Jonathan Higbee's picture

S.F. Gay Men Are Ditching Condoms In Favor Of Truvada

The results of a new survey conducted by Kaiser Permanente have become a cause for concern in the healthcare community. 

First, the good news heralded by the report: among those who take Truvada to prevent the risk of HIV infection during sex "there has been no increase in the number of their sexual partners and no new HIV infections." 

The celebration of that headline has been tempered by one of the preliminary survey's worrisome findings. A 45 percent subset of PrEP users have reported using condoms less during sex since beginning preventative treatment. Truvada may shield more than a 90 percent of a risk of HIV infection during sex, but abandoning condoms leaves users exposed to other sexually transmitted infections. 

As the San Francisco Business Times points out, the larger picture is more opaque. "It represents only self-reported condom use by a subset of about 90 PrEP patients in the Kaiser program."

"We can't say how that applies to the entire group of people on PrEP," adds Dr. Brad Hare, director of Kaiser San Francisco's HIV care and prevention program. 

Instinct spoke briefly with Dr. Hare Wednesday to clarify more of the preliminary report's results, and he revealed the following:

  • This was done for clinical care, and not yet analyzed in a scientifically rigorous manner
  • We don't have information on what demographic of patients reduced condom use (e.g, was is primarily among men in serodiscordant, monogamous relationships, or among those with multiple partners), to waht decgree condom use decreaed (100% to 0%, 10% to 0%, 100% to 90%), and in what circumstance condom use decreased (all times, just with primary partner and not with other partners).
  • We don't have a 'control' group, so we don't know how condom use may change in the absence of PrEP 
  • We don't have results over mutliple time points, so we don't if this change will be sustained

Michael Weinstein, AIDS Healthcare Foundation president and an early, controversial critic of Truvada as PrEP, trounced on the report. "Why would men take this medication if they intended to use a condom? It's utterly predictable."

Despite Weinstein's continued criticism, there is much deserved praise surrounding Truvada as a HIV prevention routine. 

"The main point that should not get overshadowed: PrEP is prescribed to prevent HIV infections, and it appears to be working in our population," Dr. Hare told Instinct. "Among >500 MSM prescribed PrEP with over 200 person-years on treatment, we have seen no new HIV infections."

"The reasons people are coming in are different," he added. "People are seeking PrEP because their friends are on it and they're sharing stories about it changing their lives. Patients are coming in and saying, 'It must be for me, too.'"

(Updated with Dr. Hare interview and the direct data he provided Wednesday at 1 p.m. est)

Comments

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Tenvir-EM (Generic Truvada) is used for HIV Prophylactic and also as treatment of HIV.
Tenvir-EM is manufactured by Cipla leading pharmaceutical in India. The cost is much cheaper than original pill.  

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Gayness is the disease...Throwing gays in pits of molten lava is THE cure!

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Shucks, You know that molten lava is not really that available. Also 'gayness' is not an official disease per the CDC, NIH, and all medical providers. It is a sexual orientation. You sound like Jenny McCarthy with her comments on needlessness of vaccinations. @heterosruleearth The only 'cure' to all this 'gayness' is to educate the ignorant like you. May you be loved by all gays when they see you. 

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Come here, I`ll fuck your silly straight face. So straight, you read Instinct. 

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LISTEN UP,  MR. FAG MCNASTY!

I'm here doing God's Work to attempt to convert you wretched, godless, demon dogs from Hell into NORMAL Hetero folk who can be accepted by society!

While it IS true that Gays are Evil and Shall Be Destroyed by the All-Consuming, Soul-Evaporating Hellfires from whence ALL Gays emerge...I am fighting a war to save lost Gay Souls before they are sentenced to have their souls torn asunder by the Satanic Master that you now serve!

You CAN rise UP against this disgusting faggotry and become respected people in today's society.  The Choice is YOURS:  Be Forever Despised or Honorable Citizens!

 

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OMG! I agree! You are fighting a losing war on your misinterpretation of your understanding of the bible.

Those poor folks you have not even met in person yet prejudge and condemn.

Have fun with that!

I hope your New Year is full of fabulous amazing homosexuals willing to accept you for your lack of acceptance and ignorance and show you what freedom of rights is all about. 

God Bless Your Soul!

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I attempted to use Truvada, and unfortunately had bad side effects.............but even if I didn't, I won't ditch my condoms quite yet. It's been hard enough to get the education on prevention into the community's head now it's going to be the easy way out...............look we have always been smart individuals.........dumb when it comes to sex (like everyone else) let's try to keep the intelligence rate up at least until we have brought down infections..........they are still to high......I hope and pray we (everyone gay and/or straight) find a peace and keep fighting and not give in quite yet on the "Safe Sex" practices............best wishes, love and joy to all of y'all

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Do none of these Truvada believers understand the concept of "Russian Roulette" ?  90% effective ?? That a 10% chance you're going to be infected with HIV at some point !!  What idiots. Not to mention the slew of other sexually transmitted diseases that are on the rise because of this nonsense. Unbelieveable.

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Has anyone mentioned that taking PrEP is likely to make people more honest in reporting their condom use? People lie when the stakes are high. TakingTruvada lowers the stakes, so the truth about condom can come out. We may not be "ditching" condoms at all (a needlessly inflammatory headline) but rather more accurately reporting our previously undiscussable behavior.

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I don't know WHY this is STILL being debuted in this day n age guys. It's simple - HIV is contracted through bodily fluids (semen, blood, needles etc). Unprotected sex IS going to get you HIV+ there is no 2 ways about that. Popping a pill instead of using condoms? #laugh - Also, saying HIV is a hoax? Dude please, your body may be fighting the virus because you are using ARVs. Stopping the meds WILL increase your viral load it's just a matter of time.

I am open and honest about my status and whether the dudes want to use a condom or not it's their choice - but with me, no condom, no sex. Irrespective of using Truvada. I will not make myself vulnerable to a new strain. My viral load is undetectable and it's taken me 1,5 years to get it that why by taking my Atripla (to me, that's my miracle drug LOL) - Guys it's simple, take the 15 seconds and put on a condom.

Safety first -

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One more thing; Do you not believe in medical advancements? Why can't there be a pill or a shot or some other kind of medicine that would give immunity from HIV? Despite what vaccine opponents say, they work! My uncle would have been first in line for the Polio vaccine. Unfortunately it came too late for him and he spent more then half his life as a paraplegic. And my husband would have been first in line if there was PrEP back in the early 90's if it was available back then.

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First of all, get with the times. No reputable medical organization refers to non-condom sex as "unprotected". It is referred to as "barrier free sex". Being on PrEP is considered safer sex. Safer then condom sex actually. "Popping a pill" builds up protection within the body making  the chances of being infected 1% or less. If you are using condoms then your chances are 20% or more for infection.

The CDC, WHO & the FDA all endorse PrEP. The only organization that apposes it is AHF which has a financial reason for promoting condoms only. They receive millions in grants every year from condom companies.

There is no evidence of a Truvada resident strain of HIV. And someone being on PrEP would not contribute to that since program participants are closely monitored.

Approximately 50% of new infections are reported for people who say that they are using condoms. But, condoms break or are not put on correctly. Or in most situations participants have had a few drinks or other substances and are not using their best judgment to say the least. There has not been a single case of seroconversion with anyone who is taking PrEP 4 or more times per week. And if you are in an "impaired state" you don't have to worry about being unprepared.

I agree, Safety first! I am on PrEP and I have taken full responsibility for my sexual health and safety.

Ignorance is not bliss in this case. But knowledge is power!

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HIV is a Hoax !  I have  tested positive in 1990  and I have always been healthy !  I discontinued antiretroviral therapy  in 2005 . 

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I really hope you don't actually believe that. Are you aware of the estimated 39 million that have die of it? And the 1.5 million a year that still do? Some people who maintain a healthy lifestyle can control the virus for long periods even without meds but discontinuing your antiviral treatment will increase the levels of virus present within your system. This puts not only yourself but others you are in intimate contact with at much greater risk.

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Its a Hoax and a billionaire business  !  Not because  I want to believe that  but because that´s what I have  concluded in these 24 years living 100% healthy with this  supposed virus  . I  had friends that died and I have many other that are still alive , paranoia and AZT killed most of them !  These days people die when they discontinue antiretroviral treatments , not because the virus advances and  causes Immunodeficiency but because the medication causes mutations and kills you when you stop taking it.   I recommend you to make a more exhaustive research on what the scientific comunity of   HIV dissidents and denialist say,  Maybe the  the secret to my longevity is that  I discontinued  truvada and reyataz  . and Im no longer being intoxicated ! I defied my doctor orders and the system and I'm healthier then ever !

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"exhaustive research" - HAHAHA, fucking good one! Where do you find these researchers? youtube? Hahaha!

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Nobel Prize in Medicine ... not the mainstream media you pay attention to !

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I really think you should keep getting your CD4 count checked even if you're not going to take the meds. Without the antivirals you will eventually fall ill. I'm no millionaire or pharma company owner just someone who is concerned for you.

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We still need to use condoms, if we want to be extra careful.

Now my question is, when is it going to be available here in the philippines and how much will it coz us?

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Straight guys have bareback sex all the time and put up with the risks of other STDs.  Why are gay men expected to be any better when HIV is not the issue?

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Because there isn't an epidemic of HIV positivity among straight people. 

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"other than HIV".  I said.  If prep is taking care of HIV, then gay men are pretty much in the same boat as everyone else for the other STDs.  And they don't use condoms!

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that is not true strait people are at risk for HIV at the same rates as Gay people were the heck did you get that gem 

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You're using wordplay. Either way you're incorrect, but no one is talking about infection "rates." Gay men, by far, consist a disproportionate population of those who are HIV+ compared to those who classify as being straight. Gay men are only 2% of the population, yet make up 20% of the new HIV infections. It is an epidemic among gay men, and it's getting worse because gay men have stopped being careful. 

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HIV is easier to transmit via anal sex, there have been many studies on it and there is a lot evidence out there. Its why our community was hit so hard by the epidemic. 

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Theres an alternative for that,  called  Epivir Hbv is an antiviral medication used to fight infection with the human immunodeficiency virus (HIV). And Sustiva is an antiviral medication to treat immunodeficiency syndrome (AIDS) or to prevent its development.

Visit:   www.DrugsinCanada.com

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I need to look into these. I unfortunately had elevated liver enzymes while taking truvada so I was taken out of the study. They are also working toward an injection that is taken monthly or every 3 months, something like that.

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It angers me when people think these numbers aren't accurate or aren't reflective of what is actually going on in the community. Yes it is true that this isn't a scientific study and based on surveys but again, it's difficult to enroll enough to participate in a quantitative scientific study to follow a large cohort of gay men. I am certain if you extrapolated this small sample, it would represent or mirror the actual population in some fashion. 

Truvada is not the answer and puts many at risk for contracting other diseases such as Hepatitis or Herpes. 

And let's face it, this only gives the younger generation an excuse to have bareback sex. I can't count how many times men have propositioned me to have bareback sex and claimed it was alright because they are on Truvada. It is very frightening that this isn't being addressed, and I fear younger men will be peer pressured into this behavior.

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I get what you're saying... But I don't think peer pressure is something to place a high concern on. The bottom line here is something that won't change, no matter what "pill" or "preventative" options the future may hold... sex is ALWAYS a risk. Especially for the bottom. It's no different than a straight girl, or even a straight Man. Sexual intercourse always carries a risk. We need to stop putting the focus on gay men. It's 2015, it's not just gay men traveling with this disease 

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Your assumption that extrapolation is an effective way to achieve accurate findings is incorrect. Too many variables enter in. Be angered if it pleases you. However, the numbers aren't reflective, no matter how much you may desire them to be.

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Also this article does not mention how many of these men were is a committed serodiscordant relationship (one partner positive and the other negative) and therefor only using PrEP to prevent HIV infection. As this is a big use of PrEP and many of the early up takers were serodiscordant couples I would imagine these men could  make up quite a chunk of this 45% Fact is that there are very few facts here. Stigmatization helps spreads HIV as well as condomless sex. Be informed use all the precautions you can.

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OK lets face truth here.   

First, this was definitely not a Scientific Study that was done merely a simple questionnaire done in an informal fashion and is not indicative of any true statistical data in the City overall.

Second, the fact is I would bet very good money, having had many good times in San Francisco with lots of friends there that the reality is that the vast majority of those polled in this survey had always been having condomless sex to begin with.  The only difference now is that they are least taking some responsibility for their sexual health by starting PrEP and being more honest with themselves and their partners about their sexual habits, which of course is a good thing.    

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LOL! And I guess readers can trust your "good times" experiences more than KP's survey results. 

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There's no "study" here. No baseline. No change over time. No before PrEP / after PrEP. All anecdote. 

Which isn't to say it won't happen. It might. But the evidence we have from valid research sources like AIDSMAP is that condom use has declined over the last decade and, depending on the study and how the question is asked, may not occur nearly 50% of the time. Outside of a general downward trend, it's difficult to be more specific.

http://www.aidsmap.com/Condom-use-in-the-real-world/page/1746225/#item1746220

None of that, though, should be seen as a reason to disfavor the use of PrEP, a drug 99% or more effective at reducing HIV transmission AND that requires consistent, quarterly STD check-ups.  The last part alone is above and beyond what most sexually active people receive and one of the most effective ways of identifying and treating disease as it happens.
 

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I have been living with this disease for nearly 20 years now, why would anyone not wear a condom is just stupid. My seroconversion was to do to a broken condom and not by silliness or laziness. After many a different drug cocktail combination, finally got it so I can function normally. Don't believe for one minute that Truvada, as wonderful as it have been for me and others, is the miracle pill or should be treated as that. Use your brain and not your dick. Think!

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Agreed. Same applies to my contraction. A super happy 30th birthday to me, eh?
It is nuts how truvada and its other combo partners took me from death to healthy, undetectable, and functional.
I have since moved onto stribild, which has had tons of side effects, but still has truvada in it. HIV is not cute, nor gone. It never will be. Wise up people!

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Please explain to me why this is not a miracle pill? 99% or better effectiveness? Sounds like a miracle. Plus, your own story is the perfect reason for a negative person to be on PrEP. Condoms break and at best only have an 80% effectiveness at preventing HIV transmission during anal sex (most studies show lower effectiveness). I think 99% beats 80% every time!

I also wonder what makes you such an expert that you can say "Don't believe for one minute that Truvada, as wonderful as it have been for me..."? What studies have you done? What research are you quoting from?

My husband has been positive for 24 years (that he knows for sure) and he is on Truvada. He researched PrEP when I started thinking about going on it. He agreed that it is a great thing. When a person starts thinking about being on PrEP it is not something that he/she can just go to their Dr and get it. There is counseling and conversations first, then testing and more conversations before you can get the recommendation. After that you are tested just as often for liver/kidney issues as someone that is poz and on the same meds. In addition to that it is mandatory to get STI tests every time you get blood work ups. If anything, someone on PrEP is more aware of their sexual health then anyone else. How many people do you know that get HIV/STI tests every 3 months?

BTW, I was one of the 500 men that were polled by Kaiser. It was a thorough poll and there was no reason to not be honest since my Dr had asked all of these questions before he approved me for the program.

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Because it's not 99% effective. Even if it is, are you seriously going to put your trust in a drug that has sometimes severe side effects, is known to harm your liver, that is horribly expensive, that you can't see working? Since when do we put so much trust in drug companies? What liability do they have? Zero. Trusting Truvada alongside condom use is the only thing to do until HIV rates become miniscule. Not using a condom is just idiocy on so many levels. 

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Anyone that believes this to be true isn't having sex in SF.
Easily 90% of the partners I have had (and there is a lot of them) in the last year didn't care if I, as a top, wore a condom. Many were not even on Truvada, they are just lazy and complacent, and take HIV status at what I told them....

I didn't have sex with many of them as they refused when I wanted the condom... the fact that 45% MORE would be going condomless can't be accurate, as these are people that weren't before. At least they are taking some precautions now.....

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