A Few Questions About PrEP

[funkytown93]

Hi, I just registered and received the pills for PrEP today, and I actually have a few questions that hopefully the kind folks here can answer:

1. I understand that the manner of taking the pills may either be daily or event-driven (2+1+1). What if I have multiple sexual intercounters in one particular week with one or two days apart, but on the following weeks I have no sexual encounters
   A) Can I still choose to take the pills on an event-driven manner instead of a daily manner, considering I will have no sexual encounters on the weeks following that particularly sexually active week?
   B) If I can take it in an event-driven basis, how would the dosage work inbetween the days of the sexual encounters(considering the 2+1+1 dosage)?

2. Should oral sex (let's say oral sex with cuts and sores to increase the risk) be considered an event that makes it necessary to take PrEP on an event-driven or daily basis?

[Jim Allen]

   A) Can I still choose to take the pills on an event-driven manner instead of a daily manner, considering I will have no sexual encounters on the weeks following that particularly sexually active week?
   B) If I can take it in an event-driven basis, how would the dosage work inbetween the days of the sexual encounters(considering the 2+1+1 dosage)?

A: Yes
B: On-demand PrEP is two pills between 2 and 24 hours before sex. After that take one pill a day for as long as you are having sex, finally followed by a single pill on each of the two days after the last sex.

Should oral sex (let's say oral sex with cuts and sores to increase the risk) be considered an event that makes it necessary to take PrEP on an event-driven or daily basis?

For a large part, you have asked and already know the answer to this: https://forums.poz.com/index.php?topic=75241.msg

In summary, a minute HIV risk that does not even warrant testing outside of routine, let alone PrEP or PEP for that matter.  Now, your question if PrEP or on-demand PrEP further reduces this near negligible risk, there is no direct data to confirm.

[funkytown93]

Thanks for clearing things up, Jim! I actually have one more question to ask: I'm planning on bottoming for the first time with someone who I'm not in a serious relationship with. Majority of the reason why I never bottomed in a hookup before was because of the paranoia of getting the virus.

If I take prompt on-demand dosage AND condom use altogether, would that experience be considered relatively safe? Also, would that still be considered relatively safe in the event of possible mishaps (such as the condom breaking)? Sorry, I'm super new when it comes to the subject of PrEP, especially after spending majority of my life being scared about the risks of sex. I just want to cover every bases. Thanks for your time!

[Jim Allen]

Look, let's get a few things clear.

Firstly, there is no such thing as safe sex, just safer sex, but when talking specifically about HIV, some sexual activity is no HIV risk, but still poses risks for other STI's.

Regarding condoms, HIV can't transmit through an intact latex or polyurethane condom. However, Condoms can break, though it's obvious when that happens. It's caused mainly by incorrect usage, so use them consistently and correctly to reduce your risks.
 
Condoms can also reduce the risks of STI's. However, the levels of protection for various STIs, depends significantly on differences in how the diseases or infections are transmitted. Some infections (Not HIV) are transmitted primarily by skin-to-skin contact or viral shredding ect which may infect areas not covered by a condom, such as genital herpes, human papillomavirus [HPV], etc.

So get STI screenings regularly if you are sexually active.

About PrEP, well as you know it's highly effective at preventing HIV when taken correctly, although, offers no additional prevention of other STI's.

[Jim Allen]

I'll add condom usage in short:

To reduce the odds of having a condom break during intercourse:

Use approved condoms, check for a certification mark (FDA, CE, ISO or Kitemark) as it means the condom complies with safety standards. Check the expiry date and make sure the condom is still within date.

Use lubricant, condom safe water-based lubricants makes condoms more comfortable and reduces the risk of breakage. – but avoid oil-based lubricants as they can weaken or break condoms.

As for putting the condom on correctly:

Incorrectly done, the risk of breakage can increase. Place the condom on top of the erect penis and pinch the teat at the end of the condom before you start to roll it down the penis. By doing this, you'll squeeze out any air bubbles and ensure there is room for the semen (cum). Roll the condom down to the base of the penis.

If it's on correctly, it will roll downwards easily. If you've started putting it on the wrong way, take it off, and even if you or your partner has not ejaculated (cum), there can still be semen or (pre-cum), so it's important to try again with a new condom. (More to do with risks from other STI's than anything else)

Hope this helps.

[funkytown93]

Last question, I promise lol. So I came back from that sexual encounter...no penetration (guy couldnt get it up). I took the double dosage yesterday as prescribed. Should I still take the two consecutive doses despite the lack of anal penetration, or can I just not take it?

I initially thought the latter option, but just making sure, because I don't know if not taking the latter two doses would fuck up my system or would affect the effectivity in future encounters since again, super new to the world of PrEP.

Thanks for the prior replies, Jim!

[Jim Allen]

So you don't have to take on-demand PrEP considering nothing happened. This will not impact the future effectiveness of on-demand PrEP.