PrEP

So I’m diving head first into a topic of news lately regarding PrEP. *This is a bit of a long post today so grab some caffeine*

If you aren’t familiar with the term PrEP, it stands for Pre-Exposure Prophylactic.1 The drug Truvada has been on the market to treat HIV since the late 90′s. It was recently approved to help with the the prevention of HIV transmission for individuals that are HIV negative. This news has been received with some very mixed reviews from within the community and the fight over it rages on.

The disturbing part is not that the decision is contentious but that there have been attempts to silence or shame anyone who has embraced the option. I must say I don’t really understand the latter. Even worse, much of the criticisms are based on ignorance and baseless (so far) assumptions. I get the advice for caution and concern but the level of vitriol and condescending attacks is unnecessary and counter-productive. If you don’t understand something don’t ramble on about how awful it is because ‘you know someone will abuse it.’ As often turns out, you don’t know and that ignorance can cause real harm in this instance. You have zero right to demean anyone who would choose a path that may help prevent them from getting HIV, even if that path doesn’t line up with your personal preferences.

I blame some of it on our conditioning in Western culture to hate our bodies and/or any idea of sex outside of coupling. We are institutionalized from birth on 1man+1women=babies. Well, that social construct doesn’t apply so well for us same-sex lovin’ folks. And having moral apprehension to a method to prevent the transmission of HIV is perfectly fine for yourself. Sex is not dirty, wrong, or shameful. And this continual shame based approach to sexuality is reprehensible. Frankly, it should dispel any remaining allusions that we are in any way unique or more evolved than our straight brethren.

This particular argument isn’t about personal standards. It is about the prevention of HIV transmission. Infections are once again on the rise at an alarming rate.2 And while HIV may not be the death sentence it once was, it is still incurable. It is time to branch out and embrace more ways to combat the spread. The ‘you should use a condom’ argument has soundly failed, as evidenced by the continual rise in infections from a generation that missed the mass die-off in the beginning. And why we of all people continue to fall prey to this failed ideology escapes me. The ‘you should’ method has never worked. If it did, we wouldn’t have teen pregnancies, drunk drivers, continued HIV transmission, or even wars for that matter. You are right, people should use a condom. Many do but many more don’t. It is time to fight the transmission from a different angle and from as many angles as we possibly can.

There are some pros and cons to going on PrEP. It isn’t for everyone based on your risk-factors, health, eating/drinking habits, relationship status, etc. If you have questions or concerns, ignore all the hype and drama. Talk to your health care professional about it. At the end of the day, what I or anyone else thinks you should do is irrelevant. You should act to protect yourself and if this would help you, then you should consider it.

*

For my own view, I support the approach to limit the spread based on sound statistical evidence. So far, the studies are showing that PrEP is truly effective in preventing the exposure and spread of infection.

One big argument I hear has been people will use condoms less. Statistically, so far that proves to be inaccurate. Two of the studies (which use blind testing – meaning you never know if you are getting the real drug or a placebo) showed that overall condom use did not decrease. But let us assume for a moment that people did. How many times have you trusted a complete stranger to be honest about their status? And how many times have you engaged in riskier sex based on that belief? The way I see it, we have several scenarios3 where HIV transmission can occur:

Both partner’s know they are neg.
This is a fallacy. You should never assume someone who has sex with others besides you is neg. But let us assume for the moment, both partners think they are neg. You aren’t in a monogamous LTR and you engage in unprotected sex. Not being on PrEP means you are at the highest exposure rate for transmission. Being on PrEP would mean the ratio of transmission is reduced significantly (As much as 95% without a condom according to the efficacy rates of the studies so far).

One partner doesn’t know his status.
I would argue most of new transmissions via sex happen when one partner doesn’t know his status or assumes his status hasn’t changed. Again, if one of you are on PrEP, the exposure rate is reduced significantly.

Only one partner is neg.
Usually this means the poz partner is already on a drug regimen and undetectable. (You should still ask)  Plenty of sero-discordant couples already weren’t using condoms prior to PrEP. In an LTR or not, now the neg partner has an extra layer of protection and assurance he is not at risk. Not only does this reduce the transmission, it also de-stigmatizes the fear that comes from being with a poz person. Knowing you can be with a poz person and not put yourself at risk helps many who want to get past the mental mind-block, overcome their fear, and move forward.

Both partner’s know they are poz.
These are the least of your worries. These guys know their status and sero-sort on purpose. Primarily, to avoid the afore mentioned stigma that comes with being poz. I’d argue the only time this becomes an issue is when you get into assuming again. “We’re barebacking so he must be neg”, meanwhile, the other guy is thinking “We’re barebacking so he must be poz.” Never assume anyone is neg.

So which category do you fit in?

There are some cons and real concerns to consider. The biggest concern so far is the idea that guys will go on it inconsistently and cause resistance. Keep in mind resistance is only relevant if you sero-convert to being positive. Adherence to the daily regimen is key to the drugs efficacy. But think on this for a moment. The drug is already used for post exposure. Say you aren’t being very consistent with taking it daily. Then you have an exposure. How many of you reading this wouldn’t, out of that same fear, start taking it every day after an a possible exposure?

So far, the medical community is much more worried about resistance from folks that are using it as treatment, not preventative care. And let’s be real, people who spend the time, energy, and money to get on it as PrEP aren’t being cavalier. I’d argue they are doing just the opposite. It isn’t just a simple prescription. You have to visit your doc every 3 months, at least for the first year, for regular checkups and blood work. That decreases over time but you see my point. And when has a doc ever given you a prescription with an unlimited refill amount? See, when you think it thru you start unraveling some of the preconceived notions.

Another issue is cost. Fortunately, most large insurers already cover it so if you have insurance, chances are higher they do cover it vs not. I won’t even entertain the conspiracy theories I’m heard on this one.

And then we get to side-effects. The are some rare but sometimes very serious side-effects that can come from long term use of the drug. That again, is why you discuss it with your doctor and get regular blood work. Almost two decades of use show overall it is well tolerated by most. Even still, you are not given a prescription and never return. The hype over some of the more serious side-effects has been quite dazzling. I encourage you to go to WebMD.com and do a search for both Truvada and the little blue pill.4 No one is up in arms over the side-effects of the latter, which by definition aren’t much better. You can choose pretty much any drug site of choice to do a comparison.

In the end, you have to decide for yourself if this is right for you. If you are someone who uses a condom without fail (pun intended) then it may not be the choice for you. However, if you find that you aren’t 100% consistent and/or just want an extra layer of protection, then it might be for you. Talk to your doctor. Talk to others who are on it, regardless of their status. Decide for yourself if PrEP would be an additional way to combat the spread of HIV for YOU.

/rant




  1. Not to be confused with PEP, Post Exposure Prophylactic. The same drug is used for both []
  2. Ironically, many don’t stigmatize the treatment of other STDs, like Gonorrhea or Syphilis, that used to be considered terminal. []
  3. excluding needle sharing []
  4. I don’t want to attract the bots so I’m not spelling it out. lolol []

Rants

For a long time I tried not to talk too much about politics or current event sort of subjects on le blog. I just didn’t want to beat a horse that everyone else was beating. I go off on some things from time to time but I’ve always kept the focus of the blog squarely on myself.

These days, I find less and less need to fight my personal demons in this space. And while I’ll continue to blather on about my personal development, I feel it is time to start branching out. I think I have a good perspective on much of the happenings in the world. And as I love to harp, I’m good at seeing subtle but often important distinctions in things.

I guess what I’m saying is you, dear reader, should expect to start seeing more current event type rants here. Not everyday and certainly not the focus but I like to think it will add a good mixture to the chronicle that is my life.

Freedom

wpid-bondage-duck-300x300.jpg

image

The recent fallout over the PR lady poking fun of AIDS in Africa and the phoney character from that stupid duck show both illustrate my point.

First of all, freedom of speech in our constitution is meant to protect citizens from government censorship. The first amendment is not relevant to either of these situations so whining about their ‘freedoms’ being violated just shows a lack of understanding. It also shows cowardice in trying to hide behind biased comments as “freedom of speech” in an attempt to avoid any repercussions for said speech.

If you’ve been living under a rock, a PR lady for a rather large umbrella company posted a tweet making fun of going to Africa and inferring she wouldn’t get AIDS because she was white. She was fired from her job for it. Many felt she deserved it, others felt she didn’t really say anything wrong. The latter being based on an erroneous belief that Africa has a large percentage of HIV+ individuals that are black. As if that makes her heinous comments about being white ok.

The other example, a completely contrived character from a ‘reality TV’ show went on a long nasty tirade about gays and religion in an interview for a magazine. He was kicked off the show for it. Several side drama stories have ensued as well. The show might even get canceled because now the other phoney characters are threatening to boycott filming. Oh what a tragedy to our national IQ that would be. /sarcasm

Getting fired from your job for making racist or homophobic comments, however innocent you might have meant them in your ignorance, is not a violation of your first amendment rights.

The moral boys and girls?
Words have consequences, good and bad. Think before you speak.

Gene

I’m on a bit of a ramble today so try to keep up with my logic jumps as I muddle thru this.

I’ve been reading all the fall out on Dirk Cable and Jesse Jackman having a picture of them kissing flagged on FB.  Then Jesse getting banned for 12 hours. The  outrage over it went a bit viral and then finally the HuffPo picked up the story.

While reading thru many of the comments (it’s always fun to read the hate, bigotry, and flat out ignorance), a general pattern of stupidity emerges based on religion. Of course, if you take religion out for the equation all of those against it lose their arguments, save one and that being propagation of the species. For some reason every time this comes up my brain bounces back to the Hubbard guy who viewed gays1 as an aberration that must be rooted out. In case you are unfamiliar, he was the founder of the Science cult church, whom I won’t even do the honor of a full reference here for search engines.

Anyway, I’ve always found his wording intriguing. Not so much his hatred for gays (he had a gay son apparently) but his thought lines. He specifically and more than a few times referred to it as an aberration. Well for anyone who knows anything about evolution and biological progression, aberrations are not always bad. Whether an aberration survives in a species is often determined on any positive benefit it gives the species. That’s how evolution works. We also see in some species if the population breeds too quickly or over breeds, a switch happens and suddenly only one sex ends up being born in much larger numbers for awhile. This obviously leads to population control. What if humans, as a species, have a similar mechanism in our genome? In essence, the gay gene (or genes now based on more recent studies) would serve as a form of population control.

Are you still with me? lol  There are now over 7 billion people on this planet and the number is growing exponentially. Frankly, we are killing this planet. There are just too many of us for our natural resources to last. Not only are we over-breeding but because of modern medicine many more are living much longer lives. In my mind, it makes perfect sense that our genome is now producing abundantly more gay people. It serves as a mechanism to keep the species in check. Being a bit of a science geek, the idea hit me at a very early age. And it has never quite gone away. Obviously, I have no proof.  It is just an observation that rings true ‘to me.’  I’m not a scientist or even educated enough in genetic research to know but it certainly would explain a lot.

So even though he was a bit crazy and homophobic, he may have hit the nail on the head, just not in the way he expected. Now wouldn’t that be a kick in the rubber pants?




  1. And pretty much any deviation from sex for procreation []

Out

It appears that today is National Coming Out day. So in case you didn’t know it, I’m a big ole homo. Died in the wool , card carrying, and totally 100% unequivocally gay. I wasn’t molested. I wasn’t brain-washed. No one made me this way. I came this way. And for some that is a hard truth to swallow1 but belief is not a prerequisite of truth.

I always enjoy seeing who will come out on days like this. Even though incredibly painful2, I’ve never regretted my coming out 28 years ago. I came out very young and the repercussions definitely changed my life and not always for the better. The events leading up to the fatal day I almost took my own life changed me forever. I left behind the fear, the worry, and the shame. Never again would I allow anyone to make me feel anything but proud of what I am.

While we have gained some major ground as of late, the fight is not over. LGBT folk all over this country and the world are still be targeted for harassment, physical violence, imprisonment, and even death just for being born different. We must continue to fight for those who don’t enjoy our freedoms. We must attempt to educate those who fear and hate us because we are different. The simplest and most effective way IMO is for them to see we aren’t that much different. The number one thing that changes a person’s mind or heart is first hand experience. Given the chance to get know an openly gay person, many people see past the stereotypes. They see past the rhetoric, the lies, the hate, and the fear. The learn we are human beings just like them who just want to get ahead in life. The fact we happen to have same-sex attractions doesn’t make us evil or perverted just different. Our ‘agenda’ is the same as theirs.3  And when people see that they begin to change their minds. They learn, they grow, they evolve.

I encourage anyone out there pondering the idea of coming out to do so. The simple act of being open and honest will change hearts and minds. Sometimes it only takes a small spark to lite a roaring fire. Be that spark.




  1. Pun intended []
  2. both mentally and physically []
  3. Even though some of the crazy stuff they say we are pushing for is hysterical! []

Split

I’ve been intrigued by some of the fallout over gay divorces lately. I surmised as we reached for equality many would brush aside or not even realize what that equal footing really meant. Now we see the down side of it, in other words divorce.

Many rushed forward to say those wonderful two words w/o truly considering what it meant. Sadly, some are discovering the unpleasant down side now. Gone are the days of DPs that can be dissolved with a simple signature on the dotted line. Welcome to the bitter brawls over assets and custody of children and pets. You no longer have the luxury of just splitting up and going opposite directions anymore. And I won’t even comment on the indignant outrage many have expressed over it. Welcome to true equality. It’s called community property because that’s how the divorce court sees it. okuuur?

And don’t get me wrong, I support our right to get married 100%. That will never change. Being equal under the law is a fundamental right. The fact we are still fighting for it in many states is an embarrassment to humanity. But now that we are finally obtaining that goal, we must take stock in what that truly means. We cannot be special but equal, only equal.

I’ve always been a big believer in levels of commitment in the legal form. And I think this is true of straight couples as well. Start out with a DP which bestows next of kin rights to your partner w/o necessarily committing to communal assets/debt. This gives you both time to test the waters to see if this is for the long haul. Then when you really think it will survive, go for the full enchilada of Marriage. To me, that would make total sense but I am not sure that will happen.

I think what will happen is you will see many cities and states do away completely with DP registries. We, like straights, will have two options, single or married. California so far hasn’t done anything. Living in SF, I currently have three options. City DP, State DP, or Marriage. The city DP gives you insurance and next of kin rights but requires no communal property. The State DP gives you pretty much the rights of marriage including communal property. The State DP also gave you joint filing on your State income taxes. Now that Marriage is legal once again in Cali, there may be no real need for the State DP anymore. The only difference I could see is if you didn’t want federal recognition, then it would be of benefit.

There has been some talk at the City level of doing away with the local DP registry. It hasn’t come to fruition yet but it would not surprise me. I hope that they don’t though. I hope they keep them separate to continue to give people a choice. Like many things in life, it doesn’t have to be all or nothing.

Regardless of whatever your options are in your city, town, or state, take the time to really think things thru. Do a little googling and educate yourself. Gay or straight, asking for a pre-nup doesn’t mean your love or commitment is any less real. It does mean that you are taking a precaution in case things don’t end with a happy ever after. Fairy tales were meant to inspire not to delude. Being in love is a wonderful feeling1, but don’t let it overwhelm your decision making skills. And for the record, you can dissolve a pre-nup at anytime you wish. You can even build a time-limit clause into it.

And to answer your burning question, no the Pup and I are not at that stage yet. I certainly hope the day will come but we aren’t there yet. He pretty much owns me anyway but that’s a whole other type of contract. hehehe




  1. don’t I know it! []

Stuff

I had a caller tell me the other day she couldn’t be bothered to worry about tying up an emergency line because “that stuff doesn’t effect me.” Well true, at least until you do need someone and then the line is tied up by some other very inconsiderate person who can’t be bothered. Karma can sometimes be a painful teacher. I hope she never finds out first hand. But the flat out indifference surprised me a bit. ‘Screw you because I can’t be bothered to care about my actions but I’ll be the first to scream when it happens to me,‘ seems to be the norm vs the exception these days. While the result of your actions may not always be readily quantifiable, it should matter that your behavior impacts others. Otherwise, we devolve into a race of adults w/the minds of self-obsessed teenagers. Think on that for a bit.  /rant

Another caller didn’t believe he’d reached the real police dept and kept hanging up. He’d then call back to try and get someone who sounded more official. He got me and apparently thought I was official enough to report his noise complaint to.

The best call was a guy reporting a 311 (naked person) in the wharf who kept going on and on about how unattractive the naked person was. I mean he really went on about it. Couldn’t be bothered so much that he was naked but that he was unattractive and naked. lol At least he was honest about it.

*

The project I’m assigned to is still ongoing. What was supposed to be roughly 6 months has turned into a year, or it will have by the time the assignment is over. I don’t mind but many of the delays, most unnecessary politics, have sucked some of the fun out of it for me. I still get to influence how it will function and look and as a user that will be the biggest benefit. I could go on and on over the drama but it’s not worth it. In the end, it’s gone from being exciting and fun to just a paycheck.1  lol I don’t think I’d be cut out for civil service in the higher echelons. I’d get too disenfranchised I think.

Speaking of, more and more of my coworkers, as they discover the breadth of work I’ve created, are saying I’m in the wrong position or I should try to wrangle another job out of this. I am really appreciative that they recognize not only the level of skill but also the amount of work I’ve put into this thing. That said, I really enjoy my job. Primarily because it matters in a very real way. My actions have direct consequences on people’s lives and I value that. While it is true I don’t use all of my available skills, I use plenty and I’m content in that. And it is projects like this that give me a chance to show off my less used abilities. I guess in the end I would consider other options if they were available but it would have to be pretty good for me to jump ship, so to speak.




  1. Ok, the geek in me still likes it but the zeal is gone. []

Russia

I rarely discuss current events here as one, not really what my blog is about and two, successful discourse these days seems to be all but impossible. Having had several discussions with friends and even a few blog readers asking my thoughts on it, I thought I’d weigh in.

First, there is no clean answer. It is a sticky convoluted problem. Every answer put forward so far hurts someone. So if you look at the least amount of harm caused vs potential success then you can sort of see a way forward.

The boycott of companies. I don’t support a boycott. Primarily, because it won’t do any good. Put – head doesn’t care about the fallout or damage he causes, he only cares about furthering an agenda. He doesn’t care if we boycott one company or all of them, he will continue his agenda unabated. This is Russia we’re talking about. It’s history speaks for itself. Frankly, I don’t see that we do all that much business with Russian companies to begin with. I’m sure we have some but as a consumer I just don’t see it. I also don’t believe that they have any influence at all over their government. They don’t have the lobbyists like we do here. They don’t have the buying power like greedy corps here. The vodka company has been a decent supporter of gay rights before and after this incident. Why is it fair to punish them when they have zero influence over their government? Plus, boycotts are becoming so common as to be pointless and ineffective IMO. Even if they make further strides to support us, I still don’t support our methodology. The end does not justify the means if we give up the ethical/moral high ground. I don’t see the extra media attention as justification either. Said attention could have been garnered in other ways.

Boycotting the Olympics. Why, so the Russian athletes can take home all the medals? No thanks. Many of these athletes work their whole lives for this. To deny them that would be just a wrong as what is being done to us. How does wronging others do us any benefit? If anything, I think it would create more animosity towards the LGBT community.

Moving the Olympics. I would support a measure if there were time. From a very pragmatic approach, there isn’t and they wouldn’t even consider it. It takes years to plan and prepare for said event. As much as I’d love it if they were willing to move it, it’s not gonna happen. Too many ripple effects for a cause that is not near and dear to their hearts. If it were an option, this would be the one to go with. It would embarrass Russia and Put – head in a major way. Sadly, I just don’t see it as a real option.

Banning Russia from the Olympics. While still causing harm to their athletes, it would send a very powerful message to the government. While I still don’t like the idea of denying athletes, many of whom are probably gay, it is the least damaging of the previous options. Sadly, I’m not even sure that would work. Put – head has some pretty hard line policies and I can’t honestly believe he’d change his mind.

Pressuring sponsors. This is probably the least likely to cause harm but also least effective. I’d support the effort but I’m having a hard time finding a positive net result.

I would push other countries into a united front against Russia. Then if they didn’t budge the IOC could resort to banning Russia from attending. To me this seems to be the most effective way to make a positive change before the Olympics. Granted, any athletes that get arrested for ‘propaganda’ would set off world wide repercussions. While I’d never wish that on anyone, I’d support any athlete who did it! And sadly, I am worried it is the only really effective way to make a difference over there. *sigh*

Dong

Ding dong Prop 8 and DOMA (parts at least) are dead! lol It is high time too. Courtesy of the rulings, ss-couples can now not only be recognized at the state level but also the federal level. This is truly historic times for us.

To wake up and feel like an equal citizen for the first time1 is amazing. And unlike before Prop 8, there is a sense of finality to the issue. There will be no more Prop 8s. We’ve gained recognition at a whole new level and I couldn’t be happier. To feel recognized and accepted under the law is just unbelievable. In a way, it is almost anti-climactic.

Of course, the fight is not over. We still have equal rights for our Trans brethren and we still have a slew of states that don’t yet recognize gay marriage and/or bar it completely. The latter is only a matter of time. If you read the DOMA ruling, the justices pretty much set it up. The bias and basis for these laws is based only on discrimination and ignorant religious dogma. As new cases wind their way thru the courts back to the supreme court, the issue of ss-marriage will be decided once and for all. All the states with these horrible restrictions and bans on ss-marriage will have to suck it up, just like they did for women voting, the end of segregation, and interracial marriages. All of which, they also tried to use religious dogma to enforce.

The tide has shifted to our side. Thanks to the multitudes of us living openly/honestly, the world is beginning to see we really aren’t that different. We want the same things in life. We aren’t out to destroy civilization. Hardly. lol With 7 billion people clogging up this poor planet, there is zero danger there. I look forward to the future w/new dreams that I never thought possible.




  1. Ok. 2nd time. The first time was when California ruled we could get married before Prop 8 []

Equal

One of the biggest complaints I heard from locals during and after pride was about all the straights. All I can say is ‘careful what you wish for!‘  We asked for equality and we’re getting it. That doesn’t mean everything becomes hunky dory nor does it mean we can remain separate. And it certainly does not it mean our fight is over.

On one hand, it is a good sign that more and more straights feel comfortable celebrating a gay event. It is yet another indication that we have become accepted by society. But sadly, our straight brethren aren’t always looking to see things our way. They’re indifference hasn’t changed. To them, it is yet another party to be celebrated, the reasons are irrelevant.1 Yes, I’m overgeneralizing to make a point here.

And we have our own realizations to adapt to as well. This idea of separate but equal is dead. Cast it aside and move beyond it. Did we think we’d get equality and still be separate? Did we think everyone would accept us and still leave us alone? Sorry, that is not how it works. You can’t get equality and then ask to be treated special. And it seems that is the confusing part for many of us. We haven’t fully realized what equality means and are still holding onto our old ideals. In essence, we’re still stuck on being separate from the whole. We’re beyond that now and we need to catch up.

Some might see our new reality as a down side. I don’t. But I guess I’ve always realized what the true equality would mean. I knew this was coming and I’ve hoped for it all my life. You can’t have special and equal rights. As previously mentioned, there will be some homogenization of our culture. Will it disappear? Of course not. But this is why some within our own community have fought against the march to equality.  Like all things, our culture will adapt. But we must realize the days of “our” events are over. It is no longer our event. It is simply an event that happens to deal with us. Like it or hate it, it simply is.

I’d rather that than the worry and fear of never having the rights I need/want/deserve under the law. I’d rather know if my partner is injured or dies, I wouldn’t be locked out of his last moments or his family couldn’t take away everything we built together in life. I don’t want to pay extra taxes because the feds don’t recognize my marriage. I don’t want my foreign born partner deported. I don’t want my children in legal limbo. The list goes on and on.

Now we begin to see the true face of equality. And having seen it, would you deny that to the thousands of families across this nation? Even if, for you, it’s not all that it is cracked up to be, would you turn back the clock to full separation?




  1. One could argue the latter for gays in many ways too []