Reducing the HIV infection rate

[Moffie65]

If anyone needs me, I'll be over here arguing with the wall.  I have a feeling I'll make more progress.

For the rest of this very exhausting thread, I'll be over with Tim arguing with that wall. 

[thunter34]

Do you know how many worried wells would be popping those pills every time they got something they "suspected" was HIV? 

Laugh Out Loud.  Really.

"I touched the spot on the wall....with the hand that had the cut on it!!! PEP!!!"

Poison Doritoes, the infamous Pussy Beer....all tragedies narrowly averted with a mouthful of pills. 

[Miss Philicia]

Do you know how many worried wells would be popping those pills every time they got something they "suspected" was HIV? 

Oh, I tried laying that out earlier for John and was summarily dismissed. 

I guess I'll come over to the wall myself, but I'm going to be bringing some glue and a small paper bag so please put up the party lights and turn up the music.

[Assurbanipal]

All this stuff on the cost of John's idea seems a bit off.  After all, he is talking about new pills and the marginal cost of producing and acquiring additional pills need not be the same as the average cost, especially for governmental buyers

More troubling is that as a widespread policy it appears inferior to other policy options for reducing infection.

A better policy choice?  How about exponentially reducing infectivity by getting more people on to drugs leading to an undetectable viral load?  Perhaps even (warning controversial!) combining this with annual population testing.  Then, in the remote event of condom breakage, the likelihood of infection would be exponentially reduced. 

But, of course, this policy choice can also be implemented on a personal level.  For those, like John, who are not yet on meds, perhaps a question to consider might be: If going on meds earlier makes you less infectious and is a better safeguard for your partners than keeping a supply of PEP on hand, how does that affect your personal moral choices about when to start?

A

[Miss Philicia]

But, of course, this policy choice can also be implemented on a personal level.  For those, like John, who are not yet on meds, perhaps a question to consider might be: If going on meds earlier makes you less infectious and is a better safeguard for your partners than keeping a supply of PEP on hand, how does that affect your personal moral choices about when to start?

A

Interesting point, "A"

[killfoile]

If your goal is to reduce HIV infection rates, then you need a broad based program that utilizes SCIENCE in developing prevention messages.  PEP should certainly be included in that program, but only as one part of the overall program.  You make rather simplistic assumptions about the cost of PEP, as if you could accurately identify the scope of the need and therefore the cost.  You also project your question, as more of a declaration, and after having thrown down the gauntlet, you are ready to defend your statement, rather than invite discussion.  Might I suggest that people will reply, because we all love a good topic, but most of us have little interest, in exchanging barbs.

I sense that your intentions are good, but are obscured by some of your sarcastic replies.

[John2038]

Moffie65, I have personally no interest to exchange sarcasm.

[John2038]

Indeed Assurbanipal
Since poz, I have ask for 2 PEP.
Got the first after 17h the 2nd after 2h.

I will have save precious time if a 4 days regimen was available.

Newbie need this kind of security I guess, a bit of time to do safer sex, especially when prior that, you was exclusively in long term relationship.

[jkinatl2]

Indeed Assurbanipal
Since poz, I have ask for 2 PEP.
Got the first after 17h the 2nd after 2h.

I will have save precious time if a 4 days regimen was available.

Newbie need this kind of security I guess, a bit of time to do safer sex, especially when prior that, you was exclusively in long term relationship.

Newbies could gain an awful lot of security by wrapping their heads around the local and global paradigm of HIV science and the politics therein. Some of this understanding comes from people who have had HIV for a long time, who have fought the legal and political battles, who understand the systems which underlie our treatment and prevention efforts. People, say, like Moffie, who is so often dismissed.

Rather than utilize strength to tilt against immovable windmills, it would serve the community better to move the stones we can. Capitalism is very difficult thing to overcome, and so long as it exists, HIV treatment including PEP will have a price tag.

I will never advocate for meds to HIV negative people until I am assured that HIV meds are available to every positive person. To date, this has not been the case.

While people with AIDS are suffering because they cannot afford medication, my sympathies for those who do not use condoms correctly will be tempered.

BTW, I have been positive for 15 years, five of that in a serodiscordant relationship. have never had to acquire PEP. When used consistently and correctly, condoms work. I have not left, and will not leave, HIV infection in my sexual wake.

Condoms are a simple and inexpensive way to prevent HIV infection an overwhelming percentage of the time. As we live in a world where the distribution and education regarding condom use is lacking, I find it disturbing that we would instead advocate for wholesale PEP.

For the record, I would love to live in a world where medications were free to all.

Affordable would be nice.

[Miss Philicia]

Why do newbies need time to learn how to throw on a rubber?  Sorry, but that doesn't make much sense to me.  Personal responsibility would tell me that if I can't learn to use a rubber than maybe I should abstain from sex for a short period of time.

Life isn't instant Jello pudding, you know.

[mecch]

Do you know how many worried wells would be popping those pills every time they got something they "suspected" was HIV? 

Good point. But I was proposing to provide the PEP to people in serodiscordant couples. Presumably for a situation in which a risk happened and it would be difficult to get PEP quickly (travel abroad, snowed in cabin... that sort of thing... eheheh). The positive partner would have a treating physician, who could be called and advise whether the negative partner should or shouldnt take the PEP.

Note that this whole situation would only happen in serodiscordant relations where the poz partner is untreated... 

Ok, you're right, the whole idea is impraticable on a large scale. 

[John2038]

The first time it has broke, it was probably due to a misuse of the condom.
The second time because the pussy was shaved.

Not nice details. But condoms may break. Misuse, or whatever, but it can happen and it happen.
Otherwise, you won't need PEP.

Now deal with that.

[John2038]

I will definitely have a PEP available at home in case of.

HIV neg girls have accept a relationship with me despite my status.

My responsibility is definitely to keep then HIV free.

And once on meds, she will get mine if needed, and all this debate won't then be necessary.

[jkinatl2]

The first time it has broke, it was probably due to a misuse of the condom.
The second time because the pussy was shaved.

Not nice details. But condoms may break. Misuse, or whatever, but it can happen and it happen.
Otherwise, you won't need PEP.

Now deal with that.

And with that, I respectfully withdraw from this discussion.

[thunter34]

The first time it has broke, it was probably due to a misuse of the condom.
The second time because the pussy was shaved.

Wait....WUT?

You're telling us a condom was torn by PUSSY STUBBLE?

[Miss Philicia]

Now I've heard everything.

[John2038]

Guys, you are not contributing to this debate. Always your short comments as usual, without added values (at least for the last you have post).

Look at your behaviors.

Condom accidents happen, for any reasons you want, IT HAPPEN.

Now when it happen with poz not on meds, so DETECTABLE, a PEP is definitely needs, the faster the better.

The faster you can get one is buy having one available immediately.

Is it feasible, this is the question.

It is not for you guys to shows me or anyone else you want that you are making bright comments, how great you are, how sarcastic you are, superior, or whatever else.

Im not behaving like that, because I am respectful. Don't abuse.

[thunter34]

I'm sorry, but it's a legitimate question.  You are suggesting a condom failed due to pussy stubble.  Seriously? 

And I've added plenty to this thread - as have several.  The fact is that this is about the only point of interest left for this thread.  Your proposal has already been discredited about a dozen different ways.  Nice thought, but just not realistic. 

Gee, it's a shame you logged off so soon.  I was hoping you'd see this right away.   

[John2038]

It wasn't stubble. But shaved days ago.

[thunter34]

It wasn't stubble. But shaved days ago.

OK.  Whatever you say.  But can you clarify what having a shaved pussy has to do with condom failure? 

Seriously asking.

[skeebo1969]

It wasn't stubble. But shaved days ago.

  Holy moly!  So this happend last night then?  I like your thinking though, blame it on her for your condom breaking.  How exactly did she shave the inside of her... ummm...  "pussy" anyways?  I was always under the impression that they only shaved the outside.   

[John2038]

Glad to see a majority of people caring for others.

About the latest comments made above, I'm not interested with such debate.

[Miss Philicia]

Glad to see a majority of people caring for others.

For the record, are you stating that those of us here that fail to agree with you don't care about infecting others?

[Ann]

John,

Get a grip already.

As a woman who has shaved and has not shaved, I'll tell you right now that it has NOTHING to do with condom failure.

Maybe you should just keep yours in your pants - and spare the rest of us from your paranoia.

Ann

edited to say - I hate typos

[killfoile]

So now you call this a debate?  Please.  You are crass and abusive and like some others, I will worry about negative people getting PEP, AFTER HIV meds are made available for all who need them.  We know how to prevent HIV and if people refuse to take precautions, why should someone else always foot the bill.  I am so tired of crusaders like you, who think they have reinvented the wheel and then get pissed, when others do not agree with them.  We talked about your idea and at least for most countries, PEP is a luxury that few can afford.  Yes, I would like to prevent every infection possible, but not by diverting funds from people who need the medications to stay alive.  There is a huge difference here, that you refuse to acknowledge and so end of discussion.

[Ann]

Debate? I call it self-loathing.

It is what it is.

John, I suggest you learn about condoms. And no, "pussy stubble" has nothing to do with it.
 Jeeze.

[John2038]

Ann

Condoms may break for a reason or another THAT'S IT and people are infected like that.
I DO NOT have to explain you how a condom can break when a pussy is recently shaved, during a sexual energetic intercourse.

I definitely DONT care what you believe or not, and you can safely keep some of the recommendations you made for yourself.

Being a girl or a moderator doesn't implies you knows all nor you are always right.

[RapidRod]

John2038, give us all a break. Condom don't fail because someone shaved and has a stubble. 

[Grasshopper]

I'm letting my imagination loose here.....if the pussy stubble's were sharp enough to rip the condom to shreds, what would the penis have looked like .......bloody chafed ?

[John2038]

Stubble is one of your invention

[RapidRod]

Condoms fail for incorrect use, mainly not enough water base lube.

[John2038]

Whatever is the reason for a condom to fail, if it fails, you need a PEP based on the risk.
The sooner the better.

[RapidRod]

If you are so concerned about people having PEP. You give up a months supply of meds and give it to the negative person you put at risk. You have total faith that those people won't have a reaction, don't need to see a doctor so share a months supply of YOUR meds.

[Ann]

Being a girl...

Sorry, mate, I'm NOT a girl. I'm a WOMAN. Haven't been a girl for thirty-odd years now. Please keep that in mind.

And I'll say it again, stubble does not break condoms. I know this through personal experience.

Ann

[skeebo1969]

  John,

   Perhaps you should check the expiration dates on them packages before you rip one open for your "energetic" sex.   Lack of doing so will make you think things like :  your more energetic than everyone else, you got a big dick, or they break because of 4 O'clock shadow....

[MarcoPoz]

it's really too bad that this thread spun out like it did (in my opinion).  I'm still very interested in the idea that a person at risk deserves whatever mechinism we have available to prevent acquistion of HIV infection. 

At the same time, there's NO silver bullet.  PEP is one option that to me, makes sense for SOME people in SOME situations.  I think we need a comprehensive continuum of prevention tools and methods.  From discussions of celibacy, monogamy, condom use, non-penitrative options, sterile syringe access, safer practices based on transmission risk and not morality, informed consent and decision making, PRE exposure meds and post exposure meds---and everything along the possible continuum.

If we accept that no medication alone can defeat HIV in a positive individual, it would make sense to think that no single prevention option works for all people in all situations.

If PEP prevents a transmission of HIV--then tell me where to send a month's supply of my meds in order to help.  To me it is exactly the same as condom, internal condom, dental damn and lube distribution.

I also think that if someone has a reason to believe they will very likely be in a situation that will infect them with HIV, they have the opportunity for PRE exposure meds.   

I'm not wrapped up in the morality and other judgements about what others 'should' do.  I'm pretty much just concerned with what will keep another person from becoming HIV positive.

I'm simple, probably wrong in many ways, but very committed to prevention.  Again, this is all just my opinion.

[skeebo1969]

it's really too bad that this thread spun out like it did (in my opinion).  I'm still very interested in the idea that a person at risk deserves whatever mechinism we have available to prevent acquistion of HIV infection. 

 

  I agree some what.  What I'm wondering though is there any proof that PEP really works?  During the incidents where probable infection has occured how do they know that the person  was not going to be infected anyways?   I mean has it been proving that PEP stopped the transmission of the HIV virus and if it has how has it been ultimately proven?  I do believe there has been people who frequented these boards who received PEP in a timely manner but still managed to become positive.  A few names come to mind but it is not my liberty here to call them on it.

  Just makes me wonder....

[MarcoPoz]

  I agree some what.  What I'm wondering though is there any proof that PEP really works?  During the incidents where probable infection has occurred how do they know that the person was not going to be infected anyways?   I mean has it been proving that PEP stopped the transmission of the HIV virus and if it has how has it been ultimately proven?  I do believe there has been people who frequented these boards who received PEP in a timely manner but still managed to become positive.  A few names come to mind but it is not my liberty here to call them on it.

  Just makes me wonder....

How does one 'prove' they prevented anything?  That's the debate tactic thrown at prevention repeatedly.  It assumes a false premise of utilization of scientific method and evaluating a pre-intervention/post-intervention change.  Eg:  if situation was experiencing 'A' effect and application "8" was applied changing the former effect to a status of 'B' ( B being a more desirable effect) then application "8" worked as a change agent.


Having a prevention mechanism that maintains stasis does not translate to this process of proof.  We need to accept that if someone is at a high likelihood of having the undesired effect occur, and we apply a change agent (PEP in this case) and despite this high likelihood of undesired effect, the individual maintains stasis, then have we assisted in protective factors?

My favorite example:  I was walking toward a helicopter while the blades were spinning...someone yelled "DUCK!", I bend low and ducked my head.  I didn't get decapitated.  Did the yell and subsequent ducking prevent disaster?  Was I tall enough to be close to the spinning blades to warrant action?  All I know is--they yelled, I ducked and I still have my head.
 

[Grasshopper]

I also think that if someone has a reason to believe they will very likely be in a situation that will infect them with HIV, they have the opportunity for PRE exposure meds.   

You said: "PRE exposure meds"  ..... instead of something as simple as a condom ?

[John2038]

Come on Grasshopper

PEP are available in almost all developed countries.

As such, the question is neither about condoms, nor about is the PEP is necessary or not.

The question is:

as the PEP IS prescribed nowadays, and as the sooner is the better, is it possible to consider having a 4 days regimen at home, to those who ask for it or need it (living far from the first hospital for exemple). The purpose of the PEP is to prevent infection. The purpose of having it at home is the same.

The pro it reduce the delay so potentially increase the chances to remain hiv free
The neutral are the costs, as so far, it haven't been demonstrated that it will cost money
The pseudo-cons is the abuse people can make using this PEP. A formation can be given, a contribution to be paid, or whatever. Solutions to reduces this problem exists.

NOTE
pseudo cons because hiv patients on meds have this possibility to give a regimen to their partner.
For what main reason should it then be a problem for treatment naive patients ?

[Basquo]

Now when it happen with poz not on meds, so DETECTABLE, a PEP is definitely needs, the faster the better.

So I can conclude from that statement that since I'm not on meds, yet I am undetectable, that my neg partner will not need to take PEP if the condom breaks. What a relief!

[John2038]

I thought you was one of those for who a condom break never happen.

Most of the treatment naive patients are detectable
Most of the treatment naive patients don't have a treatment available at home

Most of the treatment non-naive patients are undetectable
Most of the treatment non-naive patients have a treatment available at home


If this idea should be of any interest, it will be interesting at first for the treatment naive patients.

[Grasshopper]

Come on Grasshopper

PEP are available in almost all developed countries.

Nope John2038, I won't be comming on to anything/anyone. I replied to the motion of Pre exposure meds when anticipating a potential dangerous situation instead of a simple condom.

[John2038]

Sure. But we look at the situation after a risk have occurs.
By saying that PEP is available in almost all developed countries, it is mean that despite the fact that all these countries have condoms the PEP still exists. So again, if we talk about PEP, we look at the situation after a risk have occurs.
Sorry for any possible misunderstanding

[MarcoPoz]

You said: "PRE exposure meds"  ..... instead of something as simple as a condom ?

Re-read please.  I ALSO said condoms.  My entire post was about a continuum of mechaisms/tools and not any particular singular mechanism or tool.

[Grasshopper]

Re-read please.  I ALSO said condoms.  My entire post was about a continuum of mechaisms/tools and not any particular singular mechanism or tool.

I also think that if someone has a reason to believe they will very likely be in a situation that will infect them with HIV, they have the opportunity for PRE exposure meds.  

These are YOUR words and not mine.

[allopathicholistic]

By the way, related, but tangential - NYC studied the idea of giving PRE EXPOSURE HAART to "high-risk" gay men and the study showed interesting benefits....  (Which means offering guys "likely" to contract HIV with HAART when they are negative, in order to stay negative.....)

http://www.aidsmap.com/en/news/F5A6E530-125B-4C32-B843-9F1122C81776.asp

Wild stuff, epidemiology....

thanks. i read it and i should be thinking "oh, that's real cool" but instead my first emotion was jealousy     

[MarcoPoz]

These are YOUR words and not mine.

Grasshopper--note that in this post I stated the following:

"At the same time, there's NO silver bullet.  PEP is one option that to me, makes sense for SOME people in SOME situations.  I think we need a comprehensive continuum of prevention tools and methods.  From discussions of celibacy, monogamy, condom use, non-penitrative options, sterile syringe access, safer practices based on transmission risk and not morality, informed consent and decision making, PRE exposure meds and post exposure meds---and everything along the possible continuum."

I wasn't pitting PEP against condoms.  I wasn't saying any mechanism was  more correct than any other option.  I was supporting a comprehensive approach that is inclusive of condoms and meds.  So, I'm finding it difficult to understand your point.

[thunter34]

I'm finding it difficult to understand yours at that part.  I read it the same way Grasshopper did.  It read to me like:

"I'm probably gonna slam some T and get gangfucked at the baths tonight.  Gimme some pills."

I'm rather amazed this thread is still trucking along.  Go figure. 

[jkinatl2]

I am so tired of crusaders like you, who think they have reinvented the wheel and then get pissed, when others do not agree with them. 

It's almost as aggravating as those who refuse to even glance through the past of HIV research, to which you and I contributed greatly, and suck up precious time and energy by demanding to know why colloidal silver or a blood transfusion can't stop HIV.

I personally get thoroughly put off by people who insist on others to debunk every insane thought that comes through their head, yet refuse to make the smallest effort to research on their own. Like this case of universal PEP.

I agree that options should be offered, but not EVER at the expense of those who need these medications to survive. I also think that these meds are not candy, and should not be treated like Tic-Tacs to be handed out in every perceived risk situation. Like prevention efforts needed another kick in the nuts.

There are still people who need access to these drugs to stay alive. When they are taken care of, we can talk about making HIV meds OTC (which is basically what the OP is suggesting, by handing them out to others without a prescription).