Why Don’t More Americans Use PrEP?

My knowledge of this is limited. But our county has been pushing this in newpaper ads. I've started threads about this. But, they are only pitching it at people who are in high risk groups, such as DRAQ Queens and other transgender types.

I think the costs may be high.

Do other people have info about this?

SJG

There have been tv ads for this over the last 6 months or so. I seem to recall it has some serious possible side effects.

Has video
https://www.sccgov.org/sites/phd/service…

https://www.avert.org/living-with-hiv/an…

Here, this is March 7th

https://www.mercurynews.com/2019/03/07/s…

https://www.sccgov.org/sites/phd/news/Pa…

http://gettingtozeroscc.org/

I don't think they are pitching it at those not in high risk groups, and the costs then might not be covered. I really don't know though.

SJG

Lol. Excellent if you can afford the medication as a cash price. Not even close to cheap.

Well I think our own Public Heath Dept is paying for it for those without insurance. But this might be only for those in the high risk groups, like transgender.

Curious to know more about it.

SJG

It's super expensive and insurance doesn't always cover it

>Why Don’t More Americans Use PrEP?

For the same reason they don't walk around wearing a parachute.

This got on my radar about a year ago when I saw some PSAs on my local TV stations; and I posted about-it on here but most-folks didn't seem too impressed - supposedly it's been around for a good while but supposedly the government has not been too-proactive about it's adoption b/c although it makes is very-effective against HIV; it does't do anything w.r.t. other STDs; and supposedly the government was concerned people would then stop practicing save-sex an start getting non-HIV STDs (which I think is erroneous thinking).

It seems like a very-good med on the surface; but as has been noted, there are potentially undesirable side-effects - not sure how common/severe these side-effects are; pretty-much most medicines have some concerning possible side-effects but IDK how much of that is having to specify the fine-print and how much is that it being fairly-common side-effects - but w.r.t. PrEP it does seem the side-effects are of genuine concern - a few weeks ago I was watching on C-SPAN some pharmaceutical exec getting grilled in front of Congress about drug-costs; PrEP was one of the drugs discussed and one of the things the pharma exec said is that they are currently working on next generation PrEP-type drugs that have less side-effects - the little I know is that PrEP is recommended to be taken for a period of time where one may be engaged in risky-sex but supposedly not recommended to be taken continuously I assume b/c of the side-effects - I think participating on a message-board w/ folks that are taking this (perhaps a gay website); one would get some hands-on advice.

As has been mentioned; it's expensive - but from what I've heard if one pursues it w/ their insurance company they may often approve it on the thought that using PrEP as a preventative med is cheaper than treating a person that becomes HIV+ - also; one can often get brand-name meds a lot cheaper thru Canadian pharmacies; although for PrEP is would still be pretty-expensive.

Because it costs around $1,500 per month. Also, even if your insurance covers it, you may have to clear your deductible before the coverage kicks in, which could be several thousand dollars.

Right now it's mostly marketed to, and used by, gay and bisexual men. This makes sense given that they are the high risk group. Most people with little chance of getting HIV are unlikely to find the expense to be worth it.

It could be worthwhile to providers if it’s acccessible. Promiscuous homosexuals are far from the only high risk group. There are also some people on here who have described behavior which I would say is high risk.

I don't really know what Prep is, how it is made, or why it is so expensive.

And then there is a different version of it for those already HIV positive. I don't know what is actually different about it, or why.

SJG

Only "indicated " for specific high risk groups.

Heterosexuals can still qualify ( if they have unprotected with high risk partners. High risk partners defined as iv drug users or MSM)

The CDC has a nice info page

Plus you have to get tested every 3 months

The idea of Prep is to take those who are no already HIV positive and try to keep them that way.

For those already HIV positive there is some other version of the medication.

So something does not sound right about that testing every 3 months.

SJG

Any specific numbers on cost? Wouldn't be a bad idea to take some in preparation for some sex tourism.

If you're a white heterosexual male who doesn't shoot up, your odds of contracting HIV are essentially non-existent. If you look at the CDC statistics for new HIV cases each year, they don't even have a specific measurable category for heterosexual white males.

So with that said, a white hetero male taking a very expensive drug with potentially powerful side effects, just to avoid something he doesn't have a realistic chance of catching unless he suddenly decide to take it up the ass from a lady boy or stick a needle in his arm, doesn't make a lot of sense.

So you are saying SJG should start using it immediately.

@liwet. TRUVADA will cost you approximately $1,844 for a 30 day supply. However, you are still taking a chance of acquiring a resistant strain of HIV. Thus, still not fully protected.

Med is usually covered by insurance and company has copay card making it free. Side effects can be bad though and doctors will give you weird looks.

Doctor will more than likely have fill out Prior Authorization Forms justifying its use. Insurance is not going to just pay for it if it is not required.

Its a med only for those who are not yet HIV positive. So the only reason they should bet it is a high risk lifestyle.

So yes, I think this does raise many questions.

SJG

It's extremely expensive and is limited to being provided to people who are at higher risk for HIV than normal; homosexual males, intravenous drug users, and people with an HIV positive partner are all prime candidates.

HIV is actually pretty hard to spread during regular heterosexual intercourse.

The fact it hasn't gone mainstream probably says something about the pros and cons

^And the availability. Doctors aren't just going to prescribe it just because someone is cautious about contracting HIV. And it is more than simply taking a pill, the patients have to keep up with their doctor and regularly get HIV tests to make sure they are still negative. It's just not practical to have the medication available for anyone who is sexually active. That is why it is for those who are at higher risk for infection.

^ seems they also gotta be followed up fairly carefully to monitor the potential side-effects to certain parts of the body

Here is the low down
Indicated for those who do not currently have HIV, but engage in high risk activities that may contract HIV. An initial history of last 6 months activity.

Condomless penile-anal or penile-vaginal sex with someone other that their regular partner. ... ATF / CF Doesn’t count as regular for this scenario

The HIV serostatus of the partner

If sex is being had while using drugs

If you have had any other sexually transmitted infections

Number of sex partners

Serologic testing for syphilis

Nucleic acid amplification test for gonorrhea and chlamydia at mucosal sites

Drug use behavior : injecting heroin or cocaine, sharing needles/equipment, using non IV drugs like methamphetamine during sex (less likely to use condoms when stoned or high).

Get plasma HIV test prior to starting therapy. Use of 4 th Generation antigen/antibody assay preferred.

Kidney function tests to show kidneys at greater than 60 ml/min creatinine clearance. You old bastards will probably not qualify on this alone.

If you have diabetes, hypertension, greater than 40 years old, or renal toxic drugs like ibuprofen, then urinalysis to assess for proteinuria and glucosuria.

Hepatitis B and C screening

Osteoporosis screening

When you finally decide to take this therapy, you will be screened/tested every 3 months.

When you start the therapy, you need to wait 7 days for males and 21 days for females. One exception is that if you only like taking it up the ass, then you can take it more as needed if desired (concentration of drug in the anal tissue is high and achievable rapidly ).

You absolutely need to take it DAILY Without missing doses to give you that 90 percent or better protection rate.

Main adverse effects are
Osteoporosis long term
Bone fracture 2 %
Kidney failure
Liver enlargement
Lactic acidosis
Immune reconstitution syndrome
Headache 7%
Weight loss 3%
Abdominal pain 4%

There you have it. You you can now make a more educated decision as to whether or not to try this out. YMMV.

Well, that clears a lot up.

Condomless penile-anal or penile-vaginal sex with someone other that their regular partner.

Why don't strippers count?

Got links for the above material?

SJG

Strippers don’t count as your regular partner because they have countless partners.

As far as “links”. Yes, but if I shared them, I would have to charge you my $250 / hr fee. It is what I do. Take it or leave it.