “I’m very optimistic about it.” Sally Blower, Ph.D., a biomathematician at UCLA, has created a computer model that shows that if it were just partially effective, it would still lower infection rates considerably.

I'll also echo Iggy's frustration with the way the writer used a very broadbrush to sum up researcher's findings, and gay men's views and attitudes.  I find the lack of specifics and oversimplifying to be irritating.

I do applaud GQ for publishing an article on this topic.  Not that I'm a GQ reader, but it's not really the kind of publication where I'd expect to find this.  So I have to give them kudos for that.  And it will likely reach a far-wider audience.

I'll be waiting to see what kind of follow-up and response GQ and the authors provide, especially since I know they are reading this. 

Regards,

Henry
--



"Life in Lubbock, Texas, taught me two things:
     One is that God loves you and you're going to burn in hell.
     The other is that sex is the most awful, filthy thing on earth and you should save it for someone you love."
- Butch Hancock, Musician, The Flatlanders

 


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