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Author Topic: Unsafe in Switzerland  (Read 2437 times)

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Offline edfu

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  • Posts: 1,084
Unsafe in Switzerland
« on: November 16, 2010, 12:12:35 PM »
More words of caution about the controversial "Swiss statement":

http://aids-clinical-care.jwatch.org/cgi/content/full/2010/1115/1
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline odyssey

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  • One Crazy Mofo!
Re: Unsafe in Switzerland
« Reply #1 on: November 16, 2010, 02:16:50 PM »
I was always quite skeptical of the Swiss Statement. In fact, in another thread, I posted quite a few studies that contradicted the assumption that a undetectable viral load would equate to prevention of transmission. Yet people just argued with me and kept saying "but the Swiss Statement says....". Maybe now that the Statement's own authors are showing doubts people will pay attention!

odyssey
01/09/09- diagnosed HIV+
01/16/09   CD4-425    22%  VL- 32,415
11/09- started Reyetaz/Norvir/Truvada
03/10- stopped R/N/T
10/18/11   CD4- 328   20%  VL- 84,000
10/25/11   CD4- 386   22%
10/28/11- start Truvada/Reyetaz/Norvir
12/30/11  CD4- 523  29%
03/08/12  CD4- 503  31%  VL 57
07/02/12  CD4- 897  43%
08/31/12  CD4- 745  39%
12/27/12  CD4- 884  40%
03/28/13  CD4- 819  39%
07/19/13  CD4- 739  40%
10/17/13  CD4- 535  36%
01/16/14  CD4- 743  43%

02/14- switched from R/N/T to Tivicay/Epzicom because of CKD 3 suspected from tenofovir.

03/14- switched back to R/N/T due to severe nausea and inability to eat on T/E.
 
04/01/14 CD4- 898  42%   VL-

Offline ad2san

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  • Posts: 186
Re: Unsafe in Switzerland
« Reply #2 on: November 16, 2010, 02:55:44 PM »
well, in order to fuel your reflexion, you can have a look here : http://www.aidsmeds.com/articles/hiv_treatment_prevention_1667_18487.shtml

Feb   2009 CD4 358 VL 2000 16%
May  2009 CD4 305 VL 3069  14% <---- Started TVD+ATZ/r
Jul  2009 CD4 512 VL <50   18%
Jul 2010 CD4 418 VL <50 24%                     
Switched to Kivexa (Epzicom) + Norvir + Reyataz (due to sleep problem)
Aug 2010 CD4 606 VL <50 25%
Apr 2011 CD4 523 UD 21%
Jul 2011 CD4 494 UD 23%
Switched to Kivexa (Epzicom) + Viramune XR (due to kidney problems)
January 2012 CD4 564 UD 31%
October 2012 CD4 684 UD 29%
January 2013 CD4 594 UD 26%
Switched to Kivexa (Epzicom) + Isentress due to BIG increase GammaGT
Feb 2013 CD4 699 UD 28%
May 2013 CD4 385 UD 28%
July 2013 CD4 CD4 636 UD 25%
Oct 2013 CD4 588 UD 39%

Offline odyssey

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Re: Unsafe in Switzerland
« Reply #3 on: November 16, 2010, 03:34:30 PM »
92% huh? Guess it really sucks if you're in that other 8% then! They're trying to say you can't transmit the virus when you're undetectable, but that study just proved they were wrong. Yet another reason to still wear condoms!

odyssey
01/09/09- diagnosed HIV+
01/16/09   CD4-425    22%  VL- 32,415
11/09- started Reyetaz/Norvir/Truvada
03/10- stopped R/N/T
10/18/11   CD4- 328   20%  VL- 84,000
10/25/11   CD4- 386   22%
10/28/11- start Truvada/Reyetaz/Norvir
12/30/11  CD4- 523  29%
03/08/12  CD4- 503  31%  VL 57
07/02/12  CD4- 897  43%
08/31/12  CD4- 745  39%
12/27/12  CD4- 884  40%
03/28/13  CD4- 819  39%
07/19/13  CD4- 739  40%
10/17/13  CD4- 535  36%
01/16/14  CD4- 743  43%

02/14- switched from R/N/T to Tivicay/Epzicom because of CKD 3 suspected from tenofovir.

03/14- switched back to R/N/T due to severe nausea and inability to eat on T/E.
 
04/01/14 CD4- 898  42%   VL-

Offline edfu

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Re: Unsafe in Switzerland
« Reply #4 on: November 16, 2010, 04:25:11 PM »
well, in order to fuel your reflexion, you can have a look here :

I have, but as with the original Swiss Statement, once again the research and study concern only heterosexual couples. 
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline tednlou2

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Re: Unsafe in Switzerland
« Reply #5 on: November 17, 2010, 01:00:44 AM »
I've been confused by this as well.  I'm not sure how people here feel about Dr. Gallant.  I've been surprised that he often tells people if they are UD, then they really aren't at much risk.  He has said that you can never be sure of your vl, so you have to weigh the risks.  But, most often he tells people that it would be extremely rare to transmit HIV if you have an UD viral load and have had that for a long time.  Basically, he's not one of those who is always preaching condom use for people UD.   

Offline Hellraiser

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Re: Unsafe in Switzerland
« Reply #6 on: November 17, 2010, 01:20:21 AM »
92% huh? Guess it really sucks if you're in that other 8% then! They're trying to say you can't transmit the virus when you're undetectable, but that study just proved they were wrong. Yet another reason to still wear condoms!

odyssey

I'm a little unsure where you're drawing your conclusions from here.  92% does not mean you have an 8% chance or 8 in 100 chances of being infected by having sex sans condoms with an hiv+ partner who is undetectable.  It means that your base chance of being infected by a + partner is reduced by 92% if they are undetectable (it also says if you read further down that a high CD4 and low VL without treatment seems to make someone less infectious).  This means that whatever chance you have which I've heard is something like 1 in 8 as a bottom with a + top is reduced by 92%, which would be more like 1 in 100 with a + top who is undetectable.

I'm a little curious as to why you're on this anti swiss study crusade, especially considering that you've admitted that you are still having unprotected sex with a negative partner.  I'm not for or against the swiss statement, but it would make sense that the less virus there is in your body the less chance it would have of actually infecting anyone.

Offline mecch

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Re: Unsafe in Switzerland
« Reply #7 on: November 17, 2010, 03:17:23 AM »
The swiss researched hetero faithful couples.
Geez so many people have willfully taken the findings to do whatever they want, as usual.

Also before you knock it completely, the statement also had public policy objectives because it was quickly cited in a criminal transmission of HIV trial.    One of the tangential benefits of the statement is to decrease fear and stigma against HIV+ people as Typhoid Marys.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline jkinatl2

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Re: Unsafe in Switzerland
« Reply #8 on: November 17, 2010, 03:29:46 AM »
The swiss researched hetero faithful couples.
Geez so many people have willfully taken the findings to do whatever they want, as usual.

Also before you knock it completely, the statement also had public policy objectives because it was quickly cited in a criminal transmission of HIV trial.    One of the tangential benefits of the statement is to decrease fear and stigma against HIV+ people as Typhoid Marys.


Agreed, but there are many many people, including some on this very forum, who have an investment in that stigma, that status.

Often the real push comes not from without, but within.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline odyssey

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Re: Unsafe in Switzerland
« Reply #9 on: November 17, 2010, 09:23:04 AM »
I'm a little unsure where you're drawing your conclusions from here.  92% does not mean you have an 8% chance or 8 in 100 chances of being infected by having sex sans condoms with an hiv+ partner who is undetectable.  It means that your base chance of being infected by a + partner is reduced by 92% if they are undetectable (it also says if you read further down that a high CD4 and low VL without treatment seems to make someone less infectious).  This means that whatever chance you have which I've heard is something like 1 in 8 as a bottom with a + top is reduced by 92%, which would be more like 1 in 100 with a + top who is undetectable.

I'm a little curious as to why you're on this anti swiss study crusade, especially considering that you've admitted that you are still having unprotected sex with a negative partner.  I'm not for or against the swiss statement, but it would make sense that the less virus there is in your body the less chance it would have of actually infecting anyone.

Okay... so I didn't get the math right. Not the end of the world. My point was, it doesn't eliminated the risk of transmission. And bringing my own behavior into the equation is a bit of a low blow don't you think? I'm not telling my partner there is no risk of transmitting to him. In fact, I've recently told him I'm no longer comfortable having unprotected sex because I'm not comfortable risking his health. I don't think its relevant to this discussion or my stance on the Swiss Statement what I do in my personal life.

odyssey
01/09/09- diagnosed HIV+
01/16/09   CD4-425    22%  VL- 32,415
11/09- started Reyetaz/Norvir/Truvada
03/10- stopped R/N/T
10/18/11   CD4- 328   20%  VL- 84,000
10/25/11   CD4- 386   22%
10/28/11- start Truvada/Reyetaz/Norvir
12/30/11  CD4- 523  29%
03/08/12  CD4- 503  31%  VL 57
07/02/12  CD4- 897  43%
08/31/12  CD4- 745  39%
12/27/12  CD4- 884  40%
03/28/13  CD4- 819  39%
07/19/13  CD4- 739  40%
10/17/13  CD4- 535  36%
01/16/14  CD4- 743  43%

02/14- switched from R/N/T to Tivicay/Epzicom because of CKD 3 suspected from tenofovir.

03/14- switched back to R/N/T due to severe nausea and inability to eat on T/E.
 
04/01/14 CD4- 898  42%   VL-

Offline Ann

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    • Num is sum qui mentiar tibi?
Re: Unsafe in Switzerland
« Reply #10 on: November 17, 2010, 11:24:05 AM »
The Swiss Statement never claimed that being undetectable eliminated the risk of transmission. It was never meant to be an excuse to not use condoms. It was meant to show that it is possible to conceive babies the natural way with a lowered risk of transmission. Note I said lowered risk, not without risk. 

And as mentioned, it only looked at heterosexual - specifically vaginal - sex. Anal sex will always carry a higher risk for the receptive partner because of the simple fact that anal tissue is more prone to damage than vaginal tissue.



edited to fix dodgy formatting
« Last Edit: November 17, 2010, 11:28:54 AM by 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 odyssey

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Re: Unsafe in Switzerland
« Reply #11 on: November 17, 2010, 02:29:31 PM »
The Swiss Statement never claimed that being undetectable eliminated the risk of transmission. It was never meant to be an excuse to not use condoms. It was meant to show that it is possible to conceive babies the natural way with a lowered risk of transmission. Note I said lowered risk, not without risk. 

And as mentioned, it only looked at heterosexual - specifically vaginal - sex. Anal sex will always carry a higher risk for the receptive partner because of the simple fact that anal tissue is more prone to damage than vaginal tissue.



edited to fix dodgy formatting

Well then, a lot of people around here seem to be taking it out of context and saying that it means that having unprotected sex is safe as long as you are UD. I've seen that said more than once. Guess there is a lot of misinformation being spread around!

odyssey
01/09/09- diagnosed HIV+
01/16/09   CD4-425    22%  VL- 32,415
11/09- started Reyetaz/Norvir/Truvada
03/10- stopped R/N/T
10/18/11   CD4- 328   20%  VL- 84,000
10/25/11   CD4- 386   22%
10/28/11- start Truvada/Reyetaz/Norvir
12/30/11  CD4- 523  29%
03/08/12  CD4- 503  31%  VL 57
07/02/12  CD4- 897  43%
08/31/12  CD4- 745  39%
12/27/12  CD4- 884  40%
03/28/13  CD4- 819  39%
07/19/13  CD4- 739  40%
10/17/13  CD4- 535  36%
01/16/14  CD4- 743  43%

02/14- switched from R/N/T to Tivicay/Epzicom because of CKD 3 suspected from tenofovir.

03/14- switched back to R/N/T due to severe nausea and inability to eat on T/E.
 
04/01/14 CD4- 898  42%   VL-

Offline Hellraiser

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  • Posts: 4,136
  • Semi-misanthropic
Re: Unsafe in Switzerland
« Reply #12 on: November 17, 2010, 03:07:10 PM »
Okay... so I didn't get the math right. Not the end of the world. My point was, it doesn't eliminated the risk of transmission. And bringing my own behavior into the equation is a bit of a low blow don't you think? I'm not telling my partner there is no risk of transmitting to him. In fact, I've recently told him I'm no longer comfortable having unprotected sex because I'm not comfortable risking his health. I don't think its relevant to this discussion or my stance on the Swiss Statement what I do in my personal life.

odyssey

I apologize if that seemed like a cheap shot as it wasn't my intent.  I personally think the Swiss Statement is probably a pretty good indicator,but wouldn't use it as gospel in the department of transmission science.  However, when you're talking about risk transmission and reduction you are aware that even condoms are not 100% effective.  This is because science doesn't deal in absolutes.  To say that something is 100% is to set up a precedent which can eventually be proven wrong.  99.99999999% is so close to 100% as to be functionally very similar however.  Getting back to my apology I was just wondering why if you really thought you seriously posed a risk of transmission by not believing in the veracity of the Swiss study that you would be continuing a behavior which in your own mind may have carried a level of risk which you find unacceptable.  Once again I wasn't trying to attack your character, sorry Odyssey.

Offline bocker3

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Re: Unsafe in Switzerland
« Reply #13 on: November 17, 2010, 04:31:32 PM »
I apologize if that seemed like a cheap shot as it wasn't my intent. 
Apology given......

I was just wondering why if you really thought you seriously posed a risk of transmission by not believing in the veracity of the Swiss study that you would be continuing a behavior which in your own mind may have carried a level of risk which you find unacceptable. 
Apology taken away.......
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 odyssey

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Re: Unsafe in Switzerland
« Reply #14 on: November 17, 2010, 06:26:18 PM »
Apology given......
Apology taken away.......

Methinks bocker3 is on to something! Why apologize if you are just going to turn around and insult me again. That's just like saying "I don't mean to offend you but..." and then saying something totally offensive. I just doesn't get you off the hook. Apology not accepted.

odyssey
01/09/09- diagnosed HIV+
01/16/09   CD4-425    22%  VL- 32,415
11/09- started Reyetaz/Norvir/Truvada
03/10- stopped R/N/T
10/18/11   CD4- 328   20%  VL- 84,000
10/25/11   CD4- 386   22%
10/28/11- start Truvada/Reyetaz/Norvir
12/30/11  CD4- 523  29%
03/08/12  CD4- 503  31%  VL 57
07/02/12  CD4- 897  43%
08/31/12  CD4- 745  39%
12/27/12  CD4- 884  40%
03/28/13  CD4- 819  39%
07/19/13  CD4- 739  40%
10/17/13  CD4- 535  36%
01/16/14  CD4- 743  43%

02/14- switched from R/N/T to Tivicay/Epzicom because of CKD 3 suspected from tenofovir.

03/14- switched back to R/N/T due to severe nausea and inability to eat on T/E.
 
04/01/14 CD4- 898  42%   VL-

Offline wtfimpoz

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Re: Unsafe in Switzerland
« Reply #15 on: November 22, 2010, 12:17:43 AM »
Y'know, this is really a sad/classic example of how a lot of people function in relation to HIV transmission risk studies.  In order to take ONE study as carte-blanche to have unprotected anal sex, you'd have had to be LOOKING for a reason. TONS of people had certainly been looking for just such a reason though, and "The Swiss Statement" clearly served this purpose.  There was an almost palpable sentiment amongst large swathes of poz and "at risk" populations that if we just popped our pills on time, condom usage, disclosure, serosorting and other risk-mitigation behaviors could go out the door.  I can think of a few people from this forum who seemed to think along those lines, and one who stated it specifically to me.  Fortunately, MOST people on here were clearly more nuanced in their thinking.  I believe Ann brought up cited instances of transmission despite undetectable status, I recall a few members noting discrepencies between semen and plasma viral loads, someone mentioned that the Swiss statement addressed less-risky heterosexual sex, etc. 

Not every site or person walked around with counterpoints to the Swiss Statement in hand though, and I'm sure that more than a few people have found out the hard way that antiretrovirals are not absolute prophylactics even as "test and treat" was being touted by reputable public health professionals as a way to lower (read by most as stop) transmission.  Instead of acknowledging that public sentiment had been manipulated and people's lives have been harmed, we're now walking around acting like anyone who bought into the notion that pills make you "noninfectious" was a psychopath and anyone who got it from that notion was an idiot.  Well, a lot of these people aren't idiots.  The general public...even in a country like Switzerland...doesn't have the capacity to arrive at reasonable conclusions from complex, technically loaded investigations.  This study seems to indicate pretty specifically that public health declarations and their simplified blurbs have a real impact on people's sexual behavior.  We can infer that over time, by acting on a population wide basis, they can change norms and even alter the behavior of otherwise cautious people, and in doing so cause great harm.  In short, the general dissemination of The Swiss Statement has probably infected a lot of people who would otherwise have remained negative.

And yet, we get up on our high horses, and we talk about how  it was soooooo obvious that the Swiss Statement wasn't really trying to encourage mass barebacking.  We lose sight of the fact that its widespread publication might as well have encouraged this behavior.  I see the same sort of mentality with oral sex, and even condom usage.  Its all "safe fun" until someone seroconverts, then the admonishments begin about how no one ever told us it was without risk.   
09/01/2009-neg
mid april, 2010, "flu like illness".
06/01/2010-weakly reactive ELISA, indeterminant WB
06/06/2010-reactive ELISA, confirmed positive.

DATE       CD4     %     VL
07/15/10  423     33    88k
08/28/10  489     19    189k
09/06/10-Started ATRIPLA
09/15/10  420     38    1400
11/21/10  517     25    51

Offline jkinatl2

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Re: Unsafe in Switzerland
« Reply #16 on: November 22, 2010, 12:42:12 AM »
This is why a single study is not supposed to be the "be - all" and "end - all" for science. First tiered, peer-reviewed, REPEATABLE study is the key when dealing with a situation like HIV - which started, as many note, as a sprint, but has become a marathon.

The Swiss study was and is compelling. When it is duplicated two or three times over, I will certainly embrace it to a degree that I cannot at the moment. It IS a great marker for those who wish to get pregnant - a population that cannot be discounted or ignored, especially with HIV lifespans closing in on the norm.

However, I cannot help but raise an eyebrow at those who think an UD VL is a ticket to have consequence-free unprotected sex with negative folks. Like most transmission data, those who are most vociferous are those who have, to quote the vernacular, dogs in that fight.

I have not, obviously, learned to avoid arguing with crazy dogs. But I do know that it is the quantity and quality of science that we have to deal with, when discussion HIV transmission vectors and science. Two studies is a great sign, and three, I think, is the charm for gold standard - especially when dealing with long-term studies.

I seriously want to see some more long term studies, but also know that this will be a long time coming.

I have no doubt that an UD VL significantly reduces the chance for infection in high risk activities. But I would hesitate to give unprotected sex the "all clear" based on the Swiss Statement. Like I said, for heterosexual couples looking to conceive, who cannot afford sperm-washing or IVF, then it might be something that, under a doctor's supervision, might be possible. This is a far different scenario than just screwing random people and not disclosing because of the aforementioned Swiss Statement.


"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Hellraiser

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Re: Unsafe in Switzerland
« Reply #17 on: November 22, 2010, 02:27:39 AM »
Methinks bocker3 is on to something! Why apologize if you are just going to turn around and insult me again. That's just like saying "I don't mean to offend you but..." and then saying something totally offensive. I just doesn't get you off the hook. Apology not accepted.

odyssey

Eh I just clarified the statement.  I wasn't trying to put in a dig against you.  I was only curious why you would do that if you so strongly believe the Swiss Study is ultimately wrong or misinformed.  Trust that if I were attempting to be nasty, venomous, or downright evil there wouldn't be any mistaking my intent.

Offline odyssey

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Re: Unsafe in Switzerland
« Reply #18 on: November 22, 2010, 11:45:16 AM »
Eh I just clarified the statement.  I wasn't trying to put in a dig against you.  I was only curious why you would do that if you so strongly believe the Swiss Study is ultimately wrong or misinformed.  Trust that if I were attempting to be nasty, venomous, or downright evil there wouldn't be any mistaking my intent.

First of all, I'm not UD. Second, both my sex partner and I had a discussion of the risks, the statistical odds, and everything like that, and I told him he could be infected with the virus and he still wanted to bareback. He is in his forties and I figured he was adult enough to make that choice. Yes, I regret letting my horniness allow me to put another in harms way, and we have since discussed the fact that I am no longer comfortable having unprotected sex for this very reason. I am simply not comfortable with the fact that I may be the reason he becomes poz. My own behavior has nothing to do with my beliefs about the scientific validity of the Swiss Statement.

odyssey
01/09/09- diagnosed HIV+
01/16/09   CD4-425    22%  VL- 32,415
11/09- started Reyetaz/Norvir/Truvada
03/10- stopped R/N/T
10/18/11   CD4- 328   20%  VL- 84,000
10/25/11   CD4- 386   22%
10/28/11- start Truvada/Reyetaz/Norvir
12/30/11  CD4- 523  29%
03/08/12  CD4- 503  31%  VL 57
07/02/12  CD4- 897  43%
08/31/12  CD4- 745  39%
12/27/12  CD4- 884  40%
03/28/13  CD4- 819  39%
07/19/13  CD4- 739  40%
10/17/13  CD4- 535  36%
01/16/14  CD4- 743  43%

02/14- switched from R/N/T to Tivicay/Epzicom because of CKD 3 suspected from tenofovir.

03/14- switched back to R/N/T due to severe nausea and inability to eat on T/E.
 
04/01/14 CD4- 898  42%   VL-

 


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