7 ms·

Here's a link to the actual study[0]. I wonder how this new strain is affected by HIV prevention meds like PReP. [0] https://journals.lww.com/jaids/Abstract/pu

Here's a link to the actual study[0]. I wonder how this new strain is affected by HIV prevention meds like PReP. [0] https://journals.lww.com/jaids/Abstract/publishahead/Complete_genome_sequence_of_CG_0018a_01.96307.aspx https://journals.lww.com/jaids/Abstract/publishahead/Complet...

azinman2 7y ago
This is exactly what worries me about PReP. Overall is seems to be making a dent in the spread of HIV, but the reality is it lulls many into a false sense of security and implicitly blesses dangerous behavior. The history of humanity is plagued by virus epidemics — HIV is not a cure-all.
- foldr 7y ago
  >but the reality is it lulls many into a false sense of security and implicitly blesses dangerous behavior. There's very little evidence of this actually happening. I'd be curious to see your grounds for making such a bald and unqualified statement. Such statements are usually based not on evidence but on stereotyping of gay male behaviors.
  - azinman2 7y ago
    I am a gay male. I know the behaviors, because I’ve witnessed it countless times. Update: https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/ https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/
    - foldr 7y ago
      I'm also gay - and know that gay men can also have prejudices against gay people. The study you link to does not back up the claim in your original comment. It will take a great real more work to discover the overall health impact of PrEP. It helps no-one to spread unevidenced claims based on anecdata and prejudice. We currently have no clear picture of the effect of PrEP on condom use. It's extremely difficult to get reliable data on that kind of thing. And note that some increase in the spread of treatable and relatively trivial STDs is absolutely a price worth paying, if it comes to that. There's probably a paralell universe where PrEP was invented before condoms, and people like you are complaining about the fall in PrEP uptake caused by the availability of condoms...
      - azinman2 7y ago
        I don’t even know how to respond to your assertion that my personal experience is invalid because of.. prejudice? I’ve literally witnessed dozens and dozens of times people pressuring myself or my friends (or my friends pressuring others) into condomless sex because of PReP. That’s... invalid? Do I need to submit grindr screenshots, lol?! What’s not backing it up? From the study’s abstract: Pre-exposure prophylaxis use was associated with a significant increase in rectal chlamydia (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19-2.13) and an increase in any STI diagnosis (OR, 1.24; 95% CI, .99-1.54). The association of PrEP use with STI diagnoses was stronger in later studies. Most studies showed evidence of an increase in condomless sex among PrEP users.
        foldr 7y ago
        It's not invalid, but it's only your personal experience, not necessarily indicative of broader trends. Grindr itself is a tiny slice of the MSM population. There are lots of studies. The overall picture is unclear. And some increase in condomless sex combined with a wide uptake of PrEP could be a net positive.
        azinman2 7y ago
        My experience shows it’s far from non-zero, as does the meta analysis I linked. Your net positive would only be until a new virus comes along that creates a new epidemic. And that’s my point.
- krageon 7y ago
  > implicitly blesses dangerous behavior How does it do this? From where I'm sitting it's a very necessary protection for groups that are currently at risk and definitely need protecting from these things, such as sex workers. Wearing a hard hat doesn't give blessing to accidentally dropping something heavy enough to kill without it, I fail to see how this is any different.
  - azinman2 7y ago
    It comes from personal experience. People feel like everything else is treatable so if HIV is prevented than they’re all good to take off the condom. Can’t tell you the number of times I heard this from friends about their own behavior, from people trying to have sex with me, and from others trying to have sex with my friends (condomless). Also: https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/ https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/
    - foldr 7y ago
      > People feel like everything else is treatable Which common STDs other than HIV are not treatable?
      - azinman2 7y ago
        In terms of lack of cure, herpes and HPV to start. And there’s an increasing about of antibiotic resistant infections out there. But again my point is more about the future versus the current.
        foldr 7y ago
        Herpes is trivial medically, and HPV only has a minor health impact.
        azinman2 7y ago
        Not true: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer https://www.cancer.gov/about-cancer/causes-prevention/risk/i... None of this is relevant to my original point: future pandemics.
- TheRealSteel 7y ago
  I don't think it's fair to make that claim at all without data. This is the same argument that religious people use against sex education and condoms and it has never held water before. Don't seatbelts encourage dangerous driving then? Don't vaccines encourage poor hygiene? Time and time again scientists have invented something that makes life drastically safer and time and time again they've been a huge net positives. It doesn't make any logical sense to me and I've never seen any compelling evidence that this causes it to be a net negative.
  - azinman2 7y ago
    Never said it was net negative. I’m saying HIV is not the last STD — more will come one day. My personal experience shows the effect is non-zero, and this seems to confirm beyond my immediate community: https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/ https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/
- matthewmacleod 7y ago
  Please—and I can't stress this enough—do not make up lies about this kind of thing. It's dangerous. There is currently no evidence that PrEP "lulls many into a false sense of security". It's possible that the existence of a method that can effectively eliminate the risk of HIV transmission could cause a change in behaviour which exposes people to other, different risks. It is entirely far from clear that this is the case, or that if it were, then that there would still not be a net public health benefit. PrEP is, FWIW, quite possibly more effective at HIV prevention than condom use is. It would plainly be ridiculous to be worried about the existence of condoms, because they were likely to "implicitly bless dangerous behaviour", and we have plenty of evidence that abstinence campaigns pushing this message are absolute failures.
  - azinman2 7y ago
    I cannot disagree with you enough. I know from personal experience and that of my friends that frequently strangers are pressuring people into condomless sex strictly BECAUSE of PReP. And if you question it you’re told that you’re ignorant. The reality is no one wants to wear a condom, but they only do if they feel the need to. PReP removes this barrier for many because they feel that they’re still safe without one. I don’t have data I can point to, but between personal experience and at least a good understanding of the (coastal US) gay community, I have no qualms stating this is the case. Again — I already said PReP was highly effective as a public health tool against HIV, but in doing so, we leave the door open to many new kinds of viruses that it doesn’t protect against given the lack of condom usage. Update: It’s not to hard to find data that verifies my personal experience: https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/ https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/
    - gugagore 7y ago
      The problem is that you're spreading more fear around gay sex. Of course there's a higher risk of transmission of disease without a condom. It's not been my experience that anyone says, with a straight face, that you're ignorant if you want to use a condom in spite of PrEP. But what is ignorant is to decide where other people's risk thresholds should be. You're right that no one wants to wear a condom. It's not a false sense of security to have condomless sex because of PrEP. It's real sense of security. People feel safer, and they are safer from HIV. People are afraid of dying, and no one enjoys thinking about catching a death sentence when they have sex, especially sex that's been (and is) strongly stigmatized. If personally, you decide that extra security isn't enough, that is a great decision. If you want to think about the future, and the risk of catching a resistant strain of a bacterial infection, or some yet-understood (new kinds of) viral infection, that is totally okay! But I don't think it's okay for you to say everyone should think the same way. It's hard to measure the "risk" of the anxiety caused by gay sex.
- azinman2 7y ago
  *I meant that PReP is not a cure-all.
- chaosbutters314 7y ago
  Yup, Prep just encourages everyone into not using protection
  - TheRealSteel 7y ago
    I'd like to see your evidence for a) PrEP significantly decreasing condom use b) This being a net-negative when considering the hugely decreased risk of HIV transmission as a result. If you believe this, don't you also believe that seatbelts encourage dangerous driving?
    - azinman2 7y ago
      https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/ https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/ Again, we’re not talking about HIV. We’re talking about all the other potential viruses (including those known and still mutating). To think that we’re done seeing new fatal STDs is to ignore the history of biology and epidemics.
  - gugagore 7y ago
    I don't mean to nitpick, because any reductive statement ("just"), is _just_ wrong. but there are many people who would and do not use protection anyway. And taking PrEP means that's a less risky option than otherwise.
    - klipt 7y ago
      I guess the question is, is the PrEP-protected infection rate among people having unprotected sex while on PrEP, lower or higher than the not-protected infection rate among those who would have unprotected sex even without PrEP?
      - digitallogic 7y ago
        It's lower. You're safer having unprotected sex with someone who is confirmed to have HIV but is taking PrEP, than you are when having unprotected sex with someone whose status is unknown.
- peter303 7y ago
  Is PReP specific to HIV? Or would it work on many retrovirus? Probably most variants of HIV.
- Angostura 7y ago
  It's very effective however. I family member is doctor specialising in HIV, she says that with the current state of medication, if she had a choice between an HIV infection or diabetes, she'd take the former.
  - astura 7y ago
    Another doctor made exactly the same argument - "As a doctor, I’d rather have HIV than diabetes" - https://www.spectator.co.uk/2014/04/why-id-rather-have-hiv-than-diabetes/ https://www.spectator.co.uk/2014/04/why-id-rather-have-hiv-t... >A recent large epidemiological study showed that, for those diagnosed with HIV now, life expectancy is similar to someone who does not have the virus. The medical profession now considers HIV a chronic disease; it’s regarded in public health terms in the same category as, for example, type 2 diabetes. As a doctor I can tell you that, medically speaking, I’d rather have HIV than diabetes. While this might sound shocking or surprising, the facts speak for themselves: the prognosis for those with type 2 diabetes is much worse than for those with HIV.... For those with HIV, providing they take their medication, there are very few problems. >Regardless of how well it is controlled, type 2 diabetes is a progressive disease, which results in the need to increase pharmacological therapies over time. A recent study conducted in Australia showed that, after six years, 44 per cent of patients no longer responded to oral medication and required insulin injections. Oral medications eventually fail in most people, meaning that injections are almost inevitable at some point. >To put it starkly, the latest statistics show that because of Haart, HIV now no longer reduces your life expectancy, while having type 2 diabetes typically reduces it by ten years.
    - djsumdog 7y ago
      Some of the drugs HIV+ people are put on could have long term effects on the brain and other organs: https://www.npr.org/sections/health-shots/2012/07/16/156692980/treatment-gives-hivs-long-term-survivors-hope-but-takes-a-toll https://www.npr.org/sections/health-shots/2012/07/16/1566929... Some of the older drug combinations were very troublesome. They've gotten better and people live longer, yes .. but they could have a lot of long term toxicity that's hard to judge until we can study groups of people who've survived on them into their later years. You can control and even reverse type-2 diabetes by cutting sugars and starches from your diet if you do it early and are diligent. HIV infections cannot be reversed. Once you have it, you'll likely be on drugs for the rest of your life.
kylebarron 7y ago
It sounds like it's not a new strain per se, since it was tested on blood stored from 2000, just that it's a new technique to use on that amount of virus.

azinman2 7y ago

This is exactly what worries me about PReP. Overall is seems to be making a dent in the spread of HIV, but the reality is it lulls many into a false sense of security and implicitly blesses dangerous behavior. The history of humanity is plagued by virus epidemics — HIV is not a cure-all.

foldr 7y ago
>but the reality is it lulls many into a false sense of security and implicitly blesses dangerous behavior. There's very little evidence of this actually happening. I'd be curious to see your grounds for making such a bald and unqualified statement. Such statements are usually based not on evidence but on stereotyping of gay male behaviors.
- azinman2 7y ago
  I am a gay male. I know the behaviors, because I’ve witnessed it countless times. Update: https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/ https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/
  - foldr 7y ago
    I'm also gay - and know that gay men can also have prejudices against gay people. The study you link to does not back up the claim in your original comment. It will take a great real more work to discover the overall health impact of PrEP. It helps no-one to spread unevidenced claims based on anecdata and prejudice. We currently have no clear picture of the effect of PrEP on condom use. It's extremely difficult to get reliable data on that kind of thing. And note that some increase in the spread of treatable and relatively trivial STDs is absolutely a price worth paying, if it comes to that. There's probably a paralell universe where PrEP was invented before condoms, and people like you are complaining about the fall in PrEP uptake caused by the availability of condoms...
    - azinman2 7y ago
      I don’t even know how to respond to your assertion that my personal experience is invalid because of.. prejudice? I’ve literally witnessed dozens and dozens of times people pressuring myself or my friends (or my friends pressuring others) into condomless sex because of PReP. That’s... invalid? Do I need to submit grindr screenshots, lol?! What’s not backing it up? From the study’s abstract: Pre-exposure prophylaxis use was associated with a significant increase in rectal chlamydia (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19-2.13) and an increase in any STI diagnosis (OR, 1.24; 95% CI, .99-1.54). The association of PrEP use with STI diagnoses was stronger in later studies. Most studies showed evidence of an increase in condomless sex among PrEP users.
      - foldr 7y ago
        It's not invalid, but it's only your personal experience, not necessarily indicative of broader trends. Grindr itself is a tiny slice of the MSM population. There are lots of studies. The overall picture is unclear. And some increase in condomless sex combined with a wide uptake of PrEP could be a net positive.
        azinman2 7y ago
        My experience shows it’s far from non-zero, as does the meta analysis I linked. Your net positive would only be until a new virus comes along that creates a new epidemic. And that’s my point.
krageon 7y ago
> implicitly blesses dangerous behavior How does it do this? From where I'm sitting it's a very necessary protection for groups that are currently at risk and definitely need protecting from these things, such as sex workers. Wearing a hard hat doesn't give blessing to accidentally dropping something heavy enough to kill without it, I fail to see how this is any different.
- azinman2 7y ago
  It comes from personal experience. People feel like everything else is treatable so if HIV is prevented than they’re all good to take off the condom. Can’t tell you the number of times I heard this from friends about their own behavior, from people trying to have sex with me, and from others trying to have sex with my friends (condomless). Also: https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/ https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/
  - foldr 7y ago
    > People feel like everything else is treatable Which common STDs other than HIV are not treatable?
    - azinman2 7y ago
      In terms of lack of cure, herpes and HPV to start. And there’s an increasing about of antibiotic resistant infections out there. But again my point is more about the future versus the current.
      - foldr 7y ago
        Herpes is trivial medically, and HPV only has a minor health impact.
        azinman2 7y ago
        Not true: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer https://www.cancer.gov/about-cancer/causes-prevention/risk/i... None of this is relevant to my original point: future pandemics.
TheRealSteel 7y ago
I don't think it's fair to make that claim at all without data. This is the same argument that religious people use against sex education and condoms and it has never held water before. Don't seatbelts encourage dangerous driving then? Don't vaccines encourage poor hygiene? Time and time again scientists have invented something that makes life drastically safer and time and time again they've been a huge net positives. It doesn't make any logical sense to me and I've never seen any compelling evidence that this causes it to be a net negative.
- azinman2 7y ago
  Never said it was net negative. I’m saying HIV is not the last STD — more will come one day. My personal experience shows the effect is non-zero, and this seems to confirm beyond my immediate community: https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/ https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/
matthewmacleod 7y ago
Please—and I can't stress this enough—do not make up lies about this kind of thing. It's dangerous. There is currently no evidence that PrEP "lulls many into a false sense of security". It's possible that the existence of a method that can effectively eliminate the risk of HIV transmission could cause a change in behaviour which exposes people to other, different risks. It is entirely far from clear that this is the case, or that if it were, then that there would still not be a net public health benefit. PrEP is, FWIW, quite possibly more effective at HIV prevention than condom use is. It would plainly be ridiculous to be worried about the existence of condoms, because they were likely to "implicitly bless dangerous behaviour", and we have plenty of evidence that abstinence campaigns pushing this message are absolute failures.
- azinman2 7y ago
  I cannot disagree with you enough. I know from personal experience and that of my friends that frequently strangers are pressuring people into condomless sex strictly BECAUSE of PReP. And if you question it you’re told that you’re ignorant. The reality is no one wants to wear a condom, but they only do if they feel the need to. PReP removes this barrier for many because they feel that they’re still safe without one. I don’t have data I can point to, but between personal experience and at least a good understanding of the (coastal US) gay community, I have no qualms stating this is the case. Again — I already said PReP was highly effective as a public health tool against HIV, but in doing so, we leave the door open to many new kinds of viruses that it doesn’t protect against given the lack of condom usage. Update: It’s not to hard to find data that verifies my personal experience: https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/ https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/
  - gugagore 7y ago
    The problem is that you're spreading more fear around gay sex. Of course there's a higher risk of transmission of disease without a condom. It's not been my experience that anyone says, with a straight face, that you're ignorant if you want to use a condom in spite of PrEP. But what is ignorant is to decide where other people's risk thresholds should be. You're right that no one wants to wear a condom. It's not a false sense of security to have condomless sex because of PrEP. It's real sense of security. People feel safer, and they are safer from HIV. People are afraid of dying, and no one enjoys thinking about catching a death sentence when they have sex, especially sex that's been (and is) strongly stigmatized. If personally, you decide that extra security isn't enough, that is a great decision. If you want to think about the future, and the risk of catching a resistant strain of a bacterial infection, or some yet-understood (new kinds of) viral infection, that is totally okay! But I don't think it's okay for you to say everyone should think the same way. It's hard to measure the "risk" of the anxiety caused by gay sex.
azinman2 7y ago
*I meant that PReP is not a cure-all.
chaosbutters314 7y ago
Yup, Prep just encourages everyone into not using protection
- TheRealSteel 7y ago
  I'd like to see your evidence for a) PrEP significantly decreasing condom use b) This being a net-negative when considering the hugely decreased risk of HIV transmission as a result. If you believe this, don't you also believe that seatbelts encourage dangerous driving?
  - azinman2 7y ago
    https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/ https://www.ncbi.nlm.nih.gov/m/pubmed/29509889/ Again, we’re not talking about HIV. We’re talking about all the other potential viruses (including those known and still mutating). To think that we’re done seeing new fatal STDs is to ignore the history of biology and epidemics.
- gugagore 7y ago
  I don't mean to nitpick, because any reductive statement ("just"), is _just_ wrong. but there are many people who would and do not use protection anyway. And taking PrEP means that's a less risky option than otherwise.
  - klipt 7y ago
    I guess the question is, is the PrEP-protected infection rate among people having unprotected sex while on PrEP, lower or higher than the not-protected infection rate among those who would have unprotected sex even without PrEP?
    - digitallogic 7y ago
      It's lower. You're safer having unprotected sex with someone who is confirmed to have HIV but is taking PrEP, than you are when having unprotected sex with someone whose status is unknown.
peter303 7y ago
Is PReP specific to HIV? Or would it work on many retrovirus? Probably most variants of HIV.
Angostura 7y ago
It's very effective however. I family member is doctor specialising in HIV, she says that with the current state of medication, if she had a choice between an HIV infection or diabetes, she'd take the former.
- astura 7y ago
  Another doctor made exactly the same argument - "As a doctor, I’d rather have HIV than diabetes" - https://www.spectator.co.uk/2014/04/why-id-rather-have-hiv-than-diabetes/ https://www.spectator.co.uk/2014/04/why-id-rather-have-hiv-t... >A recent large epidemiological study showed that, for those diagnosed with HIV now, life expectancy is similar to someone who does not have the virus. The medical profession now considers HIV a chronic disease; it’s regarded in public health terms in the same category as, for example, type 2 diabetes. As a doctor I can tell you that, medically speaking, I’d rather have HIV than diabetes. While this might sound shocking or surprising, the facts speak for themselves: the prognosis for those with type 2 diabetes is much worse than for those with HIV.... For those with HIV, providing they take their medication, there are very few problems. >Regardless of how well it is controlled, type 2 diabetes is a progressive disease, which results in the need to increase pharmacological therapies over time. A recent study conducted in Australia showed that, after six years, 44 per cent of patients no longer responded to oral medication and required insulin injections. Oral medications eventually fail in most people, meaning that injections are almost inevitable at some point. >To put it starkly, the latest statistics show that because of Haart, HIV now no longer reduces your life expectancy, while having type 2 diabetes typically reduces it by ten years.
  - djsumdog 7y ago
    Some of the drugs HIV+ people are put on could have long term effects on the brain and other organs: https://www.npr.org/sections/health-shots/2012/07/16/156692980/treatment-gives-hivs-long-term-survivors-hope-but-takes-a-toll https://www.npr.org/sections/health-shots/2012/07/16/1566929... Some of the older drug combinations were very troublesome. They've gotten better and people live longer, yes .. but they could have a lot of long term toxicity that's hard to judge until we can study groups of people who've survived on them into their later years. You can control and even reverse type-2 diabetes by cutting sugars and starches from your diet if you do it early and are diligent. HIV infections cannot be reversed. Once you have it, you'll likely be on drugs for the rest of your life.

kylebarron 7y ago

It sounds like it's not a new strain per se, since it was tested on blood stored from 2000, just that it's a new technique to use on that amount of virus.