7 ms·

Cost and compliance are still 2 major factors that have not been solved. We also have education and stigma. While within the LGBT community it is far more comm

by nerdjon 2mo ago

Cost and compliance are still 2 major factors that have not been solved. We also have education and stigma. While within the LGBT community it is far more common to be open about status and taking prep and doxy (far from perfect though), it still feels like outside of that the conversations are not happening as much as they should. Throw in doctors that are not being proactive about the conversation. Right now it seems like having prep and doxy is largely considered only if you are engaged in "risky" behavior (not saying that in a judgmental way to be clear), instead of just being sexually active and protecting yourself. Money and investment alone won't fix that, that is a societal shift around how we talk about sex. That is also before we get into the cost issues in many other countries just for those that do need it.

bluGill 2mo ago
PReP has some side effects. While they are rare, they are things you need to be aware of. If you are not doing risky sex it isn't for you. Most people want to believe they are in a monogamous relationship and thus not having risky sex - even though they are the one cheating. Either PReP needs to be more common, are people need to stop their risky sex activities (that they are not even admitting to).
- nerdjon 2mo ago
  > If you are not doing risky sex it isn't for you. That blanket statement I very much disagree with. Sure there are side effects but that is part of why you also get tested every 3 months for liver issues (not that it is the only side effect, but still). Instead of it being a blanket statement it should be a conversation with your doctor about the pros and cons. You can still get HIV even if not engaging in risky behavior. Same with people getting pregnant when they did not intend too. I am thinking college kids that are still figuring out their sexuality and exploring new things. You're going to make mistakes so having a conversation about prep with your doctor is a really good idea.
  - bluGill 2mo ago
    I don't see how you are disagreeing. We are both saying that a lot more people are having risky sex than think they are.
    - nerdjon 2mo ago
      I guess it depends on what we call risky, I mean if someone is actively trying to get pregnant are we considering that "risky"? Someone could be taking the necessary precautions and a mistake happens, a condom breaks, whatever. Someone could have sex with one person in their life and they got it from that person. I would not consider that "risky" in any real sense of the word. Any sex carries some amount of risk, and the key is being risk aware and not assuming that just because you are not engaging in what is generally deemed "risky" that you are safe. Instead you should be having that conversation with your doctor and determining what your risk tolerance is. That is where I disagree, how many people are positive that never considered themselves engaging in risky behavior. To me it is very dangerous, and leads to the situation we are in now, to just say only even consider prep if you are engaging in risky behavior.
      - bluGill 2mo ago
        Someone trying to get pregnant is most likely to be low risk since odds are good they have a specific partner in mind and are having enough sex that they don't care to stray. Not always but in general There are many pregnancies that result from one night stands and those are high risk, but only rarely was pregnancy a goal. Also HIV spreads most often from anal sex. Someone trying to get pregnant is less likely to get HIV just because of how they are having sex and so lower risk. (Not zero though, don't rely on statistics with your life of your partner has HIV) The topic here is HIV risk. Obviously getting pregnant requires unprotected sex, but the risk of HIV is about sex with someone who has it.
  - Telemakhos 2mo ago
    You are extremely unlikely to get HIV from anything other than risky sex. That's what "risk" means: it's another word for "probability," just a probability of negative outcomes. These probabilities are known: https://www.aidsmap.com/about-hiv/estimated-hiv-risk-exposure https://www.aidsmap.com/about-hiv/estimated-hiv-risk-exposur... Some of that table is already mitigated: we test blood for HIV, so transmission by blood transfusion is unlikely. Transmission by pregnancy is less likely simply because few women have HIV: 80% of new cases in the US are male, 20% female. The real question is whether "having a conversation about prep with your doctor" is going to lead to someone caring enough to pursue a prophylactic course of medication when that same person doesn't care enough about his own health or others' to avoid risky sexual encounters. Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen? Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place. A "really good idea" depends on a level of self-control that some people obviously lack.
- simonask 2mo ago
  All sex is risky by this measure. Condoms break. Partners lie. Shit happens. It doesn’t take a lot for the risks to far outweigh any potential side effects. As far as I’m aware, every healthcare system in the developed world either recommends or enforces checkups after starting PrEP.
abirch 2mo ago
Compliance is the big thing. Vaccines are the "an ounce of prevention is worth a pound of cure"
Saline9515 2mo ago
[flagged]
- neonstatic 2mo ago
  > But I guess that sex without condoms is worth it, right? Not speaking about LGBT related matters; Sex without condom is just like everything else - it depends on the person. For some people there is little to no difference. For others, wearing the condom removes all sensation, reducing the act to physical exercise. So is sex without condoms worth it? For some people, yes, it is.
  - tigerlily 2mo ago
    And still others may be allergic to LaTeX.
    - deleted 2mo ago
      [deleted]
- matthewmacleod 2mo ago
  Any solution to a public health problem that involves moralising about how groups should change their behaviour is not only doomed, it’s actively counterproductive. And doxycycline is a PEP treatment, not a PrEP treatment; respectfully you should probably take a step back from conversations where you obviously aren’t informed about the basics.
  - Saline9515 2mo ago
    The solution to the STD epidemic was moralizing teenagers to tell them to put on condoms. I was told personally several times in sex ed, biology classes and on-the fly by teachers and adults that condoms were not an option for casual sex. It worked. Regarding PEP/PreP, Doxy has been researched and shown effective as PreP as well: https://www.sciencedirect.com/science/article/pii/S1201971224002571 https://www.sciencedirect.com/science/article/pii/S120197122... I have met doctors that recommended it to gay men, which is why I mentioned it.
gib444 2mo ago
PrEP is freely available in the UK and there is almost no requirement in practice of engaging in risky sex. I don't know anyone turned down for not having risky enough sex Which countries are you talking about out of curiosity?

by nerdjon 2mo ago

bluGill 2mo ago

PReP has some side effects. While they are rare, they are things you need to be aware of. If you are not doing risky sex it isn't for you. Most people want to believe they are in a monogamous relationship and thus not having risky sex - even though they are the one cheating. Either PReP needs to be more common, are people need to stop their risky sex activities (that they are not even admitting to).

nerdjon 2mo ago
> If you are not doing risky sex it isn't for you. That blanket statement I very much disagree with. Sure there are side effects but that is part of why you also get tested every 3 months for liver issues (not that it is the only side effect, but still). Instead of it being a blanket statement it should be a conversation with your doctor about the pros and cons. You can still get HIV even if not engaging in risky behavior. Same with people getting pregnant when they did not intend too. I am thinking college kids that are still figuring out their sexuality and exploring new things. You're going to make mistakes so having a conversation about prep with your doctor is a really good idea.
- bluGill 2mo ago
  I don't see how you are disagreeing. We are both saying that a lot more people are having risky sex than think they are.
  - nerdjon 2mo ago
    I guess it depends on what we call risky, I mean if someone is actively trying to get pregnant are we considering that "risky"? Someone could be taking the necessary precautions and a mistake happens, a condom breaks, whatever. Someone could have sex with one person in their life and they got it from that person. I would not consider that "risky" in any real sense of the word. Any sex carries some amount of risk, and the key is being risk aware and not assuming that just because you are not engaging in what is generally deemed "risky" that you are safe. Instead you should be having that conversation with your doctor and determining what your risk tolerance is. That is where I disagree, how many people are positive that never considered themselves engaging in risky behavior. To me it is very dangerous, and leads to the situation we are in now, to just say only even consider prep if you are engaging in risky behavior.
    - bluGill 2mo ago
      Someone trying to get pregnant is most likely to be low risk since odds are good they have a specific partner in mind and are having enough sex that they don't care to stray. Not always but in general There are many pregnancies that result from one night stands and those are high risk, but only rarely was pregnancy a goal. Also HIV spreads most often from anal sex. Someone trying to get pregnant is less likely to get HIV just because of how they are having sex and so lower risk. (Not zero though, don't rely on statistics with your life of your partner has HIV) The topic here is HIV risk. Obviously getting pregnant requires unprotected sex, but the risk of HIV is about sex with someone who has it.
- Telemakhos 2mo ago
  You are extremely unlikely to get HIV from anything other than risky sex. That's what "risk" means: it's another word for "probability," just a probability of negative outcomes. These probabilities are known: https://www.aidsmap.com/about-hiv/estimated-hiv-risk-exposure https://www.aidsmap.com/about-hiv/estimated-hiv-risk-exposur... Some of that table is already mitigated: we test blood for HIV, so transmission by blood transfusion is unlikely. Transmission by pregnancy is less likely simply because few women have HIV: 80% of new cases in the US are male, 20% female. The real question is whether "having a conversation about prep with your doctor" is going to lead to someone caring enough to pursue a prophylactic course of medication when that same person doesn't care enough about his own health or others' to avoid risky sexual encounters. Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen? Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place. A "really good idea" depends on a level of self-control that some people obviously lack.
simonask 2mo ago
All sex is risky by this measure. Condoms break. Partners lie. Shit happens. It doesn’t take a lot for the risks to far outweigh any potential side effects. As far as I’m aware, every healthcare system in the developed world either recommends or enforces checkups after starting PrEP.

abirch 2mo ago

Compliance is the big thing. Vaccines are the "an ounce of prevention is worth a pound of cure"

Saline9515 2mo ago

[flagged]

neonstatic 2mo ago
> But I guess that sex without condoms is worth it, right? Not speaking about LGBT related matters; Sex without condom is just like everything else - it depends on the person. For some people there is little to no difference. For others, wearing the condom removes all sensation, reducing the act to physical exercise. So is sex without condoms worth it? For some people, yes, it is.
- tigerlily 2mo ago
  And still others may be allergic to LaTeX.
  - deleted 2mo ago
    [deleted]
matthewmacleod 2mo ago
Any solution to a public health problem that involves moralising about how groups should change their behaviour is not only doomed, it’s actively counterproductive. And doxycycline is a PEP treatment, not a PrEP treatment; respectfully you should probably take a step back from conversations where you obviously aren’t informed about the basics.
- Saline9515 2mo ago
  The solution to the STD epidemic was moralizing teenagers to tell them to put on condoms. I was told personally several times in sex ed, biology classes and on-the fly by teachers and adults that condoms were not an option for casual sex. It worked. Regarding PEP/PreP, Doxy has been researched and shown effective as PreP as well: https://www.sciencedirect.com/science/article/pii/S1201971224002571 https://www.sciencedirect.com/science/article/pii/S120197122... I have met doctors that recommended it to gay men, which is why I mentioned it.

gib444 2mo ago

PrEP is freely available in the UK and there is almost no requirement in practice of engaging in risky sex. I don't know anyone turned down for not having risky enough sex Which countries are you talking about out of curiosity?