Hiv And Today

[9038421]

As a doctor in the UK I have several friends who work in genitourinary medicine and the one statement close friend is hearing from gay men is that today they believe HIV is harder to transmit and therefore take more risks. She pointed me to a study conducted in Australia which also highlighted this very statement. What’s your views?

Gay men having unprotected sex think that having HIV is still a big deal, but that it’s now harder to transmit.

References
Prestage G et al. Is Optimism Enough? Gay men's beliefs about HIV and their perspectives on risk and pleasure. Sexually Transmitted Diseases, online ahead of print, 2011. (Free abstract here).

Prestage G et al. Pleasure and Sexual Health: The PASH Study. National Centre in HIV Epidemiology and Clinical Research, Sydney, 2009. (Free full text here).

 

[RiverTrevor]

As I understand it, if you are on effective anti-retroviral medication then you are not infectious. However, there lies an issue, how do we know who is, and who is not, on effective treatment. In someways I think the medical professional are their own worst enemy for promoting the idea of zero transmission while on effective medication - seems to imply it's ok to have sex with anyone.

 

[9038421]

As I understand it, if you are on effective anti-retroviral medication then you are not infectious. However, there lies an issue, how do we know who is, and who is not, on effective treatment. In someways I think the medical professional are their own worst enemy for promoting the idea of zero transmission while on effective medication - seems to imply it's ok to have sex with anyone.

Very true, unfortunately my friend had unprotected sex with a guy in Spain who said he was HIV positive but on treatment. He wasn’t. I completely understand the U=U but the condom push of the 80’s with the government “don’t die of ignorance,” really drove down infection rates and the gay community did so well. I just feel today the younger guys have forgotten that terrible decade and not realising the dangers. We had a patient who had latent syphilis which damaged his brain and he was honest, he thought he was safe on Prep as HIV is the only STI he worried about. He died last year at 43.

 

[RiverTrevor]

I think there is another angle to consider - mental health. Sometimes promiscuous sexual behaviour can be driver by an underlying 'need' to self-harm and to even lead one to become so ill that they die. Unless a person understands the route to the cause of that behaviour then it does not matter how much advice or publicity or information they are given, that desire or need will continue.

 

[Infernal]

There is such a gap in what I experienced as a man in his 50's coming of age in the late '80s and what younger guys experience today. They didn't live through the early '90s where there were funerals every day of the week, and sometimes more than one on Saturdays. Friends dropped dead one after another, and many of them suffered horribly. Now you have magazines advertising PreP and showing men with beautiful bodies who look to be in perfect health. For many of them, there is a very carefree attitude of - I can take a daily pill, fuck as much as I want and I'll be fine. If I get it, I can just take a few pills and be fine. They may not be spreading HIV, but are they living as healthy as they could be? It's not up to me to tell anyone how to act. I just choose to protect myself in every way I can.

Treatment is far advanced from what it was, and I hope that there will be a cure within my lifetime.

 

[9038421]

There is such a gap in what I experienced as a man in his 50's coming of age in the late '80s and what younger guys experience today. They didn't live through the early '90s where there were funerals every day of the week, and sometimes more than one on Saturdays. Friends dropped dead one after another, and many of them suffered horribly. Now you have magazines advertising PreP and showing men with beautiful bodies who look to be in perfect health. For many of them, there is a very carefree attitude of - I can take a daily pill, fuck as much as I want and I'll be fine. If I get it, I can just take a few pills and be fine. They may not be spreading HIV, but are they living as healthy as they could be? It's not up to me to tell anyone how to act. I just choose to protect myself in every way I can.

Treatment is far advanced from what it was, and I hope that there will be a cure within my lifetime.

Yes, very true. I’ve spoken at length with a few colleagues about a vaccine for HIV none of them think it will work as it mutates some frequently and HIV is terrible at replicating it’s own DNA. Plus, treatment allows someone to live as long as a normal individual so the drive isn’t there like it once was.

My friend has had 8 guys who have deliberately infected themselves with HIV through unprotected sex, I think it’s incredibly sad to want such a life, a life that has caused so many around the world to suffer and die a horrible death. Whilst Prep is great news, we should still be advocating condoms. In the American trial subjects were told to wear condoms and Prep was the backup. On the UK IMPACT trial it was only available to men who had unprotected sex.

 

[SeagullDeluxe]

Too many people use PrEP as an excuse to stop using condoms, even when they fuck with strangers. It's a pretty harmful misconception, because it doesn't protect from other STDs and they don't get it. One of my former friends quickly snapped out of this mentality when he tested positive for gonorrhea.

 

[9038421]

Too many people use PrEP as an excuse to stop using condoms, even when they fuck with strangers. It's a pretty harmful misconception, because it doesn't protect from other STDs and they don't get it. One of my former friends quickly snapped out of this mentality when he tested positive for gonorrhea.

Correct, we had a patient would caught syphilis from unprotected sex and he had it for several years leading to paralysis and other neurological problems. You get gay men come into clinics and tell nurses and doctors the only STI they worried about was HIV. Prep has dealt with that threat, all the rest can be treated with a pill. It’s shocking to think all the work gay men and the government did in the 80’s has gone out the door. During my junior doctor years I spent 6 months in Sierra Leone and watching young people dying of aids was heartbreaking. It’s a horrible disease.

 

[Infernal]

As I understand it, if you are on effective anti-retroviral medication then you are not infectious. However, there lies an issue, how do we know who is, and who is not, on effective treatment. In someways I think the medical professional are their own worst enemy for promoting the idea of zero transmission while on effective medication - seems to imply it's ok to have sex with anyone.

Now that's the question, isn't it? I've seen so many sides of this. My husband is HIV positive. I am not. He's undetectable and we've always used condoms because we are not monogamous. He once told someone that he's negative and on PreP. I jumped all over him for it. Just because he's undetectable and sticking to his medication doesn't mean he's negative. I reminded him that if he says that, he's lying to his sex partners. Undetectable may mean that it can't be transmitted, but it doesn't mean someone is negative. Unfortunately, this seems to be a very common thought among those who are undetectable. For many years I was reluctant to PreP because I'm diabetic and Truvada is rough on the kidneys. I've had kidney issues in the past and I don't want to make things worse. After a very lengthy conversation with my Dr and others in the practice, I started on Descovy for PreP. Basically, I grilled them until they answered all of my questions and I was reassured that the possibility of kidney issues is minimal. The two big reasons for starting it are this - condoms break, and even though I'm rarely a receptive partner I'm not taking the chance, and men lie. Intentional, or not, I'm not taking the chance. I'm not even that sexually active outside of our relationship, but there's no piece of ass hot enough to put my life at risk.

 

[9038421]

Now that's the question, isn't it? I've seen so many sides of this. My husband is HIV positive. I am not. He's undetectable and we've always used condoms because we are not monogamous. He once told someone that he's negative and on PreP. I jumped all over him for it. Just because he's undetectable and sticking to his medication doesn't mean he's negative. I reminded him that if he says that, he's lying to his sex partners. Undetectable may mean that it can't be transmitted, but it doesn't mean someone is negative. Unfortunately, this seems to be a very common thought among those who are undetectable. For many years I was reluctant to PreP because I'm diabetic and Truvada is rough on the kidneys. I've had kidney issues in the past and I don't want to make things worse. After a very lengthy conversation with my Dr and others in the practice, I started on Descovy for PreP. Basically, I grilled them until they answered all of my questions and I was reassured that the possibility of kidney issues is minimal. The two big reasons for starting it are this - condoms break, and even though I'm rarely a receptive partner I'm not taking the chance, and men lie. Intentional, or not, I'm not taking the chance. I'm not even that sexually active outside of our relationship, but there's no piece of ass hot enough to put my life at risk.

Yeah the risk of kidney damage is low with Prep, I think kidney function is checked once a year so it’s low risk. True, no guy is worth your health. Unfortunately many seem to think a hot guy is worth the risk.

 

[MancmanMatt]

The risk of kidney damage with PrEP is just as low as with most other HIV medications. The trouble isn't in the short term, it's in the long term. If you have HIV you have no choice but to take your medication. If you're taking it as a prophylaxis then you can stop any time your kidneys start to show trouble.

One of my mates has HIV and has lost one of his kidneys to the meds.

He was on Truvada + some other stuff. It was the Truvada that killed his kidney. Truvada is the medication they prescribe for PrEP as it's the only one that has the research behind it towards its efficacy. Descovy is still undergoing its trials and Covid isn't going to have helped that progress. Descovy is basically Truvada mark 2. Better at doing it's job so they can reduce the concentration of one of the drugs in the pill 10x. It's a lot easier on the Kidney's but has only been shown to be as effective as Truvada in treating HIV patients, not when used as PrEP. Of course there's every likeliness that it's going to be as good as Truvada as a prophylaxis but we need more data.

You cannot take Truvada if your kidney function is compromised so Descovy makes the most sense. It's likely to be as effective as Truvada when used as PrEP and will definitely be better than taking nothing.

My HIV+ friend was swapped onto Descovy once his kidney died. Why he wasn't swapped way before that happened I don't know and I blame the health service.

What I do not understand is why anyone taking PrEP would think it's giving them protection for any other STD. It's clear this is to prevent HIV infection and nothing else. Here, in the UK, when you get PrEP on the health service it's done in combination with a sexual health clinic. You have to have regular sexual health screening and blood tests to monitor your kidney function. You don't end up with an undiagnosed STD that kills you off, like was mentioned above. You could always buy PrEP from an independent source and then it falls on you to educate yourself and do what needs to be done. But if you're going to be buying, and taking, a powerful drug you should be educating yourself. If you don't, and you die, well that's your own damned fault.

Back when I was educated about HIV, at school, it was taught as a death sentence. Drugs will prolong your life but you will die from HIV. Today this hasn't changed. It's true that the drugs are capable of suppressing the virus to the extent that it won't be HIV that kills you directly, but the drugs take their toll on the body. Sure HIV won't kill you but the effect of the drugs will. You might still live until retirement age but the drugs will shorten your lifespan.

The kids are no longer afraid of HIV. It's no longer taught as a death sentence. Quite rightly so. But nevertheless I can't help but think that they do still need to take the disease more seriously. Just because we can treat it more effectively doesn't mean you can go bareback across the country because you like being loaded with cum, but that's what they do. Of course not everyone thinks this about it but there's a much more casual attitude towards it than there once was.

As far as I'm concerned nothing has really changed. What was important then is still just as important now. Educate yourself and keep yourself protected from the disease. Fail to do so and you'll suffer in one way or another. Either from failure to test for other STDs when on PrEP, or from the HIV medication itself.

 

[liamhunter]

Before taking the medication you should know where and what telomeres are. Why telomerase keeps telomeres long. What reverse transcriptase inhibitors do. How cell senescence affects organisms