Why is it still difficult to reduce HIV transmission rates?

  • 1AlanZSky

    Posts: 1505

    Feb 28, 2016 1:53 PM GMT
    Even with regular PrEP you can still get HIV and that is obvious. No one thing is foolproof and the best thing is to reduce the risks. Safer sex especially.

    I blame racism, homophobia, lack of awareness, lack of proper education, lack of proper equality and inner human prejudice.

    Is the fight against HIV still worth having even if you can "survive" HIV?

    http://www.out.com/news-opinion/2016/2/25/gay-man-prep-tests-positive-hiv

    http://www.dailymail.co.uk/health/article-3466498/Dating-apps-feature-STD-warnings-60-gay-men-diagnosed-HIV-hooked-dating-apps.html

    http://www.pinknews.co.uk/2016/02/23/half-of-black-gay-men-will-get-hiv-in-their-lifetime/
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    Feb 28, 2016 2:04 PM GMT
    Even government initiatives on HIV says on their website that PReP lower your chances of getting HIV (which means it does not negate it)
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    Feb 28, 2016 2:20 PM GMT
    1AlanZSky said... Is the fight against HIV still worth having even if you can "survive" HIV...
    after that six seconds your quality of life will forever change so for some its an individual choice to fight it.
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    Feb 28, 2016 10:44 PM GMT
    There was a recent reported case of a guy contracting HIV while on Prep. Don't put all your trust in medication.
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    Feb 28, 2016 11:33 PM GMT
    xrichx saidThere was a recent reported case of a guy contracting HIV while on Prep. Don't put all your trust in medication.



    Yes! ONE SINGLE case! Among 40,000 PrEP users. By all means through out the baby with the bathwater. Let's go back to 1993 and only use condoms! (San Francisco had 2300 new HIV cases in 1993 and 302 in 2014.)
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    Feb 29, 2016 12:34 AM GMT
    1AlanZSky saidEven with regular PrEP you can still get HIV and that is obvious. No one thing is foolproof and the best thing is to reduce the risks. Safer sex especially.

    I blame racism, homophobia, lack of awareness, lack of proper education, lack of proper equality and inner human prejudice.

    Is the fight against HIV still worth having even if you can "survive" HIV?

    http://www.out.com/news-opinion/2016/2/25/gay-man-prep-tests-positive-hiv

    http://www.dailymail.co.uk/health/article-3466498/Dating-apps-feature-STD-warnings-60-gay-men-diagnosed-HIV-hooked-dating-apps.html

    http://www.pinknews.co.uk/2016/02/23/half-of-black-gay-men-will-get-hiv-in-their-lifetime/



    Ummm what is obvious? When you say "Even with regular PrEP you can still get HIV and that is obvious." it sounds like a foregone conclusion. 1 man on PrEP got HIV, from a partner who was failing his medications (not taking his meds). Yes he became positive, but the antivirals made him undetectable....so the drugs still work even though HIV got through because of an acquired resistance.



    Furthermore in cities that have a clear PrEP message (SF, NYC and DC) there has been a huge reduction of new HIV cases. Down 18% yearly. SF has gone from 2300 to 302 new cases a year. Cities that don't clearly advocate PrEP (Miami, Baton Rouge, New Orleans) have had huge increases +25% or greater.

    I've been POZ since 1985. And to ask me, as a long term survivor.....YES "the fight against HIV (is) still worth having even if you can "survive" HIV. I've been POZ for 30 years and Undetectable for 17.

    I'm fighting harder than ever. But it's for people who don't know, are indecisive, who don't get it. PrEP works (at least 96%, that has not changed) TasP works (98%+). Condoms work (70%).

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    Feb 29, 2016 12:38 AM GMT
    @timmm55 What you mean when you say

    I've been POZ for 30 years and Undetectable for 17.
    ?


    Does it mean you were undetected for the first 17?




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    Feb 29, 2016 12:53 AM GMT
    ricky1987 said@timmm55 What you mean when you say

    I've been POZ for 30 years and Undetectable for 17.
    ?


    Does it mean you were undetected for the first 17?






    Huh?

    Do you not know what undetectable means? Viral load?
    Well, from 1985 to 1998 there was little treatment other than AZT. In the late 90s a "cocktail" of 3 antiviral drugs was shown to bring down Viral Load (the level of HIV in your blood) down to "undetectable" levels. Then it was less than 200 per unit of blood. While a newly infected person could be 500,000 or even a million per unit.

    Now with more sensitive testing the benchmark for undetectable is <50. UVL or Undetectable Viral Load. It's a bit of a misnomer. HIV can still be detected. But HIV is now essentially non-transmittable. Or "non-infectious" http://news.thestigmaproject.org/post/78701812064/study-reports-men-women-with-undetectable-viral

    I've been POZ since 1985, I still am. UVL doesn't 'cure' HIV or eliminate it.
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    Feb 29, 2016 2:45 AM GMT
    timmm55 said
    xrichx saidThere was a recent reported case of a guy contracting HIV while on Prep. Don't put all your trust in medication.



    Yes! ONE SINGLE case! Among 40,000 PrEP users. By all means through out the baby with the bathwater. Let's go back to 1993 and only use condoms! (San Francisco had 2300 new HIV cases in 1993 and 302 in 2014.)

    Wow. Way to jump to conclusions. I'm just saying, there are some guys that continue to engage in risky behavior while on Prep because they think it's the cure to HIV/AIDS. They need to continue using condoms while on Prep.
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    Feb 29, 2016 5:00 PM GMT
    Let me do the math for you. Between 20-30% of gay men are HIV positive. About 50% of positive gay men are unaware of their status. About 80% of transmissions are attributed to positive men who are unaware of their status. So about 10-15 of gay men are responsible for about 80% of transmissions. In other words, a small minority of gay men are responsible for the majority of new transmissions.

    Why are so many gay men unaware of their status?

    Prejudice and stigma: 60% or more of gay men would not have sex with a positive man. Some gay men consider a positive status as sign of lack of self-control.

    Assault laws: In several states a person who is aware of his positive status is required to inform his partner before sexual activity or face years of prison. However, if the positive is unaware of his positive status, no crime has been committed.

    The strongest correlation for transmission is NOT the number of sex partners nor the use or non-use of condoms. The strongest correlation for transmission is testing. People who are aware of their status are the least likely to transmit HIV.

    If HIV testing were as normal as blood pressure testing AND if HIV treatment were as normal as birth control in about 5 years there would be nearly zero transmissions.

    Get tested. Talk to your partners about testing. And do everything reasonable to reduce transmission.

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    Feb 29, 2016 9:42 PM GMT
    xrichx said
    timmm55 said
    xrichx saidThere was a recent reported case of a guy contracting HIV while on Prep. Don't put all your trust in medication.



    Yes! ONE SINGLE case! Among 40,000 PrEP users. By all means through out the baby with the bathwater. Let's go back to 1993 and only use condoms! (San Francisco had 2300 new HIV cases in 1993 and 302 in 2014.)

    Wow. Way to jump to conclusions. I'm just saying, there are some guys that continue to engage in risky behavior while on Prep because they think it's the cure to HIV/AIDS. They need to continue using condoms while on Prep.



    "Don't put all your trust in medication" sounds like a HUGE jump in conclusions from one reported case.
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    Feb 29, 2016 9:44 PM GMT
    jimib saidLet me do the math for you. Between 20-30% of gay men are HIV positive. About 50% of positive gay men are unaware of their status. About 80% of transmissions are attributed to positive men who are unaware of their status. So about 10-15 of gay men are responsible for about 80% of transmissions. In other words, a small minority of gay men are responsible for the majority of new transmissions.

    Why are so many gay men unaware of their status?

    Prejudice and stigma: 60% or more of gay men would not have sex with a positive man. Some gay men consider a positive status as sign of lack of self-control.

    Assault laws: In several states a person who is aware of his positive status is required to inform his partner before sexual activity or face years of prison. However, if the positive is unaware of his positive status, no crime has been committed.

    The strongest correlation for transmission is NOT the number of sex partners nor the use or non-use of condoms. The strongest correlation for transmission is testing. People who are aware of their status are the least likely to transmit HIV.

    If HIV testing were as normal as blood pressure testing AND if HIV treatment were as normal as birth control in about 5 years there would be nearly zero transmissions.

    Get tested. Talk to your partners about testing. And do everything reasonable to reduce transmission.



    Thanks. We need more people like you.
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    Mar 01, 2016 12:00 AM GMT
    1AlanZSky saidEven with regular PrEP you can still get HIV and that is obvious. No one thing is foolproof and the best thing is to reduce the risks. Safer sex especially.

    I blame racism, homophobia, lack of awareness, lack of proper education, lack of proper equality and inner human prejudice.


    The only thing to blame is the promiscuous behavior of people, especially among gays.
    No one here lives in some poor African country where HIV is epidemic and lack awareness and proper healthcare for testing and treating.
    That said, if you have sex with lots of people (most of them you barely know or just hook up with randon guys from grindr when you're feeling horny) it is no surprise that eventually you will contract the virus.
    The odds are even bigger when there are so many guys out there willing to have unsafe sex.

    I'm no puritan, but also can't deny facts.
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    Mar 01, 2016 1:26 AM GMT
    timmm55 said1 man on PrEP got HIV, from a partner who was failing his medications (not taking his meds). Yes he became positive, but the antivirals made him undetectable....so the drugs still work even though HIV got through because of an acquired resistance.

    No, not just ONE man, just one case documented so far. There will be more--many more. PrEP is effective, but condoms--when used correctly are even more effective. Hell, why not do both?

    timmm55 saidPrEP works (at least 96%, that has not changed)

    That number will likely change as more and more documented cases arise of it not working.

    timmm55 saidTasP works (98%+).

    I read 96%, but close enough.

    timmm55 saidCondoms work (70%).

    Whoa, from whose ass did you pull that number? The correct statistic is 98-99%.

    But to answer the original post...

    It's simple: promiscuity and a lack of forethought in sexual activity, mostly. (No condoms.)
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    Mar 01, 2016 1:44 AM GMT
    jackedgamer said
    timmm55 said1 man on PrEP got HIV, from a partner who was failing his medications (not taking his meds). Yes he became positive, but the antivirals made him undetectable....so the drugs still work even though HIV got through because of an acquired resistance.

    No, not just ONE man, just one case documented so far. There will be more--many more. PrEP is effective, but condoms--when used correctly are even more effective. Hell, why not do both?

    timmm55 saidPrEP works (at least 96%, that has not changed)

    That number will likely change as more and more documented cases arise of it not working.

    timmm55 saidTasP works (98%+).

    I read 96%, but close enough.

    timmm55 saidCondoms work (70%).

    Whoa, from whose ass did you pull that number? The correct statistic is 98-99%.

    But to answer the original post...

    It's simple: promiscuity and a lack of forethought in sexual activity, mostly. (No condoms.)


    In theory condoms might be 98 or something like that.

    Consistent condom use in anal sex stops 70% of HIV infections, study findshttp://www.aidsmap.com/Consistent-condom-use-in-anal-sex-stops-70-of-HIV-infections-study-finds/page/2586976/


    Condom efficacy with 100% use


    Amongst all men having anal sex, men who said they used condoms 100% of the time were 70% less likely to acquire HIV than men who never used condoms, and 68% less likely than men who said they sometimes used them.

    Condom efficacy was consistently higher in EXPLORE: it was 86% for all anal sex, 87% for receptive anal sex and 76% for insertive anal sex compared with 59, 63 and 55% in VAX004.

    Why the big difference? One possibility is that because EXPLORE was a behavioural intervention, it may have helped participants use condoms better and have fewer ‘accidents’ than in VAX004, which monitored condom use but did not intervene.

    These figures are derived by comparing HIV incidence in men who said they always used condoms with men who never used them. What about the men who sometimes used them?



    My WHOA!!

    "It's simple: promiscuity and a lack of forethought in sexual activity, mostly. (No condoms.)"

    You put a lot of emphasis on condoms, and puritanical ethics, too much in fact. The OP was right IMHO when he said "I blame racism, homophobia, lack of awareness, lack of proper education, lack of proper equality and inner human prejudice."

    It's easy to blame someone by simply saying they are too promiscuous. Too much is what someone else does, right? That's basic slut shaming.

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    Mar 01, 2016 2:52 AM GMT
    eipoika said
    1AlanZSky saidEven with regular PrEP you can still get HIV and that is obvious. No one thing is foolproof and the best thing is to reduce the risks. Safer sex especially.

    I blame racism, homophobia, lack of awareness, lack of proper education, lack of proper equality and inner human prejudice.


    The only thing to blame is the promiscuous behavior of people, especially among gays.
    No one here lives in some poor African country where HIV is epidemic and lack awareness and proper healthcare for testing and treating.
    That said, if you have sex with lots of people (most of them you barely know or just hook up with randon guys from grindr when you're feeling horny) it is no surprise that eventually you will contract the virus.
    The odds are even bigger when there are so many guys out there willing to have unsafe sex.

    I'm no puritan, but also can't deny facts.


    That is a puritan response. "The only thing to blame is the promiscuous behavior....." What about the person who gets HIV while using condoms?

    And don't be such a stupid racist. "Zimbabwe has the fifth highest HIV prevalence in sub-Saharan Africa at 15%. 1.4 million people are living with HIV including 170,000 children, equating to 4% of the global total.1

    New infections dropped by 34% between 2005 and 2013, with behaviour change communication and high treatment coverage thought to be responsible for this decline.2 Yet there were still 69,000 new infections in 2013."

    http://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/zimbabwe

    So what about places like Miami where HIV has increased 20+%?...in one year? Is Miami a place "where HIV is epidemic and lack awareness and proper healthcare for testing and treating."?

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    Mar 01, 2016 3:00 AM GMT
    jackedgamer said
    timmm55 said1 man on PrEP got HIV, from a partner who was failing his medications (not taking his meds). Yes he became positive, but the antivirals made him undetectable....so the drugs still work even though HIV got through because of an acquired resistance.

    No, not just ONE man, just one case documented so far. There will be more--many more. PrEP is effective, but condoms--when used correctly are even more effective. Hell, why not do both?

    Sure do both! Prove there will be many more. I can't rely on any evidence you've posted so far.


    timmm55 saidPrEP works (at least 96%, that has not changed)

    That number will likely (really?) change as more and more documented cases arise of it not working. Or it won't. Since this is the first case with 40,000 PrEP users, there will have to 160 cases to be 96%.

    timmm55 saidTasP works (98%+).

    I read 96%, but close enough.

    Actually it's virtually 100%. Not a single case of HIV has been proven from someone with full ART suppression. In the Partners Study 4 people got HIV, but not from their POZ Undetectable partner.

    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

    No transmissions is not the same as zero chance of transmission. BUT "PARTNER study principal investigator Dr Jens Lundgren pointed out that this meant that there was a maximum 5% chance that over a ten-year period, one in ten HIV-negative partners in a gay couple who had unprotected anal sex might acquire HIV; equally, though, it was more likely that their chance of acquiring HIV from their partner was nearer to zero, and indeed could be zero."


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    Mar 01, 2016 11:47 PM GMT
    timmm55 saidAmongst all men having anal sex, men who said they used condoms 100% of the time were 70% less likely to acquire HIV than men who never used condoms, and 68% less likely than men who said they sometimes used them.

    That study you're quoting is from almost two decades ago. It is outdated.

    You put a lot of emphasis on condoms, and puritanical ethics, too much in fact. [...] It's easy to blame someone by simply saying they are too promiscuous. Too much is what someone else does, right? That's basic slut shaming.

    I'm not slut shaming, I'm pointing out an obvious fact. I have a fair share of HIV+ friends, and every single one of them said that they became positive after engaging in high risk activities--two of them via barebacking group sex at leather convention in Chicago. There's no denying that if they had not opted to engage in this high risk activities, they likely wouldn't have contracted HIV.

    Perhaps I AM puritanical, but I will not be contracting HIV and never need to worry about it happening. icon_biggrin.gif
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    Mar 02, 2016 12:18 AM GMT
    jackedgamer said
    timmm55 saidAmongst all men having anal sex, men who said they used condoms 100% of the time were 70% less likely to acquire HIV than men who never used condoms, and 68% less likely than men who said they sometimes used them.

    That study you're quoting is from almost two decades ago. It is outdated.

    You put a lot of emphasis on condoms, and puritanical ethics, too much in fact. [...] It's easy to blame someone by simply saying they are too promiscuous. Too much is what someone else does, right? That's basic slut shaming.

    I'm not slut shaming, I'm pointing out an obvious fact. I have a fair share of HIV+ friends, and every single one of them said that they became positive after engaging in high risk activities--two of them via barebacking group sex at leather convention in Chicago. There's no denying that if they had not opted to engage in this high risk activities, they likely wouldn't have contracted HIV.

    Perhaps I AM puritanical, but I will not be contracting HIV and never need to worry about it happening. icon_biggrin.gif


    2013 is too old? It corroborates the 1989 results. Condoms have not changed much in decades. That's a really dumb way to dismiss a valid CDC clinical study. But hey if you want to believe, INSIST, that condoms are 100% you do so at your own risk.



    I remember a nurse back in the 80s badmouthing a "friend " with your same prejudice. His tune changed when he too became POZ. Yeah, you can get HIV while using condoms.

    There are many selfrightous fools who became infected.

    Don't be too smug. Especially if condoms are all you depend on. Glad you admit to being puritanical. ...and being an ass for a friend. If they had PrEP they wouldn't have gotten it either. Or their partner was uvl.

    Maybe you just Jack off or suck cock. That is legit risk reduction. But it doesn't address the social problem of HIV and it's prevalence.
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    Mar 02, 2016 12:51 AM GMT
    eipoika said
    The only thing to blame is the promiscuous behavior of people, especially among gays.
    No one here lives in some poor African country where HIV is epidemic and lack awareness and proper healthcare for testing and treating.
    That said, if you have sex with lots of people (most of them you barely know or just hook up with randon guys from grindr when you're feeling horny) it is no surprise that eventually you will contract the virus.
    The odds are even bigger when there are so many guys out there willing to have unsafe sex.

    I'm no puritan, but also can't deny facts.


    timmm55 saidThat is a puritan response. "The only thing to blame is the promiscuous behavior....." What about the person who gets HIV while using condoms?


    I'm pretty sure you can still be promiscuous while using a condom. Look up at the dictionary the definition of promiscuity if you are not sure.


    timmm55 saidAnd don't be such a stupid racist. "Zimbabwe has the fifth highest HIV prevalence in sub-Saharan Africa at 15%. 1.4 million people are living with HIV including 170,000 children, equating to 4% of the global total."


    You're saying that if I claim that poor african countries have higher incidence of HIV and struggle much more with the virus than rich countries like the USA based on scientific data that makes me a racist?
    Again, píck up a dictionary and go to the letter 'r'.

    Why can't we discuss anything without you yelling at people "racist! sexist! homophobe!"? Be rational and have valid arguments.

    timmm55 saidSo what about places like Miami where HIV has increased 20+%?...in one year? Is Miami a place "where HIV is epidemic and lack awareness and proper healthcare for testing and treating."?


    Of course not. Miami is not an african country. But I'm sure there are a lot of people having promiscuous sex all over the city.
    Maybe Miami should be renamed to Sodom and Gomorrah? ;)
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    Mar 02, 2016 1:03 AM GMT
    Get a grip. You referred to an African country as being backward and uninformed. Truth is they have done a better job than some of our cities. African rates are going down, Miami UP.

    Your rationalization is flawed.

    Sodom and Gomorrah? Really? Are you going to take the fundie name calling?

    You need to look up Dr. Fauci. Science has no moral prejudice. He has said that TasP works even without condoms. And the CDC recommends PrEP for anyone at high risk.....promiscuous Or not.

    If it were a moral issue I'm sure many Right Wing zealots would not have funded AIDS research.....because they still think we deserved it. You are no better.
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    Mar 02, 2016 1:07 AM GMT
    timmm55 saidGet a grip. You referred to an African country as being backward and uninformed. Truth is they have done a better job than some of our cities. African rates are going down, Miami UP.

    Your rationalization is flawed.



    So African countries are equal to the USA? lol

    Sorry, I can't take you seriously.
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    Mar 02, 2016 1:18 AM GMT
    eipoika said
    timmm55 saidGet a grip. You referred to an African country as being backward and uninformed. Truth is they have done a better job than some of our cities. African rates are going down, Miami UP.

    Your rationalization is flawed.



    So African countries are equal to the USA? lol

    Sorry, I can't take you seriously.


    Then compare the capital of Zimbabwe then. Whatever that is. Point is the same.

    Africans are not stupid and religious crap just creates more problems.
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    Mar 02, 2016 1:22 AM GMT
    One reason I didn't cite Zimbabwe to the US is our results are extremely varied. San Francisco is "Getting to Zero" but the deep south is accelerating.
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    Mar 02, 2016 1:37 AM GMT
    I never said that africans are stupid.

    But it's known that extreme poverty in Africa is a real issue. You can't fight diseases if you don't have resources. That is why Africa gets so much help from european and american countries.

    Don't try to make me look bad by distorting my words.