3 ms·

A lot of misconceptions in this and other comments. To address the two most glaring ones: > 1. Not everyone takes their medications exactly as prescribed. Tha

A lot of misconceptions in this and other comments. To address the two most glaring ones: > 1. Not everyone takes their medications exactly as prescribed. That's irrelevant. Not only is there a fair amount of leeway in the standard dosing schedules (meaning that missing some doses does not actually cause a clinically meaningful impact), but the studies that demonstrate that U=U are based on real-world applications. Variability from adherence is already captured by the results. > 2. Lots of folks on antiretroviral therapy are not undetectable, or may move between undetectable and detectable over time. This is not true and based on an incorrect understanding of what "undetectable" signifies clinically. Once a person has durably achieved clinical undetectability under HAART, they do remain undetectable, as long as there is no prolonged disruption in treatment[0]. The most common reason for a disruption in treatment is an inability to access treatment - not something that happens without the person's full awareness. People on Internet forums like HN like to get worked up about bogeymen like people intentionally not taking their medications, but actual clinical data shows that stuff is largely the realm of urban legends, not reality. And if you're that concerned about it, the answer is simple: PrEP prevents HIV with a near-100% efficacy, rendering the question "is this person undetectable?" moot. [0] Emphasis on prolonged. Missing a few days, or even a week or two, does not cause HIV to become detectable again. These sorts of treatment interruptions are contraindicated, but for other unrelated clinical reasons, not because of the impact on viral load.

nostromo 4y ago
> as long as there is no prolonged disruption in treatment Which happens all the time. Treatment is significantly more burdensome and expensive than women taking birth control, for example, and we all know how accidents still happen. Notice how you’re shifting the blame to the victim, who was knowingly put at risk. “It’s really your fault because you’re not on Prep.” It’s just bizarre how worked up people get about not wanting to be honest with their sex partners. It’s basic human decency.
- SamoyedFurFluff 4y ago
  Birth control has way less leeway than the parent describes hiv treatment. Oral birth control fluctuates wildly and must be taken literally within the same hour or so every day. I don’t think birth control and hiv transmissibility are comparable cases here, because the potential for pregnancy and the potential for hiv infection don’t appear to work remotely similarly. I don’t personally have a horse in this race, I’m merely pointing out I think this comes off as not understanding pregnancy prevention, hiv treatment, or both.
  - nostromo 4y ago
    No analogy is perfect. My point is that people go on and off HIV medication all the time for all sorts of reasons: costs, burden, side effects, etc. By comparison birth control is very easy. It’s an example how medicine can be effective, but still create risks in real life.
    - SamoyedFurFluff 4y ago
      The parent poster says going off hiv medication doesn’t really happen outside of external circumstances and even when it does it takes weeks to cause a problem. This isn’t the same for birth control.
      - deleted 4y ago
        [deleted]
throwaway22023 4y ago
While you are right, I don't think any of this is an excuse for not sharing your status. Yes we should remove the stigma around HIV and I am sympathetic towards those that have it and still deal with that stigma that very much exists within the gay community. Myself I am on Prep, and while it is a near 100% it is not in fact 100%. And yes I know I can't get it from someone who is undetectable. But I also know I had a situation where after hooking up with someone I found out they were undetectable. That made me feel uncomfortable, largely because he did not tell me. It immediately made me question, is this guy actually undetectable as he is claiming? Is he taking is medication properly? Is there something else he didn't tell me. To be clear I have hooked up with people who have that information in their profile or they told me beforehand, but I have major issues with not being up front with that information if we are about to have sex. I would expect the same for any STD, testing positive for Covid, or any other thing that could have an impact on me.

nostromo 4y ago

> as long as there is no prolonged disruption in treatment Which happens all the time. Treatment is significantly more burdensome and expensive than women taking birth control, for example, and we all know how accidents still happen. Notice how you’re shifting the blame to the victim, who was knowingly put at risk. “It’s really your fault because you’re not on Prep.” It’s just bizarre how worked up people get about not wanting to be honest with their sex partners. It’s basic human decency.

SamoyedFurFluff 4y ago
Birth control has way less leeway than the parent describes hiv treatment. Oral birth control fluctuates wildly and must be taken literally within the same hour or so every day. I don’t think birth control and hiv transmissibility are comparable cases here, because the potential for pregnancy and the potential for hiv infection don’t appear to work remotely similarly. I don’t personally have a horse in this race, I’m merely pointing out I think this comes off as not understanding pregnancy prevention, hiv treatment, or both.
- nostromo 4y ago
  No analogy is perfect. My point is that people go on and off HIV medication all the time for all sorts of reasons: costs, burden, side effects, etc. By comparison birth control is very easy. It’s an example how medicine can be effective, but still create risks in real life.
  - SamoyedFurFluff 4y ago
    The parent poster says going off hiv medication doesn’t really happen outside of external circumstances and even when it does it takes weeks to cause a problem. This isn’t the same for birth control.
    - deleted 4y ago
      [deleted]

throwaway22023 4y ago

While you are right, I don't think any of this is an excuse for not sharing your status. Yes we should remove the stigma around HIV and I am sympathetic towards those that have it and still deal with that stigma that very much exists within the gay community. Myself I am on Prep, and while it is a near 100% it is not in fact 100%. And yes I know I can't get it from someone who is undetectable. But I also know I had a situation where after hooking up with someone I found out they were undetectable. That made me feel uncomfortable, largely because he did not tell me. It immediately made me question, is this guy actually undetectable as he is claiming? Is he taking is medication properly? Is there something else he didn't tell me. To be clear I have hooked up with people who have that information in their profile or they told me beforehand, but I have major issues with not being up front with that information if we are about to have sex. I would expect the same for any STD, testing positive for Covid, or any other thing that could have an impact on me.