This is exactly what worries me about PReP. Overall is seems to be making a dent in the spread of HIV, but the reality is it lulls many into a false sense of security and implicitly blesses dangerous behavior. The history of humanity is plagued by virus epidemics — HIV is not a cure-all.
It's very effective however. I family member is doctor specialising in HIV, she says that with the current state of medication, if she had a choice between an HIV infection or diabetes, she'd take the former.
>A recent large epidemiological study showed that, for those diagnosed with HIV now, life expectancy is similar to someone who does not have the virus. The medical profession now considers HIV a chronic disease; it’s regarded in public health terms in the same category as, for example, type 2 diabetes. As a doctor I can tell you that, medically speaking, I’d rather have HIV than diabetes. While this might sound shocking or surprising, the facts speak for themselves: the prognosis for those with type 2 diabetes is much worse than for those with HIV.... For those with HIV, providing they take their medication, there are very few problems.
>Regardless of how well it is controlled, type 2 diabetes is a progressive disease, which results in the need to increase pharmacological therapies over time. A recent study conducted in Australia showed that, after six years, 44 per cent of patients no longer responded to oral medication and required insulin injections. Oral medications eventually fail in most people, meaning that injections are almost inevitable at some point.
>To put it starkly, the latest statistics show that because of Haart, HIV now no longer reduces your life expectancy, while having type 2 diabetes typically reduces it by ten years.
Some of the older drug combinations were very troublesome. They've gotten better and people live longer, yes .. but they could have a lot of long term toxicity that's hard to judge until we can study groups of people who've survived on them into their later years.
You can control and even reverse type-2 diabetes by cutting sugars and starches from your diet if you do it early and are diligent. HIV infections cannot be reversed. Once you have it, you'll likely be on drugs for the rest of your life.
I'm sure doctors (of all people) see the actual, real, progression of diabetes in real patients; not the hypothetical progression of the hypothetical diabetes patient who is able to never eat carbs again.
>but the reality is it lulls many into a false sense of security and implicitly blesses dangerous behavior.
There's very little evidence of this actually happening. I'd be curious to see your grounds for making such a bald and unqualified statement. Such statements are usually based not on evidence but on stereotyping of gay male behaviors.
I'm also gay - and know that gay men can also have prejudices against gay people.
The study you link to does not back up the claim in your original comment. It will take a great real more work to discover the overall health impact of PrEP. It helps no-one to spread unevidenced claims based on anecdata and prejudice. We currently have no clear picture of the effect of PrEP on condom use. It's extremely difficult to get reliable data on that kind of thing. And note that some increase in the spread of treatable and relatively trivial STDs is absolutely a price worth paying, if it comes to that.
There's probably a paralell universe where PrEP was invented before condoms, and people like you are complaining about the fall in PrEP uptake caused by the availability of condoms...
I don’t even know how to respond to your assertion that my personal experience is invalid because of.. prejudice? I’ve literally witnessed dozens and dozens of times people pressuring myself or my friends (or my friends pressuring others) into condomless sex because of PReP. That’s... invalid? Do I need to submit grindr screenshots, lol?!
What’s not backing it up? From the study’s abstract:
Pre-exposure prophylaxis use was associated with a significant increase in rectal chlamydia (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19-2.13) and an increase in any STI diagnosis (OR, 1.24; 95% CI, .99-1.54). The association of PrEP use with STI diagnoses was stronger in later studies. Most studies showed evidence of an increase in condomless sex among PrEP users.
It's not invalid, but it's only your personal experience, not necessarily indicative of broader trends. Grindr itself is a tiny slice of the MSM population.
There are lots of studies. The overall picture is unclear. And some increase in condomless sex combined with a wide uptake of PrEP could be a net positive.
Please—and I can't stress this enough—do not make up lies about this kind of thing. It's dangerous.
There is currently no evidence that PrEP "lulls many into a false sense of security". It's possible that the existence of a method that can effectively eliminate the risk of HIV transmission could cause a change in behaviour which exposes people to other, different risks. It is entirely far from clear that this is the case, or that if it were, then that there would still not be a net public health benefit.
PrEP is, FWIW, quite possibly more effective at HIV prevention than condom use is. It would plainly be ridiculous to be worried about the existence of condoms, because they were likely to "implicitly bless dangerous behaviour", and we have plenty of evidence that abstinence campaigns pushing this message are absolute failures.
I cannot disagree with you enough. I know from personal experience and that of my friends that frequently strangers are pressuring people into condomless sex strictly BECAUSE of PReP. And if you question it you’re told that you’re ignorant. The reality is no one wants to wear a condom, but they only do if they feel the need to. PReP removes this barrier for many because they feel that they’re still safe without one. I don’t have data I can point to, but between personal experience and at least a good understanding of the (coastal US) gay community, I have no qualms stating this is the case.
Again — I already said PReP was highly effective as a public health tool against HIV, but in doing so, we leave the door open to many new kinds of viruses that it doesn’t protect against given the lack of condom usage.
The problem is that you're spreading more fear around gay sex. Of course there's a higher risk of transmission of disease without a condom. It's not been my experience that anyone says, with a straight face, that you're ignorant if you want to use a condom in spite of PrEP.
But what is ignorant is to decide where other people's risk thresholds should be. You're right that no one wants to wear a condom. It's not a false sense of security to have condomless sex because of PrEP. It's real sense of security. People feel safer, and they are safer from HIV.
People are afraid of dying, and no one enjoys thinking about catching a death sentence when they have sex, especially sex that's been (and is) strongly stigmatized. If personally, you decide that extra security isn't enough, that is a great decision. If you want to think about the future, and the risk of catching a resistant strain of a bacterial infection, or some yet-understood (new kinds of) viral infection, that is totally okay! But I don't think it's okay for you to say everyone should think the same way.
It's hard to measure the "risk" of the anxiety caused by gay sex.
First, I’m glad that has been your experience. It hasn’t been mine, including friends who have been pressured into condomless sex. Being told you’re ignorant is a common tactic amongst the stories I’ve heard and texts I’ve been shown.
I’m not spreading fear. I’m looking at this history of viral epidemics and saying it’s foolish to think that now that we have PReP there’s no other way to die from sex. Does PReP stop Ebola? Or even bacterial infections that are antibiotic-resistent?
HIV in humans is only decades old. That’s nothing in the timeline of humanity. At some point in the future another terrible STD will come along. The history of viral mutations guarantees it. And PReP won’t be able to stop it, condoms might, but those on PReP will be vulnerable.
Again, is PReP making a big dent in the spread of HIV? Yes. Is it allowing some to feel ok about not using a condom where as they would have before? Absolutely. It’s “net positive” (no pun intended) for now... until the next scarier virus comes along...
"until the next scarier virus comes along..." is the part I call "spreading fear".
If you want to worry about Ebola, and use condoms because of a possible risk of contracting Ebola, I would say you have set your risk threshold at a place more conservative / risk-averse than pretty much every sexual adult, at least in my part of the world. Every interaction with another organism, whether it's a handshake or sharing the same air, carries the risk of transmitting something terrible and scary. And there are people who think about that, and probably have different standards for sharing drinks, or double dipping, or handshaking strangers, or whatever. Other people do not care. They will hug someone who has the flu. It's a personal call.
When someone has sex without a condom and takes PrEP, I argue they are not thinking "Oh good, there's no possible way I'm going to die." They are not even thinking "I will not get any STIs". They are thinking "Oh, good, I don't have to think about dying from HIV". That's not foolish. Your characterization is unrealistic and equivocates risk-taking with foolishness. You imply (say) that people are ignorant of the risks, as opposed to taking a deliberate risk. And I would be more careful before saying something so offensive and disrespectful. That's where I set _my_ risk threshold, at least.
Spreading fear? How about having an honest debate?
Let's see.. so far in this thread I've been accused of being prejudice against gays (ad hominem), had goal posts moved repeatedly from my original post, accused of having no data and when presented it's rejected without sufficient reason provided, had my own personal experiences negated as if they don't happen and when acknowledged they're minimized, and now apparently I'm a fear monger. Amazing what happens when you point out vulnerabilities in public health with PReP!
That's great for you that you're educated enough to perform rational risk analysis (assuming so given you're on HN) -- and you're willing to take the non-trivial semi-known long-term side effect trade offs. Plus you're honest with yourself about exactly what PReP is. However, that doesn't mean everyone follows. A diversity of education and logic-oriented thinking exists out there, yet sex is universal. I've personally heard individuals express that now that they're on PReP there's nothing to worry about so they can have condom-less sex worry-free, so I know this is non-zero. This is foolish.
I think it's dishonest to not acknowledge the risks and vulnerabilities of a large population on PReP. Please look at a short history of epidemics [1] and tell me we're somehow magically done. Ebola was an example of something that once was contained now spreading again. Drug-resistant Neisseria gonorrhoeae is classified as an urgent threat by the CDC [2], and isn't shared by a handshake (to my knowledge). And that classification is from 2013. What will 2025 look like? 2045?
Nothing about what I've said is saying we shouldn't have PReP. My original comment said it's made a big dent in the spread of HIV... hardly fear mongering. But it DOES make some portion of users feel safe to have condomless sex, and that creates new vectors that condoms were protecting against. Why is this so hard to acknowledge?
First off, you keep writing PReP, it's PrEP. No big deal, but it's hard to keep ignoring!
Yes, PrEP _allows_ (makes) many people to feel safe having sex without a condom. Yes, this shift can have consequences for the transmission of other diseases. It's not hard to acknowledge that. It follows completely that if there's a new outbreak, its transmission will be accelerated because people are having sex without condoms. I am not following your other postings on here, so I can't say if you think I haven't acknowledged those things, or what. I think you're talking about other people on this thread, in which case, why? Maybe something in how your expressing your thoughts feels really radical to you, but to be you've been expressing pretty obvious ideas. I can't tell if you got to this point after a previous disagreement, or if this is your baseline feeling about PrEP, but I will say if you just focus on the negative aspects of things that are already stigmatized, you're perpetuating stigma! And my push back on that doesn't mean the negative aspects aren't true (though we should always be dubious). It means I don't like your framing of the situation.
Disease is the cost of doing business. Getting down to business? You didn't like the handshake analogy, but think about all the different things we can do to mitigate the spread of disease. We do a lot of them! But we also share buses, go to big events, and we also have sex with each other. It's not wrong to do those things without worry. And it doesn't mean the risk isn't there, it just means you don't worry about it. It rubs me the wrong way that you decide what's foolish to worry about and not.
I don’t think I’m being radical at all, and I’m glad you agree with my points. If you read my original post, then you should agree with it. But there are quite a lot of replies against, and many disagreed that it would lead to less condom usage.
I don’t, however, believe I’m perpetuating stigma. I’m pointing out that new (to the world) strains of HIV are a perfect example of what worries me about a generation that feels a false sense of security. I’ve already watched previous generations die off, and I don’t want to see lessons lost. If you want to call my concern stigmatizing, we’ll then I wear that with pride.
We learned in the 80s/90s that safe sex meant condom use, and that did have a tangible impact. For those particularly at risk PrEP is great because condoms break. Abstinence is the only thing that’s 100% and it’s unrealistic. But removing condom usage because we think there’s no more diseases to worry about beyond HIV to me is foolish, and the evidence of the history of epidemics validates that.
How does it do this? From where I'm sitting it's a very necessary protection for groups that are currently at risk and definitely need protecting from these things, such as sex workers. Wearing a hard hat doesn't give blessing to accidentally dropping something heavy enough to kill without it, I fail to see how this is any different.
It comes from personal experience. People feel like everything else is treatable so if HIV is prevented than they’re all good to take off the condom. Can’t tell you the number of times I heard this from friends about their own behavior, from people trying to have sex with me, and from others trying to have sex with my friends (condomless).
I don't think it's fair to make that claim at all without data. This is the same argument that religious people use against sex education and condoms and it has never held water before.
Don't seatbelts encourage dangerous driving then? Don't vaccines encourage poor hygiene? Time and time again scientists have invented something that makes life drastically safer and time and time again they've been a huge net positives.
It doesn't make any logical sense to me and I've never seen any compelling evidence that this causes it to be a net negative.
I guess the question is, is the PrEP-protected infection rate among people having unprotected sex while on PrEP, lower or higher than the not-protected infection rate among those who would have unprotected sex even without PrEP?
It's lower. You're safer having unprotected sex with someone who is confirmed to have HIV but is taking PrEP, than you are when having unprotected sex with someone whose status is unknown.
> You're safer having unprotected sex with someone who is confirmed to have HIV but is taking PrEP, than you are when having unprotected sex with someone whose status is unknown.
PrEP is for hiv negative people.
If you’re virus level is undetectable from treatment, then you’re not contagious.
It's a rather academic distinction given that it's the same drugs in either case. Definitionally, it's PrEP only if those drugs are being taken as a preventative measure.
This is an actual distinction. At present PrEP only means Truvada. Truvada is not effective alone for treating HIV. It would be taken in combination with another drug. Also, There's a newer alternative to Truvada that is preferred/less toxic for HIV treatment, but is not yet approved for PrEP. To be clear there are many more drugs used for HIV treatment that are not used for PrEP.
Again, we’re not talking about HIV. We’re talking about all the other potential viruses (including those known and still mutating). To think that we’re done seeing new fatal STDs is to ignore the history of biology and epidemics.
It sounds like it's not a new strain per se, since it was tested on blood stored from 2000, just that it's a new technique to use on that amount of virus.
[0] https://journals.lww.com/jaids/Abstract/publishahead/Complet...