Condoms while on PrEP?

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    Nov 23, 2014 11:08 PM GMT
    About the author: Howard Grossman, M.D., is the director of AlphaBetterCare, an LGBT-friendly primary care provider serving New York City and New Jersey. An HIV physician and researcher for more than 20 years, Grossman is also a senior attending physician at Mount Sinai Roosevelt Hospital.



    "Let's face the fact that everyone hates condoms! We hear a lot about gay men not using condoms these days, but how many heterosexual men are using them if their female partners are on birth control? Are doctors counseling that all of their straight patients need to use a condom every time in every situation, now and forever? You know they're not. But that's the only message we've had for gay men for a long time. It's a message that was vital in the days when we had no other tools, had unreliable testing and did not understand transmission well. It's a message that saved countless lives. But now it's a message that pathologizes gay sex and fails to recognize that people are making reasonable and rational choices about risk. Now we have PrEP and treatment as prevention (TasP).


    To those who say they would use a condom, I say that is the way they then need to handle every unknown hookup."

    http://www.thebody.com/content/75205/do-hiv-negative-gay-men-need-condoms-if-theyre-on-.html?ap=2004

    Pathologizing gay sex is, of course, a form of stigmatization. I await Art Deco and Sydney's rants of "You must be stopped!" "You are a Danger!" "Cut out like a cancer!" etc. for further stigma and insults.

    Better yet, save your hyperbole comments to the author. Please write back with his reply.
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    Nov 23, 2014 11:13 PM GMT
    Sydney, please note this comment is from an Australian Doctor


    Comment by: Dr Clovis Palmer (Melbourne, Australia) Mon., Nov. 17, 2014 at 10:27 pm EST
    I agree with the analysis of Dr Grossman overall and they are reasonable comments. The only point that I am not in complete agreement with is that EVERYONE hates condoms. Many persons also us it for sanitary reasons especially in resource constrained homes or places without the luxury of douching facilities. Sometimes one sences that PrEP is being promoted as THE alternative rather than 'AN" alternative. Not necessarily in this nicely written and fair commentary but in other media-sphere. Thus another question is, what is the added benefit of PrEP for those individuals where condom is the preferred choice? Most men would hate the symptoms of PrEP such as, diarrhea (albeit not very common), which could turn PrEP-using participants in full circle. Based on recent data perhaps a caution regarding bone demineralization, and hence the use of vitamin D/calcium supplements may be another point of discussion between patients and their health care providers.
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    Nov 24, 2014 1:18 AM GMT
    I really don't care to be honest and won't be adding anything to this forum. Your a BB advocate through and through and be aware that Sydney siders are always suspicious of a Melbournian agenda. Go ahead Timm55 and educate us all into STI carriers
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    Nov 24, 2014 1:24 AM GMT
    Sydneyrugbyjock73 saidI really don't care to be honest and won't be adding anything to this forum. Your a BB advocate through and through and be aware that Sydney siders are always suspicious of a Melbournian agenda. Go ahead Timm55 and educate us all into STI carriers


    Another agenda! lol
  • Posted by a hidden member.
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    Nov 24, 2014 2:52 AM GMT
    Of course you didn't read the article I posted, did you?


    The STI Issue

    "Of course, there is always the STI issue as well. If someone has an infection in the urethra with a discharge and burning, most would assume that person would not be having sex with others. Unfortunately, most anal infections (and oral ones too) are asymptomatic. So people are unaware that they are infected and will continue to have sexual encounters. Using a condom for intercourse when you're hooking up with people will definitely reduce your risk of acquiring an STI."

    The STI issue as well, as in a different issue. People like you, who bring up STIs as a negative to TasP and PrEP, are muddling the issue.

    There is a cure for STDs. There isn't a cure for HIV. Since only 47% of Gays use condoms. 53% have "condomless sex." CDC to Stop Using "Unprotected Sex" for "Condomless Sex"
    "The change in language is long overdue. The new language reflects current advances in biomedical, treatment as intervention, viral suppression and more. Perhaps once upon a time, all condomless sex was viewed through a lens of heightened risk for HIV. That is no longer the case. Men and women are using PrEP and antiretrovviral therapy, for instance, as tools to substantially lower their risk. What if you are on treatment and have an undetectable viral load? That is a new 'protection' that thankfully has become available."
    http://www.hivplusmag.com/research/2014/02/13/cdc-stop-using-unprotected-sex-condomless-sex

    If you don't understand the distinction, then you will never understand the eradication of HIV.
  • RunnerMD

    Posts: 157

    Nov 24, 2014 12:59 PM GMT
    "Doctor, now that you've put me on Lipitor can't I just skip all the worrying about what I'm eating now?"

    Obviously whether to wear a condom or not is situationally dependent. Are you in a monogamous relationship? Sure go for it. Are you in an open relationship with occasional playing? You may want to take a precaution because you don't know what you are starting to dip into a pool of people that have a much higher probability of having STDs. You doing weekly or daily hookups off of Craigslist with strangers or Manhunt? You probably want to because not only will those people have a far greater probability of having an STD and a good chance of not only being HIV+ but not being in active treatment to keep viral loads down.

    The "but the don't tell heterosexual couples to do it" is a false equivalency. If you were in a completely monogamous relationship and had been for a long period of time the doctor would probably say you can ditch the condoms. Since most gay guys are not in that arrangement, whether they are in a relationship or not, the are going to get the advice that straight people would get: use a condom when you have sex.
  • tj85016

    Posts: 4123

    Nov 24, 2014 1:34 PM GMT
    keep believing you don't have a disease you can't spread through various mucus membranes moron, it's the sign of a sociopath
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    Nov 24, 2014 4:27 PM GMT
    RunnerMD said"Doctor, now that you've put me on Lipitor can't I just skip all the worrying about what I'm eating now?"

    Obviously whether to wear a condom or not is situationally dependent. Are you in a monogamous relationship? Sure go for it. Are you in an open relationship with occasional playing? You may want to take a precaution because you don't know what you are starting to dip into a pool of people that have a much higher probability of having STDs. You doing weekly or daily hookups off of Craigslist with strangers or Manhunt? You probably want to because not only will those people have a far greater probability of having an STD and a good chance of not only being HIV+ but not being in active treatment to keep viral loads down.

    The "but the don't tell heterosexual couples to do it" is a false equivalency. If you were in a completely monogamous relationship and had been for a long period of time the doctor would probably say you can ditch the condoms. Since most gay guys are not in that arrangement, whether they are in a relationship or not, the are going to get the advice that straight people would get: use a condom when you have sex.



    Brilliant. Thanks.
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    Nov 24, 2014 4:59 PM GMT
    The straights "don't get it" either. I constantly remind my straight buds that getting a girl pregnant is the least of their worries. Also, wtf is up w/chicks letting a dude put their dick in them w/o a rubber on unless they are in a "monogamous" relationship. WE all know how many dudes are on the DL either closeted or bi and taking huge risks w/their and their partners sexual health. Straight male partners are just as dishonest and sneaky, cheating, lairs as gay ones can be.

    I don't know any guys who couldn't use help in lasting longer and wasn't PreEp designed/intended to be used WITH a condom to further lower risks of HIV transmission?

    Typical human behavior. Take a pill and it'll solve all the problems. NOT!
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    Nov 24, 2014 9:15 PM GMT
    RunnerMD said"Doctor, now that you've put me on Lipitor can't I just skip all the worrying about what I'm eating now?"

    Obviously whether to wear a condom or not is situationally dependent. That is problem with condoms all the time. Got one on you now? PrEP is another layer of protection. Are you in a monogamous relationship? Sure go for it. Are you in an open relationship with occasional playing? You may want to take a precaution because you don't know what you are starting to dip into a pool of people that have a much higher probability of having STDs. Yep, as stated, use a condom, but again PrEP is another tool in the toolkit of HIV prevention. And a partner who is Undetectable. But there are TWO issues here STDs and HIV. You doing weekly or daily hookups off of Craigslist with strangers or Manhunt? You probably want to because not only will those people have a far greater probability of having an STD and a good chance of not only being HIV+ but not being in active treatment to keep viral loads down. <<<Your more likely to get HIV from someone who says he is negative and hasn't been tested.

    The "but the don't tell heterosexual couples to do it" is a false equivalency. If you were in a completely monogamous relationship and had been for a long period of time (that is the equivalency, if in fact the straight couple is monogamous and long term also) the doctor would probably say you can ditch the condoms. (That's what he said!) Since most gay guys are not in that arrangement, whether they are in a relationship or not, the are going to get the advice that straight people would get: use a condom when you have sex.(Equivalency again! Again as the Doctor said!) (Condoms) saved countless lives. But now it's a message that pathologizes gay sex and fails to recognize that people are making reasonable and rational choices about risk. Now we have PrEP and treatment as prevention (TasP).


    There's no question that condoms are great at preventing STDs. PrEP and TasP are great at preventing HIV (condoms too). None of them prevent the common cold....so are they not useful? Introducing STDs is another issue. As is introducing the common cold. It muddles the discussion by introducing irreverent (to HIV) issues.

    If this was 1990 and we had these medications to stop and prevent HIV there would be no question about taking them. It was something we literally prayed for.

    One message that I really welcomed is the acknowledgment that we (Gays) pathologize Gay sex. If we can be equal by getting married, why do we have to be 2nd class in bed? Should everyone have condomless sex? NO, of course not. But now people can make reasonable and rational choices about risk.
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    Nov 24, 2014 9:23 PM GMT
    tj85016 saidkeep believing you don't have a disease you can't spread through various mucus membranes moron, it's the sign of a sociopath


    Calling someone HIV Undetectable a moron and a sociopath is blatant stigmatization, because you don't agree with me...or science.

    This level of stupidity doesn't exist in the real world. Why is RJ so infected? Write to the Doctor, call him a moron and a sociopath. Or Dr. Fauci. Or the CDC. Or WHO.

    As to your assertion that I have active HIV in semen or other mucus membranes:

    IHS (Isolated HIV Shedding) became progressively less common with an increasing duration of effective ART, with no IHS seen beyond 3 years of ART. We hypothesize that the size of the genital reservoir may decrease over this period in the absence of productive virus replication, as has been seen in both the blood and gut reservoirs of individuals receiving ART.

    [url]http://www.pfizerpro.com.co/sites/g/files/g10013506/f/publicaciones/042013%20V207I8-%20Impact%20of%20Antiretroviral%20Therapy%20Duration%20and%20Intensification%20on%20Isolated%20Shedding%20of%20HIV-1%20RNA%20in%20Semen.pdf[/url]


    Read more, learn more. I've been undetectable for 10 years.
  • Posted by a hidden member.
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    Nov 25, 2014 2:30 AM GMT
    "If some people want to take PrEP and still use condoms, I salute their choice. They will be the safest among us. "


    Howard Grossman, M.D., is the director of AlphaBetterCare, an LGBT-friendly primary care provider serving New York City and New Jersey. An HIV physician and researcher for more than 20 years, Grossman is also a senior attending physician at Mount Sinai Roosevelt Hospital.


    THE WISEST WORDS OF ALL.
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    Nov 25, 2014 2:57 AM GMT
    Determinate said"If some people want to take PrEP and still use condoms, I salute their choice. They will be the safest among us. "


    Howard Grossman, M.D., is the director of AlphaBetterCare, an LGBT-friendly primary care provider serving New York City and New Jersey. An HIV physician and researcher for more than 20 years, Grossman is also a senior attending physician at Mount Sinai Roosevelt Hospital.


    THE WISEST WORDS OF ALL.


    No question it is the safest.

    But his takeaway line is in his closing comment:

    Moving the Message


    "PrEP is a game-changer in so many ways. I think one of the biggest changes is that we can reasonably start looking at risk in various types of sexual encounters. With real data, we can help people to begin to think about their risk in very clear ways. Perhaps, if our message moves from "you have to use a condom in every situation now and forever" to "there are definitely times when using a condom will work to reduce your risk in significant ways, but there are situations where not using a condom is a reasonable choice," we may be able to improve outcomes, improve sexual decision-making and lower new infection rates."

    Using condoms is hardly a game changer (still good advice to many applications). It's always been my contention that if you don't address the 53% who don't use condoms, the epidemic will never end. PrEP and TasP does exactly that. That's why they are a Game Changer.
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    Nov 25, 2014 3:22 AM GMT
    Game changer yes. Gay men become pawns for Big pharma now and forever.
  • RunnerMD

    Posts: 157

    Nov 25, 2014 3:32 AM GMT
    I'm fascinated by the people who think that asking people to wear condoms means we are telling them to not go on PrEP. Everything I see is people asking people to continue wearing condoms even if they are on PrEP. Why is that a controversial position?
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    Nov 25, 2014 8:47 PM GMT
    Alpha13 saidGame changer yes. Gay men become pawns for Big pharma now and forever.


    Except PrEP isn't "now and forever" it can be stopped at any time. Say you get in a relationship, both are tested negative, stay monogamous and go off it. No big deal. There's also a French study of "PrEP on demand".

    If you are POZ and don't go on antivirals, you will probably develop AIDS sooner or later, and are still VERY capable of spreading HIV in the meantime.

    If I've been a pawn all these years, well, I'm grateful!

    At some point soon I expect gene therapy to become the norm.

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    Nov 25, 2014 9:04 PM GMT
    RunnerMD saidI'm fascinated by the people who think that asking people to wear condoms means we are telling them to not go on PrEP. Everything I see is people asking people to continue wearing condoms even if they are on PrEP. Why is that a controversial position?


    The Dr. in the article above is saying some can go without condoms while on PrEP.

    Julio Montaner two YEARS ago said : “So I’m perfectly comfortable to tell people that if you want to go forward and have, for example, unprotected sex while you are being protected by antiretroviral therapy, that is perfectly acceptable. On the other hand, you need to know that in the process of doing that, if there was a breakdown in adherence for example, you put yourself at risk. As long as you are willing and able to live with that kind of small risk, I’m perfectly happy to live with it.”

    “Some people, they want to be 100% sure that there is no risk. So they are not very comfortable with this kind of approach. What I usually tell people is look, if you think wearing condoms is the way to go and you are happy to advise and counsel people that condoms are as good as safe sex, I think you should be fully comfortable with advising fully suppressed individuals on HAART that they are as well protected as when using condoms, if not better protected. If they are concerned and want to use HAART and condoms, that would be even more protective. But that’s a judgement that fully informed couples should make.”


    It's not controversial to me, but if you don't read data from the last several years there's a real disconnect.

    But then there are people like Michael Weinstein and Larry Kramer who are adamantly against PrEP. I've read their opinions and it makes no sense to me....and most people in the HIV medical field.
  • Sincityfan

    Posts: 409

    Nov 27, 2014 6:26 AM GMT
    Don't people still bareback even when not on prep anyways?
    Grindr guys all say "safe only" yet when the time comes they're more than willing to go bare.
    Even with Prep+condoms I'd still be uneasy when it comes to having sex with a poz guy.
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    Nov 27, 2014 8:50 PM GMT
    Sincityfan saidDon't people still bareback even when not on prep anyways?
    Grindr guys all say "safe only" yet when the time comes they're more than willing to go bare.
    Even with Prep+condoms I'd still be uneasy when it comes to having sex with a poz guy.


    Then don't!

    Don't be be too easy when someone says they are Negative either. You should know about those odds by now.
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    Nov 27, 2014 9:09 PM GMT
    You can contract HIV while on PrEP. The chances aren't as "slim" as some of you seem to believe.

    It happened to a good friend of mine. I'm sure he's not the only one it's happened to.
  • Sincityfan

    Posts: 409

    Nov 28, 2014 6:41 AM GMT
    timmm55 said

    Then don't!

    Don't be be too easy when someone says they are Negative either. You should know about those odds by now.


    Which is why I ask for valid documentation up front.

    credo saidYou can contract HIV while on PrEP. The chances aren't as "slim" as some of you seem to believe.

    It happened to a good friend of mine. I'm sure he's not the only one it's happened to.


    Only idiots believe that.
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    Nov 28, 2014 11:58 AM GMT
    Upon reviewing the profiles of some of the fools posting in this thread - I'm curious as to why the HIV positive ones are promoting condom-free PrEP sex.

    Hmm ... I wonder why these guys would want us all to think PrEP was bullet proof.

    Weird.

    There are plenty of sites out there with information that validates the type of information that "only idiots believe." To all of you considering PrEP, do your own research; don't take direction from anybody who tells you that PrEP is 100% effective. It isn't!

    http://www.hivpositivemagazine.com/Prep.html

    ...the FDA approved Truvada for PrEP along with using condoms and other prevention methods. PrEP is not 100% effective on its own, and in clinical studies people used condoms with PrEP. In the best-case scenario people would use condoms as much as possible while taking PrEP. Anyone being prescribed PrEP can get free condoms through Gilead, the company who makes Truvada.


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    Nov 28, 2014 6:50 PM GMT
    The Human Race is what will destroy the Human Race through blatant stupidity and sheer ignorance.

    Wear a fucking condom. It's not hard to do and there's no good enough excuse not to. Get regularly tested and know who the fuck you're fucking. That simple. Men in general (particularly gay men) have the worst habit of having no control over their sexual urges and it shows.
  • Sincityfan

    Posts: 409

    Nov 28, 2014 7:50 PM GMT
    credo saidUpon reviewing the profiles of some of the fools posting in this thread - I'm curious as to why the HIV positive ones are promoting condom-free PrEP sex.

    Hmm ... I wonder why these guys would want us all to think PrEP was bullet proof.

    yup yup.
    only 16% of gay men always use condoms, yet 99% of the gay men here claim they always use them. hmmmm....
  • Posted by a hidden member.
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    Nov 28, 2014 8:10 PM GMT
    credo saidUpon reviewing the profiles of some of the fools posting in this thread - I'm curious as to why the HIV positive ones are promoting condom-free PrEP sex.

    Hmm ... I wonder why these guys would want us all to think PrEP was bullet proof.

    Weird.

    There are plenty of sites out there with information that validates the type of information that "only idiots believe." To all of you considering PrEP, do your own research; don't take direction from anybody who tells you that PrEP is 100% effective. It isn't!

    http://www.hivpositivemagazine.com/Prep.html

    ...the FDA approved Truvada for PrEP along with using condoms and other prevention methods. PrEP is not 100% effective on its own, and in clinical studies people used condoms with PrEP. In the best-case scenario people would use condoms as much as possible while taking PrEP. Anyone being prescribed PrEP can get free condoms through Gilead, the company who makes Truvada.




    What's "Weird" is that instead of arguing facts (and there are other opinions from AHS that I will cite) you make it a personal, stigmatizing issue of HIV men. "I wonder why these guys (HIV/Undetectable) would want us all to think PrEP was bullet proof."

    !) NO one EVER said anything was bulletproof. Condoms aren't. PrEP isn't.

    2) Am I "... promoting condom-free PrEP sex.?" No, yes, maybe.

    Here is what I agree with:
    There are now at least five strategies that reasonably constitute ‘safe sex', provided that certain parameters are met. Theyare:
    1.
    The use of Condoms during casual encounters between men of unknown or discordant serostatus.
    2.
    HIV negative men taking effective pre-exposure prophylaxis (PrEP)
    .
    3.
    Men living with HIV who only have sex without condoms when they have a sustained undetectable viral load (UVL) and in the absence
    of sexually transmissible infections (STIs).
    4.
    Effective use of serosorting between HIV positive men.
    5.
    Effective negotiated safety agreements

    http://www.acon.org.au/sites/default/files/What-is-Safe-Sex-Position-2014.pdf


    If you wanted an intelligent conversation you could cite something like this:

    New National AHF Ad Asks, ‘CDC: What if You’re Wrong on PrEP?’
    http://finance.yahoo.com/news/national-ahf-ad-asks-cdc-154500000.html

    or this:
    Condom use during most recent anal intercourse event among a U.S. sample of men who have sex with men.
    http://www.ncbi.nlm.nih.gov/pubmed/22353190

    But you'd rather make it an issue about HIV people and their "weird" opinions. My opinions are based 100% on ACON and the CDC. Current SCIENCE. Not myth or stigma. By marginalizing by opinion as "weird HIV guys" you do a disservice to yourself, me, POZ men and everyone Gay.