Question about PrEP and daily sex hooksup

[Bay Area Jeremy]

I have a question about PrEP.  I thought you guys might know the answer.

Will PrEP deal with (keep a guy HIV negative) if he barebacks with approximately 14 guys in a row (day after day) and takes approximately 28+ loads over a period of 2 weeks?  The guy is on "event" PrEP so up until now he's been taking it for only when he knows he's going to have sex, as in 2 hours before.  But over the past 2 weeks, his get-togethers with guys have been one after the other.   Night after night.  Seems to me that he's pushing PrEP "to its limits," but I thought you guys could give me more info.  He's my roommate and I don't like to pry into what he's doing.  I'm just concerned about his recent behaviour.  He's partly doing this to pay the rent by being a rent boy.  I suspect if he's honest with his physician that he will be changed to taking PrEP permanently on a daily basis, which he's not done up until now.  Also, I know there are some poz Tops, but are most Tops neg?  If that were true, that might make this situation better.  My concern is that so far, there have been 17-18 documented cases of guys getting pozzed while on PrEP adhering to the schedule strictly.  He just has far more sex hookups than the schedule shows.  I also read that a person is considered very high risk for having 3 bareback hooksup a month.

He's maxing-out Example 2: Multiple Sex Encounters at this link
https://preprx.ucsf.edu/sites/g/files/tkssra2846/f/wysiwyg/PrEP-OI%202-1-1%20handout%20w%20Strut%20table.pdf

He's followed the schedule above but has far more sex hookups than that schedule and has extended the number of days.

Can PrEP deal with his behaviour?

Thanks for your input.

[Jim Allen]

On-demand PrEP users should take two pills between 2 and 24 hours before they intend to have sex. They should then take one pill a day for as long as they are having sex, finally followed by a single pill on each of the two days after they last have sex.

The example you provided is just that, an over-simplistic example to highlight taking the pill for two days after the last sexual encounter. It does not mean that they can't have sex more frequently than the example used.

Also, I know there are some poz Tops, but are most Tops neg?

Few gaps in this logic. Firstly being top during one encounter does not mean they always top or don't have other HIV risk.

Anyhow, the insertive partner is statistically considered slightly less at risk of acquiring HIV per act of intercourse. However, that does not mean there is no HIV risk to the insertive partner.

Sadly there are plenty of myths or misunderstanding around this topic.

He's my roommate and I don't like to pry into what he's doing.

Then don't.

Look I presume you are not watching each sexual encounter your roommate has to check for condom usage or watching them take each pill or present during a conversation they have had with their Doctor. So a lot of this must be based on what your roommate has perhaps said to you, who knows what the real details are.

What does seem to be the case is your roommate is aware of PrEP.

Here's what you need to know:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions. Consider talking to your health care provider about taking PrEP going forward as an additional layer of HIV protection.

Keep in mind that some sexual practices which may be described as ‘safe’ in terms of HIV transmission might still pose a risk for transmission of other STI's, so please do get fully tested regularly and at least yearly for all STI's including but not limited to HIV and test more frequently if unprotected intercourse occurs

Also, note that it is possible to have an STI and show no signs or symptoms and the only way of knowing is by testing.

Kind regards

Jim


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