89 replies
19h24m
We’ve been on the road to this for a while, and it’s so exciting to see. I switched to injectable prep a few months ago to avoid having to take a daily pill - it’s an injection once every two months, and my doctor told me that the guidance might soon change to once every three months.
It sounds simple but for a lot of people it’s not a trivial thing to take a pill every day or adhere to a strict appointment schedule to get an injection. I’d imagine that adoption & compliance goes way up if it’s that much easier.
I have been debating on switching to the shot but Havnt yet.
Just to avoid the accidentally missing a dose or the chance interactions (lower efficacy) with dairy and many fiber supplements, this would be amazing.
Would be nice to never need to worry about that or think, hey I missed a dose is it actually true that it doesn’t matter or do I need to wait a full week. Half a week?
My only concern here though, if it’s in your system for 6 months what if you have an adverse reaction or just some unpleasant symptoms.
I'm going to assume a bit and for that I'll apologize in advance. I'm assuming you're in a high risk group for HIV. Why not just use condoms? Is it because they aren't 100% effective?
Condoms are less effective at HIV prevention, but also they’re unpleasant and don’t prevent most STIs because of oral sex. Nobody’s giving or getting head with a condom. People who stay on top of preventative measures tend to not bother with condoms since PrEP became prevalent.
Preventative:
1. Gardasil 9 (vaccine against 9 strains of HPV, prevents genital warts and cancers caused by HPV)
2. Monkeypox vaccine
3. Meningitis ACYW vax
4. Meningitis B vax (35% effective against gonorrhea)
5. doxyPEP (two pills of doxycycline taken after sex, 90% effective against syphilis, 80% chlamydia, 50% gonorrhea)
6. PrEP (prevents HIV infections)
7. and the usual suite of vaccines against the rest like hepatitis A/B, mumps etc
Treatment of the bacterial ones (which transmit through oral too):
1. syphilis - butt shot of penicillin 2. chlamydia - 1 pill of an antibiotic 3. gonorrhea - a week of doxycycline pills or one butt shot of ceftriaxone
Remaining: HSV. Half of the population has it, so no big deal. Condoms dont prevent it either.
As for hepatitis: even though it requires blood contact and as such is not necessarily considered an STI, hepatitis c is curable these days thanks to DAAs taken over the course of 8-12 weeks. a/b have vaccines.
Preventatively using antibiotics is a horrible idea, for one it increases the risk of creating resisitant strains, and we are already running out of antibiotics (especially broadband ones). Moreover, antibiotics in general are known to mess with you gut biome whose importance we are just beginning to understand (we know it plays a role in many physical and mental illnesses for example). Then there are the side effects which for doxycyline include diarrhea, increased risk of bowel cancer, higher sensitivity to the sun (and associated risk of skin cancer).
Been taking it every day for 15 years with no problems and actually I seem to look 10 years younger than everyone in my age group.
Please tell me this is a joke / satire
No, there are many many people who are this entitled.
The problems are for humanity not for you, with spurious use of antibiotics. Resistant strains can kill everyone.
This is really surprising to me since there is a lot of evidence that oral antibiotics can mess up your gut flora, creating all sorts of bad side effects. Do you have any digestive issues?
The people responding to this seem to assume you’re doing so for funsies, which might be true. But that’s not what you said. So for their benefit, it’s worth pointing out that daily doxycycline is a pretty normal therapy for a range of chronic stuff—malaria prophylaxis, rosacea and skin that’s prone to infections, I’m sure there’s more.
If loopdoend’s doing this, it feels like a good bet that there’s a doctor in the mix judging that it’s medically appropriate for them.
antibiotics are toxic in general, likely affecting way more than bowels. many are ototoxic for example.
Doxy is already prescribed in the US as a treatment regimen for acne, so if that’s going to be allowed STI prevention seems way more useful.
The overuse of antibiotics is mostly in farm animals, which represent 73% of global antibiotics use, and 90% of American antibiotics use.
This all feels really general—precipitated on the idea that there’s one Right Way for everyone to use these drugs, about which the doctors and public health professionals recommending doxyPEP are somehow uninformed.
Suppose you’re immunocompromised. Wouldn’t it be worth the diarrhea to avoid infections your body couldn’t fight off?
Suppose you’re in a situation where you’re having lots of opportunities for infection. Whether you can or can’t control that situation, the end result is the same: you know your body is going to be challenged by infectious disease frequently in a way that most people’s bodies aren’t. Isn’t it plausible that the infectious agent may have less opportunity to evolve if you didn’t contract it as frequently?
Different forms of therapy might be both individually and collectively optimal for people in different situations. What’s right for a person who isn’t at risk isn’t the same as what’s right for a person who is at risk.
Inefficacy against HSV is interesting. I had no idea. Why is it ineffective?
Oral sex is a big reason. Michael Douglas got tongue cancer* from HPV.
Actually it appears the 9-polyvalent HPV vaccine protects against multiple cancers but insurance won't pay for it once your outside the age window.
* originally he said "throat cancer" at the advice of his agent!
[edited: wityl pointed out I’d typed HSV for some reason]
You are thinking of HPV, HSV is herpes.
There is no vaccine, it doesn't cause cancer (that we know of, at least not like HPV), and spreads via skin contact on the genital area.
Since fluids are not required for HPV or HSV and it's present on the area that a condom won't cover, condoms aren't effective for either.
Yes it was a brain fart — fixed!
I looked through the literature and it seems that condoms are quite effective at preventing HSV infection when used, especially from male to female (on the order of 99%), and less so for female to male (around 60-70%). I would suspect the reason for failure is behavioral. People probably don't apply the condom until after most of foreplay is over and HSV-2 can be transmitted during "outercourse".
HSV-1 and -2 transmit through contact from skin location to skin. Including through asymptomatic shedding. Only sometimes is that location covered by a condom - in location and in timing.
See also: Wrestlers' "Herpes gladiatorum" which is just HSV-1. Which demonstrates how HSV-1 survives for transmission far more easily or broadly than just genital contact. Is there "HSV-2 gladiatorum"? Apparently it's usually HSV-1 but probably yes - neither HSV-1 or HSV-2 are really location specific.
In the early days of AIDS (wasn't called HIV back then) the recommendation was to use a condom or dental dam (depending on the hardware of the recipient). That's how I learned what a dental dam was. Later it was suggested that plastic food wrap would work (the jokes just write themselves).
Sadly the ubiquity of paper toilet sheet covers in US bathrooms dates back to the 80s due to straight paranoia over AIDs + widespread and overt anti-gay prejudice, so every time I see one of those dispensers I grit my teeth.
Reminds me of the early days of COVID (not the anti-gay part, but the weird practices when nobody really had yet a good theory of what's going on).
HIV (human immunodeficiency virus) is the virus, AIDS (Acquired Immune Deficiency Syndrome) is the syndrome caused by untreated HIV. Everybody with AIDS has HIV, but not everyone with HIV has AIDS.
The reason for the reversal in terms is treatment options. When HIV was first found, there were no treatments so AIDS was inevitable. Nowadays, medication can permanently prevent HIV from progressing to AIDS, so AIDS is much less common than HIV.
You might be thinking of “GRID” (gay related immuno deficiency), the original name of AIDS when it was believed it only affects gay people. Once the virus causing the illness was identified it was called HIV.
PreP actually reduces the chances of acquiring other viral STDs to varying degrees.
Although we have to admit the moral hazard element too: by altering the risk calculus, it does seem to have helped weaken cultural norms around condom use and risky sexual behavior. Business is booming for bacterial infections.
Personally I’d say that’s a pretty good tradeoff: fear, stigma, and death for a different problem that’s more an annoyance than a mortal threat right now.
I think another overlooked portion is that we shouldn't be using meds (for infectious diseases) to enable fun (which seems common with sex). Eventually those meds will lose effectiveness, that's just evolution. Then the people who really do need them will be out of luck.
...And your odds of making it through that pharma-minefield with zero side effects are not encouraging.
Worse still--large scale casual sex is a great way to introduce new, novel and un-contemplated STDs into the population. STDs are opportunistic that way, just ask Mr. triple-resistant Gonorrhea.
It's decidedly not the way I want it to be, but that's just how it works. For casual sex to be safe I think its more like "Hi, please spit into this tube so we can get busy" and red means HIV, Green means Monkeypox, comprehensively.
It's not just about casual sex though is it. There are many people in long term monogamous relationships with a partner who has an STD, but who don't want to catch it themselves. Vaccines and medications can allow them to have active sex lives while staying healthy and in some cases even help women go through pregnancy and childbirth while preventing the spread of an STD to the child. For these people minor side effects (and at times even more severe ones) can be entirely worthwhile.
Or perhaps maybe a future for occupational health. My wife is a nurse. Needle sticks happen. When it does, she has to get tested, full works. The hospital pays for that and the treatment. Maybe with a shot that lasts a year rather than the current 2-3 months(?), hospital staff can just opt that route then the test and treatment. Apparently the treatment is rather gnarly.
Pardon my puritanism, but this seems like an awful lot to put your body through to get your rocks off and engage in this sort of indulgence.
I'm not going to make such an assumption, but two reasons people prefer PrEP generally:
1. in sex work, "not using a condom" is an "extra" that clients will pay quite a bit for
2. people who "party and play" tend to be in an altered state of consciousness that biases against use of condoms
To me, that is such a weird thing.
People literally paying money for something that can damage them for life and may even kill them.
Though the same can be said of addictive things (smoking comes to mind), is this some form of that maybe?
Risk always entails a premium.
Not generally, no. Driving that car with the sketchy suspension is cheaper than getting it fixed.
This is obtuse. The intent of expressing that if you are paying someone else for a service, it predisposes them to demand a higher price if you're asking them to take additional risks if they have any negotiating power at all was pretty obvious.
The discussion was about the additional risk to the customer, not the vendor.
The comment above the one you replied to was. The comment you replied to was not, and it'd be reasonable to suggest it didn't really address what it replied to. But its intent was clear.
it does, because the chances of you needing expensive medical care after using the sketchy vehicle go up
If you drive faster still in a car that also lacks crumple zones and airbags, your expected medical bill probably decreases.
A better analogy would be to buy a '60s sports car that predates nearly all modern safety tech at auction for $$$$$$ instead of just buying a 2024 Corolla with modern safety features.
You could say the same about sky-diving.
Yep, sure could. :)
i'm confused. are we acting like we don't full-well know that using a condom sucks for everyone involved? it's like wondering why people didn't like using a face mask during covid: because it sucks. that, of course, is independent from whether it's prudent, but if something sucks, it's no surprise when people avoid it, right?
There's that middle ground!
Maybe you want the real thing. I get that, even though I have never had sex with a prostitute or fall into the risky sex category. I'm not going to go as far as to be childishly disrespectful and say I'd rather die doing the real thing, but I do understand the apprehension of using artificial barriers during the most intimate act know to humankind.
People have a risk level they're comfortable with, and sometimes people feel added excitement pushing right up to or past that level, and sometimes they're just happy to pay extra for something they feel is within that risk level if they enjoy it more.
We all choose to take risks all the time and often pay for the privilege, sometimes explicitly seeking out the thrill of a risk.
I'm guessing what makes this specific scenario weird for you is more likely that this risk doesn't seem worthwhile to you relative to what you get from it (and I agree with that - I've never had an appetite for taking risks with STDs)
Being horny also counts as being “in an altered state of consciousness that biases against use of condoms.”
As someone who took the condom off in a risky situation recently, there’s no comparison between the on and off feeling. It’s like licking a piece of candy vs crushing it with your teeth and sucking it all at once.
Yes but it feels good
Maybe... they shouldn't, then? You also don't go shooting your guns or driving your motorcycle when drunk, even though it might be more fun?
Why not just not have sex unless trying to procreate? It's amazing in 2024 this line of discussion is happening.
We all know exactly at a individual level what to do and not. We can keep asking "Why not just use a condom?" and see how far that gets us, or actually understand psychology and use patterns and work with what people actually do (good or bad).
Same can be said about (illicit) drugs, why not just not do drugs? Simple!
It is a well known fact that people (except incels & asexuals) will have sex whether you like it or not. It's part of the human experience. Policy must deal with the real world.
When all it takes is a daily pill, or an injection, to reduce the risks of drunk-driving a motorcycle to practically nil - wouldn’t you want to do it? You don’t even need to wear a helmet, you can just do whatever on your motorcycle and not worry about it.
You never have to think to yourself “hoo boy I’m at two beers, and I don’t know, should I have the third? Will that be too many? Am I going to need to get on my motorcycle in an hour? Or will it be more like three hours? What will my blood-alcohol level be at that point? Is this legal? Is this safe?”
You can just have fun getting fucked up and driving your motorcycle.
Modern medicine has given us this incredible thing, and you’re really going to be like “Naw I don’t know about all that.”
I think that the only actual complaint I've ever heard against Prep is the costs being socialised and covered solely not by the user (ie insurance or public healthcare or whatever). It is (was?) not cheap!
"why do you use prep when you can use condoms" > "in a state where they prefer to not use condoms" > "maybe they shouldn't do it then"
or... they can use prep.
You don’t, but people do. And even if they “shouldn’t,” the cost of contracting HIV—which very few people set out intending to do—adds up to an eyewatering sum over a lifetime, no matter who’s paying for it. Not to mention rendering someone, often young, dependent on heavy drugs to stay alive. Forever. Assuming the drugs remain effective.
What other risky lifestyle decisions do we advocate to punish that severely? Especially when the technology exists to ameliorate the risk?
Wouldn’t it be cool if simulated guns were as fun as real ones? Then your hypothetical person could get drunk and shoot guns all they want, and there’s no problem anymore! So what’s the virtue in leaving the real loaded gun lying around to test their willpower?
It’s not that complicated. A lot of people don’t like condoms, either wearing them or having a partner wear them. PrEP, to many, has rendered condoms unnecessary.
Why not just not have sex unless trying to procreate? It's amazing in 2024 this line of discussion is happening.
We all know exactly at a individual level what to do and not. We can keep asking "Why not just use a condom?" and see how far that gets us, or actually understand psychology and use patterns and work with what people actually do (good or bad).
Same can be said about (illicit) drugs, why not just not do drugs? Simple!
I guess you aren't assuming to be around when the osteoporosis kicks in?
What are you implying, if I have sex without a condom I'll die sooner?
It is actually simple. Just not easy. Same with losing weight - consume fewer calories than you burn.
Isn't this like asking by do we have multiple methods of birth control? Pill, IUD, etc?
This is a great way of looking at it, thank you for that.
Why not just save money and not install those ECP brakes on your vinyl chloride freight train?
Why not just use one unshielded Raspberry Pi on that spacecraft instead of a 3-of-5 quorum from the output of 5 identical engineered-for-space systems?
Using/requiring condoms AND being on PrEP helps me live my best life with less fear-based inhibition and cognitive load.
The same reason why not everyone drives the safest car: cost and other negatives.
In case of a pill perhaps negative side effects.
I have no clue how often a person in high HIV risk has sex or behaves.
It should be fine to ask that question
this might be news to HN, but condomless sex feels significantly better
moreover, condoms can have numerous issues like tearing or stealthing
Have you had sex wearing a condom vs not? Its gotten better in the last twenty years but it is still noticeably worse
Condoms aren't perfect, and PrEP is cheap and has basically zero side effects. Plus, rapists don't use condoms, no matter how nicely you ask.
Edit: lmao touched a nerve? I will never understand why folks here get so prudish when we talk about sex... "Just wear a condom!" is remarkably insensitive, as though 100% of HIV transmission is your own fault, and not, say, someone else who has bad intentions.
Who prefers to chew gum with the wrapper on?
People lie and condoms break.
They can break, so multiple protective elements is better.
Some of us prefer to enjoy sex as a beautiful act of human connection and condoms detract from being in the moment of joy.
This is like saying to someone killed in a motorcycle accident why didn’t you use a car. It’s a reductive, unempathetic and frankly unproductive take. Please think before asking this again.
Besides the other nice reasons people offered, because "stealthing" (when someone removes a condom during sex without the other person's consent or lies about having put one) is remarkably common, and not as easily noticed as you might expect.
It’s because they’re no fun.
The drug is cabotegravir and if you want to feel safer you can take the pill form of it first to test it out.
Any chance these will ever be self injectable (with Rx)?
Couldn't you get an injection like Ozempic/Wegovy? Just have it in the fridge? Does it have to be administered in a physician's office?
I think the GLP-1s are subcutaneous injections - tiny, tiny needles you can stick in a variety of locations - Apertude is intramuscular, it’s a much larger needle, I’m guessing there’s some level of skill involved.
I get an intra muscular injection of testosterone every two weeks and it's true that it's not as easy as a sub q injection would be, but it also definitely doesn't require a nurse.
there's a few good injection sites (upper arm, buttock, thigh or even pecs) and after I was shown once how it's done, I can do it myself. it's also essentially painless.
Off topic, feel free not to answer if it's too personal but I'm curious how is every two week injections working for you for Testosterone? Are you on TRT for Hypogonadism or is it something else? I haven't heard too many people be on that kind of protocol..
I'm Hypogonad and I'm on self administration of sub q injections twice a week and it's quite annoying. My urologist told me it's best to split it this way since more frequent injections avoids a "crash".
I would like to have less frequent injections if I could!
It depends on the exact type of Testosterone being used. Each type has a different half-life and absorption profile.
The most common - Testosterone Cypionate should be best used twice a week to avoid the "crashes" - if you care about keeping your levels relatively stable. Other forms of Testosterone have different half-lives and should be taken at differing schedules.
I never saw the point in subq shots for TRT. They are less effective, and are recommended solely for patient comfort and compliance. If you can manage a twice-weekly deep IM injection, I personally have had great results with that once I learned the locations. Nearly as painless as subq and better more consistent results.
Overall it doesn't matter a whole ton unless you are doing it for specific performance enhancing reasons. Being off "optimal schedule" a few days isn't going to make a meaningful difference for most.
I take subq TRT twice a week (cypionate). I may lose some efficiency in fat vs muscle but it is easy, painless and my levels are perfectly fine.
I don't see why I change and my doctor essentially said the same.
Sub q is complete nonsense. Once every 10 days or so is fine. You simply feel like you need another shot and take it. No advantage and not necessary.
Unless, of course, you hit a nerve. Every damned time I try my thigh..
For what it’s worth you might want to try a weekly dose if you haven’t. Most do better on it.
A lot of these medicines that require patients to inject themselves come in a self administrating auto-injector. There are really simple to use, I mean literally anyone can inject themselves, then throw the one-use auto-injector out.
There's also needle guides[1] which provide a lot of flexibility for those who self-administer.
1. https://unionmedico.com/45-reusable-s1/
Like birth control. The pill has a higher “failure” rate than many people think. It’s of course “user error”
As evidence, despite theoretically being over 99% effective most birth control pills are around 91% effective in ordinary use.
https://www.nhs.uk/contraception/choosing-contraception/how-...
how much does it cost?
Agreed, it’s another treatment in a continuum of adherence— pre relations testing, barrier precautions, daily pills, semiannual injections. All running up to the eventual asymptote of cure and eradication.
Do you mind sharing how you got insurance approval? I looked into it but it was needlessly complicated. I couldn’t even get a cash price quoted.