Health : Negative On PrEP – Positive Undetectable
Hey guys, below is a comment we received few days ago when we announced that A4A was now offering “HIV negative on PrEP” as an option in your profile’s sero status. We thought about sharing it with you guys as a great piece of information. If you have any questions or comments, please add them below, I will try to get them answered. By posting this comment, I want people to understand more about HIV and how undetectable guys that are very careful with their medication are not to be scared of. I am not saying “let’s fuck bareback with random people even though they are poz!!!”, I’m saying that poz guys that are undetectable are wayyyy more safe than someone sexually active who got tested 2 months ago who wants to fuck you bareback. PLEASE use condom when you have sex though, because there are other STDs out there and some of them ARE VERY DANGEROUS! Now read the comment we received below:
“Before anything else, I am an MD.
The irony of this whole thing is that because of research findings of 0 transmission from undetectable patients even through unprotected sex, you actually have greater odds of getting HIV even from a person (maybe even with a condom on) who tested negative today (unless it was the PCR RNA viral load method: the same one that indicates real-time undetectable viral loads) than from having unprotected sex with a positive person on meds with undetectable load. Testing negative for HIV using the ELISA method (which is what most people get) only means you tested negative for the HIV antibody proteins, which takes an average of 3 months for most people to develop titers high enough of to be detected. That means your negative test today only indicates that you PROBABLY did not have the virus 3 MONTHS AGO, not today. So unless you absolutely had no sexual contact with anybody (not even oral) for the last 6 months (the maximum time in the window period), you are not guaranteed that you do not have HIV in your system right this moment even with a negative ELISA test today. And that only goes for the ones who got tested TODAY. There are much more who do not get tested regularly, if at all.”
“This is the reason why the WHO has decided, after being backed up by research, that Truvada in addition to proper/consistent use of condoms PLUS getting HIV-positive people treated to get their viral loads down to undetectable in combination is the best way to prevent transmission. 14% of positive people (and that includes people who tested negative with ELISA recently) in the US alone are estimated to be unaware of (or refuse to know) their status. Source: Dec 2014 from the CDC). And that is where the danger lies, NOT with the positive people on meds. It was 1 in 5 (20%) in Nov 2011.”
“The constant decrease in trend through time is good indication that we are headed in the right direction, it by no means lessens the danger of getting HIV from those unaware of their HIV infection. It would be prudent to emphasize again that they are THE primary source of new infections, not the on-treatment and certainly not the undetectable population.
A4A should be applauded for doing this instead of spreading irrational fear.”
Sources:
http://www.cdc.gov/nchhstp/newsroom/HIVFactSheets/Challenges/TooFewPeople.htm
http://www.medicalnewstoday.com/articles/238399.php
http://www.ncbi.nlm.nih.gov/pubmed/16791020
We just added this addendum from the same doctor :
I would like to clarify the “window period.” We develop the HIV antibodies within the range of 3 weeks to 6 months, although most people do within 3 to 6 weeks. However, the false-negative predictive value reaches its near-peak only within 3 months of the window period but, although rare, it could reach 6 months (when we could really rule it out precisely because of those rare instances, which you can never know for sure you are not a part of). This makes it reasonable for us to tell patients to reach back up to 3-6 months from the date of the testing to determine when exactly they may have gotten the infection if they got it.
There is a new 4th generation test, however, that detects the presence of HIV itself (not just the antibodies) through the detection of HIV’s p24 antigen in addition to the antibodies, which decreases the false-negative window period to 2 weeks.
Having said that, let us not miss the point to be made here: NOBODY should be considered “safe” to have unprotected sex with (and/or use Truvada for) including those who have tested negative recently precisely because of the window period and the limitations posed by the false-negative predictive values of the tests within a certain period of time. The only objective of the HIV screening tests (whatever the method) is to find out if you need medications, NOT to get the FALSE SENSE OF SECURITY that you are somehow “safer” to have sex with.
For further reading:
http://www.hivguidelines.org/clinical-education/hiv-qa-fact-sheets/window-period-for-hiv-infection/
http://www.cdc.gov/hiv/pdf/HIVtestingAlgorithmRecommendation-Final.pdf
To “K,” I guess it was because of how my post was edited to include the addendum that I posted later that you misconstrued the intent of the 2nd to the last paragraph. I did not mean that the HIV infection rate has been decreasing; I meant that the trend in the rates of those unaware of their infection has been. But I maintain that we should still be greatly concerned that it is still 14% instead of close to 0 because the closer we are to the latter, the closer we are to stifling transmission on its tracks.
I’d hope must people who’d get tested did so three months their last sexual encounter. I mean, what’s the point in getting tested otherwise? I mean it’s been proven that unless you have other issues, three months is like 99.9% chance you’re negative.
Of course it’s more complicated if they sex within those three months..
oh great, this is going to become another “nobody wants to have sex with me!” poz guy whinefest
“The constant decrease in trend through time is good indication that we are headed in the right direction, it by no means lessens the danger of getting HIV from those unaware of their HIV infection
My caseworker said that there increases in the infection rate for HIV or at the very least it’s leveled. I would like it if it was decreasing.
My only concern about the PREP designation is it still undoes all the good work about how to prevent HIV infection that does not involve costly medication — putting on a condom. Having an undetectable viral load is a blessing, but it’s still not to be taken as carte blanche to act irresponsibly or that contracting HIV is still not a very real event to be avoided. The men who are infected are not to be shunned; contracting the virus is to be avoided.
I hope PREP or any other splitting of hairs will not lead men into taking unnecessary risks. Remember PREP may be an option; you wouldn’t want to make taking Truvada or any other HIV drug a necessity.
Do not get lulled into a false sense of security. Put on a condom regularly.
I said the same thing in my post when you talked about truvada. It doesn’t mean screw whoever you want, but an extra step of preventing yourself from getting HIV. I been on Prep since it basically came out and my doctor recommended it for me and my now deceased husband (no he did not die from HIV). One thing I would also state is this. A person who hooks up with some who is on meds & HIV positive HAS LESS THAN 4% chance of getting the disease from that person than versas a person who took the test 3 months ago and you have about a 95% rate of getting it from him. Its about time that A4A posted something that is serious and I applauded you guys for promoting education, facts & not fear and paranorna.
I am HIV undetectable and finally published it this year after going two year’s with publishing nothing!My doctor’s have also informed me it’s better to know your status,and better than these dude’s who publish negative and haven’t even been tested!!!Sign me-UNDETECTABLE!!
I was diagnosed with full-blown AIDS 20 years ago most of my generation of gay men has been decimated by Aids. I’ve been very careful all these years and I can say I never passed it on. I find negative on prep .
Really hard to deal with. I’ve been undetectable for years. I’ve run into many bug chasers that have asked me to infect them with HIV.
Glad to say that I was able to get quite a few some real help.
But I am seeing so many guys that don’t know the facts. And are putting themselves at risk for other nasty stds . And don’t have a clue who is really infected or not guys say they are negative when they’ve never been tested .
For myself I still can’t have intercourse with somone negative even with a condom. Even if they are taking an antiretroviral medicine I just can’t do it.
Before anything else, I am not a doctor. But–
According to Dr. Trevor Hawkins of Southwest Care Center in Santa Fe, New Mexico, the average window period for detectable antibodies after HIV infection is about 30 days. A 90 day (3 month) window period is uncommon, and a 180 day (6 month) window period is rare. Stating flatly that the average window period is 3 months is just plain wrong as it defies statistics. Just to be on the safe side, it is recommended that people at risk operate under the assumption that they may be part of the 3% who actually take 3 months to test positive for antibodies, and that is sound advice. But again, the average window period is not 3 months, it is 3o+/- days. Get your facts strait, Doc. Misinformation does not help matters.
I appreciate Kevin’s post above so much. I am 49 and remain negative. After being paranoid about getting HIV in the 80s, I now realize it isn’t easy to get if you practice safer sex (otherwise I would be positive by now, God knows). I’ve had HIV+ boyfriends and random partners. For me the issue communication. I find it sexy when a guy knows what he’s about and that includes his knowing his HIV status. When I know what he is, I can make the decisions that are right for me. And if I am in a sexual situation where I can’t or don’t know a dude’s status, I assume he’s positive and have sex in the ways that feel good to me. I now get tested about twice a year but I’m no longer paranoid about it.
@Mike: From what I’ve read nobody on this topic is whining about not being able to find sex partners or about being HIV positive. Really, if you have nothing to contribute why waste your energy just to sound dismissive? And as you cannot tell who has HIV any longer just by looking, odds are most of us have had sex with a man who is HIV positive, or with a man who’s had sex with a man who’s positive. So those who are infected still get plenty of sex if they want it.
I still don’t understand why so many young guys 18-21 who
are trying to get the “bug” they are negative and search to take only poz loads..what is the deal with that?
Kevin
The average window is 3 months. That is what the National Institute of Health informs as a policy. I am talking about NIH and not some doctor in some university of this vast land. I dont think your reaction to disagreement is apropriate, and even less when dealing with these matters.
So, 90 days, not 30
I’m NOT a doctor, but someone who is open-minded and highly skeptical about the American medical establishment, which just happens to be the 4th leading cause of death in this country (taking drugs prescribed by your doctor).
If anyone bothers to look into authentic scientific research, instead of medical establishment propaganda, lies and fraud, you will learn HIV does not cause AIDS. HIV cannot cause AIDS. There never is enough HIV found in the body to cause disease.
Furthermore, the HIV-causes-AIDS theory violates Koch’s postulates–4 criteria designed to show a causative relationship between a microbe and a disease. The HIV latency theory–you get infected with HIV and then it might be 10 or 20 years down the road before you come down with “full-blown” AIDS–is totally BOGUS. For all other microbes, the onset of symptoms happens within days to a couple weeks–never YEARS down the road.
Unfortunately, fraudsters Robert Gallo and Anthony Fauci were highly successful in marketing the HIV-causes-AIDS theory out of fear and convinced HIV+ people they should take AZT and other anti-retroviral drugs to fight against HIV. Those who took these drugs long enough or took a large enough dose, unwittingly terminated their own lives. Remember the televised, passionate pleas of poor Kimberly Bergalis asking the medical establishment to do more to help save her life? If only she had stopped taking AZT, she could be alive and well today.
The thing that really amazes me is how many people who are more intelligent than me, and who have more years of schooling are content to just sit back believe whatever the medical establishment and corporate controlled media spoon feeds them. No questioning, no investigating, just buy it hook, line and sinker, even when it doesn’t make any sense.
Michael Summers, I wish all HIV+ men were like you. You have my total respect. If more were like you, there would be far fewer gay men contracting HIV today. Way too many gay men are getting HIV considering we know how to prevent it. It’s just inexcusable.
As for Prep, I considered it, but it is VERY expensive and it it can be hard on your body. They make you do a bone density test every few months. Sorry, but I’m not willing to risk my bones just to get boned!
I have been HIV+ for about two years now. I knew better, but I made the mistake of bareback sex “just a few times” and got it. Shortly after my diagnosis, I started meds and have been undetectable from a month after and ever since. Never missed a dose. But I think an important thing to remember that with this great news that undetectable people don’t transmit the virus, is that just like people will lie and say they are negative, they will also lie and say they are undetectable. Or they’ll say their negative and not really be sure, they’ll just as easily say they’re undetectable and not really be sure or even understand what that means. I’m all for PrEP, but, guys, take it from me — condoms are worth it. The stigma, rejection, and cost of HIV is NOT so simple as “I’ll just take a pill everyday”. And on a final note of my soapbox please remember that HIV is not the ONLY thing out there in terms of sexually transmitted infections.
No, Salvador33, the average is definitely NOT 90 days. The AVERAGE is 30 days, and spreading misinformation saying 90 days is the average time after exposure that antibodies can be detected is a falsehood propagated to scare people. So your response to my post is what is inappropriate, NIH claims notwithstanding.
Incidentally, Trevor Hawkins’ Southwest Care Center is a cutting edge HIV care facility in a town that has a large gay population. Dr. Hawkins is as knowledgeable about HIV as anyone. I know him personally, and I have discussed HIV transmission with both him and his staff at length.
From the Black Aids Institute website–
Joanne Stekler, M.D., M.P.H., associate professor in the Division of Infectious Diseases at the University of Washington’s Harborview Medical Center in Seattle says third-generation tests can detect infection on average about three to four weeks after exposure. Fourth-generation tests can detect the presence of HIV as early as two to two-and-a-half weeks after infection.
So it really depends on which test is administered, but most HIV testing facilities now use third or fourth generation tests, which are much more sensitive to HIV antibody proteins than the older first and second generation tests. Fourth generation tests detect HIV antigen proteins as well as antibody proteins. If you’re getting tested, it’s probably a good idea, for your peace of mind, to ask specifically what generation test is being administered and what the ACTUAL average window period is for the test.
all of this “prep/undetectable” information coming out out recently is completely irrelevant and absolutely dangerous if people fail to accept that there is a high percentage of men who flat out LIE in order to increase their chances of having sex. Perhaps even unintentionally (and I’m giving the benefit of the doubt, which I know is unwise), but I know from experience that it’s hard to think with two heads at once. How many of us have said “I’m negative. I got tested a few months ago” mere moments before an invitation to have bareback sex by someone claiming the same thing, when upon further reflection we know that it was more like 6 months ago or a year ago. Harmless miscalculation, we though, I’m probably negative, so what, we justified. Now, how many of us are HIV positive now. And on meds, though maybe not the best at remembering to take our meds at the same time every day, or let our schedule lapse now and then because we were cracked out or ran out before a holiday and couldn’t get a refill…? We know what it’s like to be rejected, and suddenly all of these articles start coming out saying there is no risk if the guy is UNDETECTIBLE. All of a sudden, viola! a solution to the rejection, and as an added bonus it can be bareback! Sure, I’m undectible…I think. Telling people you are positive is frightening, and now this UNDETECTIBLE business gives people hiv positive guys ammunition to soften the blow, and a perfect excuse to throw the condoms out the window.
Personally, I think having a line in your public profile stating your HIV status only helps to demonize or disillusion people, and it’s just as likely wishful thinking than truth. My profile doesn’t specify, because personally it’s nobody’s damn business unless I’m gonna stick my dick in them. And I reveal my health conditions only when asked or in person before my dick gets wet. There’s no reason anybody else needs to know, and since I have sex with probably 1% of the guys who look at my profile, why on earth do I need to broadcast it to all the gay guys in town? I know guys who list “negative,” and only after I tell them I’m poz do they say “oh, me too. But I don’t want people to know,” or “I’m a bottom so it really doesn’t matter.”
Men are LIARS. And, there are people out there that do not care. Hiv will continue to be diagnosed on guys, because there will undoubtedly be guys who lie, and two dudes who lie and say they’re neg and on prep will one day be two dudes who lie and say they’re undectible, the day they are diagnosed.
Let’s be real people! If you want to protect yourself, protect yourself. If you are on prep and wear condoms, then the hiv status of the rest of the people in the works is irrelevant and taken off the table,
To be honest…18-21 year olds want the virus as they see it as an easy income..SSI…not realizing the future ahead. HIV infected individuals did not “ask” to be infected and I applaud those that take care of themselves. And for those that don’t to shun them are just plain ignorant. Spread of HIV is largely mis-understood and education is a must. Love on the other hand is a choice…and just because someone is POS and you are not should not stop a true love bond…nor a safe sexual encounter. I personally want a lover forever…and a man who may be pos while I am neg does not not bother me. Love should be just that…love
Even more reason why the status option has become irrelevent. #removethestatus
I think the whole PReP thing and stating it on a profile is ridiculous. I feel that it is advertising that you can bare back. The thing is that HIV is probably the least STD to worry about. There are much more serious diseases that you can get. In fact, most HIV+ guys are also infected with herpes (HSV-1 & HSV-2) yet I see nothing mentioned about that on profiles. I have talked with people that have “On PReP” mentioned in their profiles and the they act like it’s a free ticket to BB. A couple of the guys that I spoke with didn’t even know what the medication was that they were supposed to be taking, nor what the cost was, so I am certain that they lying about it. I fear that just like + guys lie about being neg guys are now going to be lying about being on PReP. I think that we need to concentrate on using condoms each and every time, pure and simple! I think we need to teach people to treat everyone as if they were HIV+ and we would all have a lot less to worry about!
I’ve made it a point to stop getting ELISA tests. I now get PCR/RNA tests which are valid after 21 days. They cost a bit more, but at least I don’t have to deal with the window period. I make my partners get them too. I think these tests should be the norm.
Hopefully there will come a day we can finger prick someone in our living room and know their status with no window periods.
Any step towards education and away from shaming people is a good move, so I’m glad for this thread and for A4A’s attempt to spread accurate information. My concern is, as someone mentioned, PrEP will become the answer and not an option. A chemical that has to be ingested every single day should not be our only method of preventing new transmissions (not to mention the cost of maintaining a daily prescription medication). Especially since PrEP a) is not a cure, and b) does nothing to prevent other STIs. So, while promoting PrEP is certainly an important step, it doesn’t remove the need to educate people about safer sex, and it certainly doesn’t make those who are on it invincible.
Irrational fears and moralistic posturing seems to be the tone of most of these comments. And to the 20year Poz guy you don’t speak for most of us, u are non infectious, get counseling for Prep and don’t blame HIV,your a turns reinforce stigma as much as the irrational head in the sand neg guys. That said most of u are still missing the point.
UNDETECTABLE IS SEXUALLY NON INFECTIOUS.. PERIOD.
PrEP works at >96%. Condoms are 70% effective per CDC. Google “Dawn Smith condom efficacy CDC”
Hell, i got laid off and I am not able to gets meds. ADAP still not gotten back to me.
Sugar-coating a positive status with the word ‘undetectable’ in Adam4Adam, or promoting PReP by adding it to a status doesn’t stop the fact that the risk or contacting HIV is still out there.
I’ve noticed that most, A4A articles (and several disgruntled comments) regarding lack of ‘dating’ people with HIV+, blame people in negative status’ (mis)information, ignorance, fear, and lack of education. A scare tactic like that won’t convince someone that care about their well-being to engage sexually with someone they don’t feel comfortable with.
I feel anyone who believes in any kind of HIV/AIDS denialism, or those who do research by Googling or reading opinion blogs, is far more dangerous than any barebacker or hiv positive/undetectable person(s).
@Jay: You “MAKE” your partners get a more expensive blood panel before you decide to get sexually involved with them? I can see you probably don’t get laid a lot.
Seriously, this insistence on a man prying into every aspect of your sex life is the other extreme to men who sleep around indiscriminately, thinking HIV infection is inevitable.
As others have opined, AIDS gets all the press but there are a host of other nasty STDS that are becoming more resistant to treatment. Being on PREP or waiving around the latest lab report is still not the golden ticket that lazy gay men seem to crave not to use the head above their shoulders in every sexual encounter. It is only when we, as sexually active gay men, accept the constant responsibility for our sexual behavior that we can hope to stem the tide of HIV infection.
As for the voluntary information of being on PREP, every man taking HIV meds could tell the same half-truth; the meds are same. Men do lie to get who they think they want in the heat of the moment. Yet the biggest lie is the one we tell to ourselves. Nobody is exempt from taking precautions. Put on the condom! It’s cheap, very effective against ALL STD transmission, and — let’s be real — it’s also more hygenic.
I wish the note about oral sex was more than just half a sentence. I’ve had so many guys balk at using a flavored condom. Oral isn’t much safer than anal, especially if you are at either spectrum of the oral hygiene spectrum (brushing too often can leave the gums abraded while no care leaves them inflamed) which greatly increases your risk of infection, not to mention you can still get most of the other STDs in your mouth and throat.
If you have one night stands with strangers then you need to understand your risk for everything is higher. I’m not saying there’s anything wrong with that. It would be great if we didn’t have to worry about all this. But you need to be aware of the risks. You can get warts and herpes and chancroid just from a handjob – but I consider that to be low enough risk. Oral without a condom is too high risk for me. I don’t have health insurance and we don’t have free testing clinics in my area. I pay to get tested, but I think people of any orientation need to understand that oral still carries a non-trivial risk for HIV and other infections.
So people are actually willing to pay $1500 a month for PReP (Truvada), they are going to make sure that they take it everyday at the same time and expose their bodies to the side effects and long term risks associated with this medication (which we probably don’t know the long term effects of) but they are not willing to use condoms instead? I’m sorry, I’m just not buying it! This medicine requires a strict daily regimen and missing it one day isn’t acceptable. In fact, you have to take it the same time everyday with food! I think HIV status needs to be removed from profiles altogether and everyone should just treat everyone as if they were positive and not on medication! There is no need to give anyone a false sense of security…
We are moving to a world where someone who is engaged in care on meds that has suppressed the verima to undetectable levels and stays compliant has no legal moral or ethical reason to disclose their status to you because it is impossible for them to give you the virus. So all u hysterical neg guys that can’t understand this will b facing a world where ur partners hiv status is non of your fucking business 🙂 how u like them apples! Sign me formerly poz now none of ur business or was that negative to just shut u up 🙂
What? Hiv pos guys get SSI? REALLY? 100 percent disabled for a purely preventable condition? What freaking bizarro world did i just wake up in? Screw this..im going back straight and just play at home alone..so sick of getting screwed in bad ways for being a decent tax paying working man…fucking freeloading assholez….
Don’t get the 30 vs. 90 day debate. Unless your tested many times a year or are not having sex with different partners throughout the year, there exists the possibility that you could have been infected.
The emphasis should always be in knowing your status and realize that anyone could be potentially carrying HIV even if they have been “recently” tested (how can we really know how much a guy hooks up… it’s dangerous to believe that all horny total strangers are telling the truth and don’t just want to get in your pants). Therefore we should act accordingly, which means safe sex.
Realize that a POZ guy on his meds is probably less dangerous than the guy with many partners and an annual test is a good additional tool to use when making the decision to be with another guy.
prep is just stupid STD’s are up because of this and HIV will go up most likely Get it in your head guys… HIV Kills and this virus does kill… this pill totally undoes the education process and progress ..guys just don’t get it…I don’t care what medical people say.. it keeps them in business ..they are interested in making money
Bob, doctors don’t make money on pills…
first of all the writer DID NOT publish his name and he is a ‘doctor’? Why? if it’s there i didn’t see it. anyone can copy and paste and add links. fact of the matter is to educate YOURSELF, start with your own doctor. but the fact remains common sense prevails when it comes to sex. are ‘men’ really that ignorant when it comes to diseases?
Here’s SOUND ADVICE
I believe the everyone should understand what PrEP is before a clear discussion can occur here. PrEP means Pre-Exposure Prophylaxsis. PrEP is intended for people who are NOT HIV infected and maybe at high risk as defined by the CDC to prevent them from becoming infected with HIV. PrEP is NOT the same thing as ART therapy to suppress HIV in an individual who is already infected with HIV (HIV undetectable). More PrEP background information should be provided to blog readers to clarify any discussions placed here.
Breifly, these studies have many implications regarding ART therapy, i.e. when it should be started to prevent transmission. CD4 counts have been previously used to determine when ART therapy should begin. However, these studies may shed more light into this subject. It appears viral load maybe more appropriate to determine when to start ART for viral load suppression. Only 46% of people on ART achieved viral load suppression. Undetectable is defined as a viral load less than 20 copies/cubic mm. The PrEP study used a viral load of less than 200.
Nevertheless, PrEP is intended for individuals HIV negative and not infected. Whereas, ART therapy is for HIV infected individuals for viral load suppression.
Here is a link from the CDC so everyone can better understand PrEP, PEP and HIV positive undetectable status:
Quick helpful links to help for those with questions about what PrEP, PEP, and HIV Positive undetectable status:
http://www.cdc.gov/hiv/basics/prep.html
http://www.cdc.gov/hiv/basics/pep.html
http://www.cdc.gov/hiv/basics/livingwithhiv/index.html
Full website from the CDC on HIV:
http://www.cdc.gov/hiv/basics/index.html
HIV Testing Center Locator:
http://www.aids.gov/locator
Subject Matter Experts (SME) discussion of the PreP studies:
http://www.aidsmap.com/No-one-with-an-undetectable-viral-load-gay-or-heterosexual-transmits-HIV-in-first-two-years-of-PARTNER-study/page/2832748/
Subject Matter Experts discussion of the first study:
http://www.aidsmap.com/Treatment-is-prevention-HPTN-052-study-shows-96-reduction-in-transmission-when-HIV-positive-partner-starts-treatment-early/page/1879665/
A full journal publication on the HPTN 052 study (the first published study) by the New England Journal of Medicine.
The second study currently underway until 2017:
http://www.aidsmap.com/The-PARTNER-study/page/2407924/
In summary, PrEP means Pre-Exposure Prophylaxsis for those individuals HIV antibody AND antigen negative to prevent these individuals at high risk from becoming infected with HIV. This does not negate the fact that condoms should be used in addition to PrEP. But as we all know here, the choice to take that risk has been up to the individual. My opinion regarding HIV status, your HIV status should be confirmed by RNA testing for all sexually active(i.e. sexual activity within the past 3 months;6 months for those rare cases)individuals who want to be certain they are not HIV infected. Why? Because you should know your status for you own health and to prevent transmission of HIV. Get checked frequently if you are at risk as defined by the CDC.
Although, after careful selection, the initial PrEP study evaluated 1763 couples with one partner diagnosed as HIV-1 infected and the other partner negative. The study group was divided into two classes of couples who were having unprotected sex at various times with/without their partner during the study: 1) those diagnosed as a HIV infected partner with early ART(anti-retroviral treatment) therapy and a partner who was negative and 2) those diagnosed as a HIV infected with late ART therapy and a partner who was negative. During the study, there were a total of 39 HIV negative individuals who became HIV infected whose HIV infected partner was in either the early or late ART study arm. While 28 of the 39 were classified as linked to their HIV infected partner,7 converters were classified unlinked (not by their partner),and 4 classified in a different manner. However, only one negative partner in the early treatment arm clearly converted due to his partner. In this case, the previously diagnosed partner was on ART therapy for his HIV infection; however, his viral load was greater than 300 copies/cubic mm and the undiagnosed partner converted.
Excerpt:
In the immediate treatment arm the only verified transmission took place during the early months of treatment, with HIV antibodies fully detectable 85 days after baseline in the partner who became infected. The transmitting partner had a baseline viral load of 87,202 copies, and after 28 days a viral load below 400 copies/ml (Alcorn).
However, note that viral transmission generally occurred at viral loads less than this in the delayed-treatment arm.
Excerpt:
In the delayed arm, the median viral load (as measured at the last clinic visit) at which transmission took place was 4.9 log (approximately 80,000 copies/ml), while the median CD4 count was 391 cells/mm3 (Alcon).
Please everyone take the time to read the through the links I have provided above. Again, PrEP is intended for individuals who are not infected and at risk as defined by the CDC. ART is used for for individuals with HIV infection to suppress the viral load to an undetectable level. Also consult your doctors or Infectious Disease Specialist if your need to discuss this topic with someone for a full understanding of the implications of this information. Everyone needs to understand these terms IF adam4adam uses these designations.
References:
Alcon, Keth, nams,aidsmap,
http://www.aidsmap.com/Treatment-is-prevention-HPTN-052-study-shows-96-reduction-in-transmission-when-HIV-positive-partner-starts-treatment-early/page/1879665/
Accessed 03.07.2015
The problem is not the use of PReP or a virual load that is not detectable. The problem starts when individuals claim to be”cured” and then they begin practicing unsafe sexual acts. Multiple sex partners who may or may not be infected under the pretense that they have been “cured” somehow. This is the true underlying issue within our community. This is the point no one wants to talk about….Cures, low virual count, not dectectable, all false statements. CDC still maintains that once you are infected you are HIV Positive. Stop using the drugs, PReP and an individuals HIV status will quickly change. There is NO CURE for HIV infection.
Here’s my take on it. If you’re having sex, there is no HIV Neg. There is HIV positive, HIV undetectable, and I don’t know.
Arm yourself with the facts.
If you want to go a step further you should put negative on prep/undetectable in the same category. . . It would go along way to the destigmitization of hiv
@Mike…no one is saying cured here. The issue is forward transmission. TasP makes a poz guy neutered for forward transmission. PrEP prevents a forward transmission from taking hold, infecting a neg guy. Truvada which is FTC and TDF is currently being reformulated and TDF is being replaced by TAF. This reformulation greatly reduces the amount of drug needed and also greatly reduces the kidney and osteopenia risk. These drugs do not need to be taking at exactly the same time every day. There is a great deal of latitude, plus or minus 8hours is fine as long as u take them at least 95%of the time. Side effects are also minimal especially when taken with food, honestly a multi vitamin has more side effects.
Undetectable… U guys make it sound like it is the Holy grail of impossibility to achieve. Most guys who are on meds are undetectable and compliant, they have a much more vested interest in staying compliant than a guy of prep because their continued good health depends on it. So who are these 70%that can’t reach undetectable status? One interesting statistic is they are smokers. They are also substance abuse, mentally ill, closeted, or low income people of color in the south.
sorry but all this discussion is just stupid …common sense goes a long long way.. in response to Bob doctors don’t make money on this..sorry but you are wrong in the sense…overall just practice safe sex or get infected plain and simple guys will poo poo anything just to be hip or fit the current trend.. guys think they are cool for taking this more like FOOLS I do not care what people do but in general its just stupid
IS IT RELIABLE TO GET TRUVADA FOR PREP ONLINE, I KNOW AUSRALIANS ARE USING ONLINE PHARMACY TO GET GENERIC TRUVADA BECAUSE IN AUSTRALIA INSURANCE DOES NOT PAY FOR THE DRUG, TRUVADA IN USA IS MADE BY GILEAD AND IT IS 1300 DOLLARS A MONTH, IF U HAVE INSURANCE BUT IT DOESNT PAY FOR THE DRUG YOU CANT GET IT FROM GILEAD CHEAPER , THAT ONLY HAPPENS IF U MEDICAL, SO IF U HAVE A SHITTY INSURANCE U ARE KINDA STUCK..I AM AFRAID OF GETTING IT ONLINE BECAUSE ITS GENERIC AND MADE IN LABRATORIES IN INDIA ITS NOT FDA STANDARD… I THINK INSTEAD OF DISCUSSING SHOULD WE OR SHOULD WE NOT USE IT WE SHOULD DISCUSS HOW WE CAN MAKE IT AVAILABLE TO EVERYONE..
COME ON PEOPLE FINALLY THE CURE IS HERE… IT IS NOT AS DRAMATIC AS WE
ALL HOPED FOR LIKE A MIRACLE VACCINE.. IT IS SUBTLE .. BUT THEORETICALLY IF EVERY GAY MAN TAKES THIS PILL DAILY EVENTUALLY HIV CAN BE ERADICATED… IT IS A SOCIAL OBLIGATION!!!..
I’m confused. I thought we were talking about HIV- people taking PrEP and being able to put that in their status. Most of the comments have been about HIV+ undetectable status instead.
FWIW I was on PrEP until I last my insurance and I noted it in my profile when I had it. Now that I don’t, I removed it. I’m not interested in lying to get sex.
I never had any intention of stopping condom use while on PrEP. There are still other STIs that can spread that way, and personally I do find it more hygienic for anal.
I’ve discussed oral with professionals when I go in for testing at a local clinic (which I do multiple times year). They generally recommend condoms for oral too, again because of the other STIs that definitely can spread that way (oral transmission of HIV is hard to pin down methodically).
I’m not a fan, and I kind of feel the same about it that people apparently feel about bareback, but health is important, and if I didnt use one and caught something I will wish I had been more careful.
All that said, someone above said using PrEP was a lazy way out of taking responsibility for one’s sexual health. I don’t really understand that statement. You have to commit to regular testing, get referred by a regular doctor to an immunologist who will educate you on all the risks and concerns with the med and with STIs, you have to spend a significant amount of money for the med unless you have good insurance and the Gilead benefit (in US at least), and you have to commit to taking it as prescribed and getting checkups to watch for the side effects.
How is all that lazy? And what things should someone do to truly take charge of their health in your opinion?
Condoms are good but only when you use them properly and are careful to not use expired or heat damaged ones. Do people know about lubing yourself before you put one on to reduce the risk of tearing it? Do you get rid of condoms like that one you keep in your wallet or the car just in case?
Someone also pointed out that oral health is connected to all this. I’d like to add that brushing and flossing within an hour before making oral contact with someone exposes you to risk because of all the tiny cuts and abrasions in your mouth. (Don’t use that as an excuse to have bad breath before meeting up though 😉 just plan the timing better.)
So there are many things to consider in a sexually active life if you want to avoid STIs. Substance use can impair not only judgment about whether you should be having sex with someone, but whether you take the proper precautions such as the above concerns.
PrEP is just one of many tools to decrease risk from sexual contact, and it only specifically addresses HIV. I don’t think anyone should rely on it as their sole strategy for prevention, but that doesn’t mean it isn’t useful and that taking it isn’t a thoughtful and important decision.
Anyway, I think it’s good if A4A is making it easier to indicate that one is on PrEP, and if people have questions about what that means, the information is out there, on reputable websites or in the minds of healthcare professionals and well trained volunteers at clinics.