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Author Topic: Is PEP needed when we are UD?  (Read 1474 times)

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Offline Pek

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Is PEP needed when we are UD?
« on: November 14, 2012, 01:16:19 PM »
On my last appointment I was talking with my nurse about serodiscordant relationship so I asked about PEP if the condom breaks. She said to me as long as u are UD PEP is not suggested. My ex-girlfriend, who I am triyng to get back, got worried coz she would like to have the PEP even if it is not suggested.
I would like to hear from someone what do your doctors says about
thanks

Offline ad2san

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Re: Is PEP needed when we are UD?
« Reply #1 on: November 14, 2012, 01:47:03 PM »
Hi PEK,

the PEP is not suggested .... well this does not mean that it is not recommended! So if your GF thinks it is better then should get it (and I hope u get back ur GF as well).

Cheers
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 jkinatl2

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Re: Is PEP needed when we are UD?
« Reply #2 on: November 14, 2012, 03:00:33 PM »
Hi PEK,

the PEP is not suggested .... well this does not mean that it is not recommended! So if your GF thinks it is better then should get it (and I hope u get back ur GF as well).

Cheers

Not even sure how to parse that.

If the nurse/doctor said that PEP wasn't suggested, she MEANT it was not recommended.

I imagine if yougot a doctor to write you a script for a month of meds, then your pharmacist would fill them. I imagine they would be expensive however. Have you considered springing for PreP?

Again, expensive, and she's have to take it every day. But it's a consideration.

"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 ad2san

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Re: Is PEP needed when we are UD?
« Reply #3 on: November 14, 2012, 03:09:30 PM »
Not even sure how to parse that.

If the nurse/doctor said that PEP wasn't suggested, she MEANT it was not recommended.

I imagine if yougot a doctor to write you a script for a month of meds, then your pharmacist would fill them. I imagine they would be expensive however. Have you considered springing for PreP?

Again, expensive, and she's have to take it every day. But it's a consideration.

Yep I did not read the mail of PEK properly. PEP is not to be mixed up with safe sex. If you practice safe sex your girl friend won't be infected. If for a reason a condom break, then PEP may be recommended .... but not as an alternative to condom.
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 jkinatl2

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Re: Is PEP needed when we are UD?
« Reply #4 on: November 14, 2012, 07:15:18 PM »
Yep I did not read the mail of PEK properly. PEP is not to be mixed up with safe sex. If you practice safe sex your girl friend won't be infected. If for a reason a condom break, then PEP may be recommended .... but not as an alternative to condom.


In many places, if a condom breaks during penetrative sex where the insertive partner is positive, whether it be the top in anal sex or the male in vaginal sex, then PEP might not be recommended if the positive partner has an undetectable viral load.

It should be noted that many straight couples use "natural" methods to conceive, and many do not return to religious condom use afterwards so long as the positive partner remains undetectable. It's a personal choice, of course, but well grounded in science.

"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 mecch

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Re: Is PEP needed when we are UD?
« Reply #5 on: November 14, 2012, 07:17:28 PM »
Yep I did not read the mail of PEK properly. PEP is not to be mixed up with safe sex. If you practice safe sex your girl friend won't be infected. If for a reason a condom break, then PEP may be recommended .... but not as an alternative to condom.

WTF???  The OP is quite clear. He's talking about what to do if there is a CONDOM BREAK while having safe sex.  Geez. 

jkinatl2 then explained that another option is to follow PreP - pre-exposure prophylaxis.  An HIV- person taking Truvada daily to prevent transmission.  Presumeably, the only people who would consider this, would be because they want to screw without condoms.

Your posts don't make any sense. 
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline leatherman

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Re: Is PEP needed when we are UD?
« Reply #6 on: November 14, 2012, 10:48:27 PM »
Quote
the only people who would consider this, would be because they want to screw without condoms.
or the negative partner in sero-discordant relationship that wants to take more precautions that just the condom and so adds PrEP to the equation.

Of course, a hetero couple could be looking for a way to conceive while really making sure that they are not putting the neg partner at risk. An undetectable viral load in the poz partner and the negative partner on PrEP would certainly be a lot of precautions.  ;)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline jkinatl2

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Re: Is PEP needed when we are UD?
« Reply #7 on: November 15, 2012, 12:58:15 AM »
Quote
or the negative partner in sero-discordant relationship that wants to take more precautions that just the condom and so adds PrEP to the equation.

Of course, a hetero couple could be looking for a way to conceive while really making sure that they are not putting the neg partner at risk. An undetectable viral load in the poz partner and the negative partner on PrEP would certainly be a lot of precautions.

Which, regardless of the noble goal of conception, is still "screwing without condoms." An admirable use of the double standard, but you know.

I am constantly perplexed when I hear the glowing stories of natural conception using the miracle of an Undetectable viral load, yet when two guys do the same thing, it's barebacking.

I know you didn't mean to bring that up, but ever since I responded the first time, it's stuck in my craw.



"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 leatherman

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Re: Is PEP needed when we are UD?
« Reply #8 on: November 15, 2012, 01:21:14 AM »
I am constantly perplexed when I hear the glowing stories of natural conception using the miracle of an Undetectable viral load, yet when two guys do the same thing, it's barebacking.
i couldn't agree more.

I just had a big old brouhaha with my case manager about this during my yearly assessment. She asked if I was still having sex (the personal questions in these things are just rude, intrusive and dehumanizing) and I emphatically said yes. She followed that up stating "I know you always use condoms then because you know all about how bad reinfection is." Now that bee got under my bonnet and I fessed up to not using condoms with my poz BF. Needless to say that led to a time-consuming conversation, and I guess "bad marks" on my reassessment. ::)

I should learn to keep my mouth shut, nod my head and smile. LOL Last time I was in the clinic and accidentally answered yes to the "are you having sex?" question, I had to drop my drawers and get a q-tip jammed somewhere it shouldn't be going. :o I need to remember the answers are "no, I'm not having sex" and "I would always use condoms if I was having sex because reinfection could lead to teh aidses all over again.  ::)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline jkinatl2

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Re: Is PEP needed when we are UD?
« Reply #9 on: November 15, 2012, 01:39:19 AM »
i couldn't agree more.

I just had a big old brouhaha with my case manager about this during my yearly assessment. She asked if I was still having sex (the personal questions in these things are just rude, intrusive and dehumanizing) and I emphatically said yes. She followed that up stating "I know you always use condoms then because you know all about how bad reinfection is." Now that bee got under my bonnet and I fessed up to not using condoms with my poz BF. Needless to say that led to a time-consuming conversation, and I guess "bad marks" on my reassessment. ::)

I should learn to keep my mouth shut, nod my head and smile. LOL Last time I was in the clinic and accidentally answered yes to the "are you having sex?" question, I had to drop my drawers and get a q-tip jammed somewhere it shouldn't be going. :o I need to remember the answers are "no, I'm not having sex" and "I would always use condoms if I was having sex because reinfection could lead to teh aidses all over again.  ::)

Argh. I sympathize with females whose HIV related concerns have ALWAYS been late to the table. But this hypocritical judgment does nothing to further an honest conversation based on science.

Of course this is only helpful if there is a scientific consensus at the beginning. Which, as you are aware, there's not.

Worst part of doing outreach: When you have to reach out to your case workers. doctors, and other providers who are in charge of your freaking life.
"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 mecch

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Re: Is PEP needed when we are UD?
« Reply #10 on: November 15, 2012, 05:17:36 AM »
She followed that up stating "I know you always use condoms then because you know all about how bad reinfection is."
I know you know that I know that you know that you know you know.

It's worthy of Gertude Stein if she wasn't an idiot.

I sort of got a judgement from my GP the other day but it was unspoken, just in the tone of his questions when I was requesting another STD screen.
_________

Would any doctor REALLY recommend PreP to the HIV- partner in a serodiscordant relationship if they couple is having safe sex, AND the HIV+ parter is undetectable.  It seems like OVERKILL to me.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline leatherman

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Re: Is PEP needed when we are UD?
« Reply #11 on: November 15, 2012, 10:22:00 AM »
Worst part of doing outreach: When you have to reach out to your case workers. doctors, and other providers who are in charge of your freaking life.
amen to that too!

Bhaving gone to the doctors for AIDS/HIV for nearly 20 yrs (next month is my 20 yr AIDSaversary - even though I was infected 27 yrs ago this month! w00t! LOL) it's par for the course telling doctors, nurses, case workers, social workers, etc. stuff that I know and that they should know but don't. I completely understand that it's my health, my life, my welfare and thus I am more concerned about it than these people; but when I know more that a doctor or understand the system better than someone that works in it all day every day, then something is really quite wrong. So I educate them and move on along taking care of myself better than they ever would.

oops! sorry for the LTS griping. I forgot this was the happy "living with hiv" forum.  ;D LOL
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline jkinatl2

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Re: Is PEP needed when we are UD?
« Reply #12 on: November 15, 2012, 04:27:43 PM »
amen to that too!

oops! sorry for the LTS griping. I forgot this was the happy "living with hiv" forum.  ;D LOL

Gripe away! If we (or someone) doesn't educate these people, then they in turn perpetuate misinformation to newly infected people who, in turn, do the same.  Then they come up in here with "My doctor said you can get it from kissing" and nonsense like that.

As you and I are painfully aware, not everyone with HIV knows an awful lot about the virus - but because they HAVE it, they are treated as though they do. I rather think a little LTS (or anyone who has the time and brain matter to actually research the virus) griping is necessary in this forum. Especially in THIS section and in the Newly Infected section.

Seeing bad/wrong information passed around these forums like candy is sometimes more than a little frustrating.  It's not like this site isn't filled to the brim with accurate, current information or anything.



"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 Pek

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Re: Is PEP needed when we are UD?
« Reply #13 on: November 16, 2012, 12:00:02 AM »
Thanks for helping me. I will try to filter the information. About the PrEP is not even an option where I live. But I think it wouldnt be suggested as well. I really believe that we are not sexually-infectious as long as we are UD for 6 months, no other STD, bla bla bla. But I would like to be really carefully about my ex-GF(the only one person that I had sex after my diagnosis). I dont want to play with her health. So that is the reason I am trying to get more information as possible.
Anyway thanks!
« Last Edit: November 16, 2012, 12:05:21 AM by Pek »

Offline leatherman

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Re: Is PEP needed when we are UD?
« Reply #14 on: November 16, 2012, 12:53:35 AM »
I really believe that we are not sexually-infectious as long as we are UD for 6 months, no other STD, bla bla bla.
most of the science shows that an HIV+ person, under those circumstances, are much LESS infectious, not "not infectious". No where does the science ever say that positive people are NOT infectious, just a lot less likely to infect. You get no 100% guarantees - even though the odds can get pretty close to that at times. ;)

But I would like to be really carefully about my ex-GF(the only one person that I had sex after my diagnosis). I dont want to play with her health.
then use condoms and don't have unprotected sex with her. As Ann says in the AII? forum, "it really is that simple". Not only will that keep you from infecting her but you won't impregnate her either.

About the PrEP is not even an option where I live.
seems like you should be focusing on the things you can control, not things out of your control. If Prep is unattainable in your area, you shouldn't even be wasting your time on what-if scenarios. Focus on what you can do to prevent your GF from being infected - safer sex habits. ;)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline jkinatl2

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Re: Is PEP needed when we are UD?
« Reply #15 on: November 16, 2012, 02:33:20 AM »
Exactly. No one will EVER tel you that unprotected sex, even with an undetectable viral load, is a hundred percent safe. Semen can often have viral blips that bloodwork simply does not detect.

I think one of the problems here is that we tens to lump all sorts of sex under one umbrella.

If a female is HIV positive and the male is negative, then penetrative intercourse with an undetectable viral load is about as safe as a condom. Same can more or less be said in a gay relationship, if the receptive partner in anal sex has an UD VL.

However, if the male in a heterosexual/vaginal situation is UD, the risk, though reduced to ALMOST insignificant, is not as low. Same can be said for a male in the penetrative role in anal sex, if that male is positive. The risk, though still plenty diminished, is still higher. It's really all about the level of risk a partner (or partners) is/are willing to undertake.

In my ten odd years dealing with problems/concerns on the AM I INFECTED forum, I have yet to see a male test positive after a condom break. I cannot say the same about a female, though having an undetectable viral load would certainly provide a huge amount of protection.  Best possible advice- read ANN's condom links in her posting signature.

Used correctly, a condom should very very very rarely break.


"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

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