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HIV-negative Michael Lucas is giving medical advise
A month ago, I began taking a blue pill each day, called Truvada.
It's a combination of two of the three antiretroviral medications that form the cocktail used to treat people with HIV. Last year, the FDA approved the prescription of Truvada for the preventing of HIV in people who are uninfected. The term for this is pre-exposure prophylaxis (PrEP).
I'm HIV negative.
My choice to begin taking a highly-potent HIV drug wasn't an easy one. And the decision to come out publicly as someone who's on PrEP is not one that I take lightly.
But the more I learn about PrEP, the more shocked I'm becoming that gay men are not shouting from the rooftops about this potential game changer in the fight to prevent new HIV infections, which we're losing badly.
I'm ready to shout about it.
Here's what helped convince me: Dr. Robert Grant of UCSF, the researcher who led the multinational study on PrEP, was quoted at an AIDS conference as saying that “No one in iPrEx [the PrEP study] acquired HIV infection with a drug level that would have been expected with daily dosing.”
Was this really possible? Whether they used condoms or not, people who took Truvada, as prescribed, were protected from the virus? Before writing this column, I reached out to Dr. Grant to make sure I understood correctly.
While emphasizing that PrEP is still "very new," Dr. Grant confirms that "we have not seen anyone become infected that indicated daily use." He explained that the people in his study were among those at highest risk of becoming positive: gay men whose partners were already positive, and other men who frequently had unprotected sex.
Before I go any further, I do realize that I'm committing heresy. I'm certain there are safe-sex advocates in our community who are reading this right now, and whose heads are about to explode. Am I telling people to pop a pill and go have bareback sex?
I'm not. I am advocating that we look at both the social and medical science, and begin responding accordingly. And I too am angry.
In the past month, eight people I know have told me that they've tested positive for HIV. A couple of them had boyfriends who cheated on them. These friends, who didn't know about PrEP, are now unfortunately among the 50,000 Americans newly infected with HIV each year — one in four of whom is under 24 years old.
Whether we want to admit it or not, safe-sex education has been an epic failure. In a recent national survey, the majority of gay men—58%—admitted to not using a condom the last time they had anal sex. Is PrEp better than condoms? Dr. Grant won't go that far, but here's what he did say in a phone conversation: "That actual use of PrEp is more effective than saying you'll use condoms and not using them. And that's often the choice people make."
I'm know I'm not a public health expert, but I can't understand why we're not discussing, in a serious way, getting the most at-risk in our community on this medication immediately. With new and preventable HIV infections happening every hour, is the silence about PrEP among the safe-sex establishment not criminal?
One more statistic: US News reports that if HIV infections among gay men continue to rise at current rates, more than half of college-aged gay men will have HIV by the age of 50. We desperately need a new approach to battling new infections.
To be sure, taking Truvada is not like taking a vitamin. This is serious medication, and unless people take it every day, the protection it offers is greatly reduced. And like all medications, it carries risks and potential side effects—some of which are potentially quite serious. But none of the friends I know who are taking Truvada PrEP have experienced anything abnormal.
And here's as another good thing about Truvada PrEP: You can stop taking it! You can use it at times when you're most sexually active, and stop taking it when you're not having sex. If the side effects are a problem for you, you can simply go off of it.
But if you are HIV positive, that's simply not an option. As of now, you're on it for life. And if you're positive, you have to take another pill, which often causes diarrhea and other unpleasantness. I know this because I've slipped up before, and went on post-exposure prophylactic treatment, which includes all three medications.
There are a few other downsides to the PrEP strategy. If your insurance doesn't cover it, Truvada costs around a thousand dollars per month. But Gilead, the maker of Truvada, is offering assistance (free pills) to qualifying individuals who can't afford it.
You also must get an HIV test before starting Truvada, and between any "breaks" in using it. And, yes, you should continue to use condoms even while taking Truvada to avoid getting other STD's.
I'm now 41 years old, and have been sexually active for at least 23 years. I've lived through the horrific period when AIDS was untreatable. It's a memory that will never go away. But since this disease is no longer a death sentence, our daily fear of has diminished, and we have become more likely to slip up. That's why the possibility PrEP offers our community is one we need to be talking about. Now.
- Can't wait to hear about. All the side effects both known & unknown
- So now that pig's shilling for big pharma? Maybe he's a shareholder and he wants to make a profit (after all, his porn isn't selling...). He obviously doesn't care whether he endangers people by lulling them into a false sense of safety.
- [quote]medical advise
- :::Before I go any further, I do realize that I'm committing heresy. I'm certain there are safe-sex advocates in our community who are reading this right now, and whose heads are about to explode.:::
If by "safe sex advocates" he means the folks in GLBT healthcare who have been advocating for the investigation of all sorts of tools, including prep, to reduce the number of new infections to below epidemic levels, then no. There are no heads exploding.
We already know the guy's an asshole, but demonizing people who care about the health of their community (while taking advantage of their work) brings his assholeism to deeper levels.
- [quote]I'm now 41 years old,
I'm now 29 years old.
- He's the gay porn Jenny McCarthy!
- He's only 41? Being a repulsive whore really ages a guy.
- He says that he slipped up a few times regarding use of condoms. I've never seen any of his films. Do he and his actors regularly use condoms? Does he bottom?
- Sayeth the Chris Kattan of gay porn, "Quack, Quack, Quack!"
- Sounds like an ad. Somebody's getting paid!
- Or, you know, you could just not be a whore. I'm sure taking otherwise unnecessary pills is the smarter solution.
- So is he really saying he's become a sloppy pass around bottom boi now or that he's really HIV + but doesn't want to admit it. This is goofy as hell.
- [quote]But the more I learn about PrEP, the more shocked I'm becoming that gay men are not shouting from the rooftops about this potential game changer in the fight to prevent new HIV infections, which we're losing badly.
Probably because Truvada costs about $16000/year.
The Voice of the Night
- How do you say SHUT UP in Russian and Hebrew?
What am I missing? If there were an effective pill that would prevent HIV infection, I would want to be on it (making assumptions about minimal side effects and manageable costs). And I would absolutely want to be on that pill.
What is all the whining about?
- Wow. Such a short article, yet chock full of lies. He's not neg, he's not 41...but since I own stock in Gilead, I encourage idiots to take advice from a hooker.
- He's a sleazy, ugly whore. I never could take him, his mug, his schtick.
- yep r13, i understand a condom is much cheaper and is more effective. Isn't it kinda stupid that were telling people to take a pill and you can fuck bareback but the pill only works some of the time. Wouldn't that increase HIV infections?
- Why the pearl clutching? What's so terrible about admitting that you're very sexually active and that, yes, you're human and screw up once in a while when it comes to condom use? We should be applauding him, not placing a scarlet "W" on his chest. He's acted in and produced porn that obviously appeals to many, many guys. Personally, I don't find him attractive and his films do nothing for me, but there's no denying a lot of guys are attracted to him and his performers. Please explain the outrage.
- " He's acted in and produced porn that obviously appeals to many, many guys."
Please. His brand is going down the drain and he makes his real money pimping out underage European boys to greasy mockies.
- His talking about casually going on and off the pill is giving me nightmares about the treatment-resistant strains of HIV that will be brewed.
- I like him for being one of the few gays with enough balls to call Pisslam culture out for what it is: an exercise in bloodthirst against gays (and in opinion poll after opinion poll the majority of "nonviolent" muslim pigs support executing homosexuals). Gay liberals who defend Pisslam are every bit as treacherous as Log Cabin republicunts.
- The problem is that people who are looking for excuses for not using condoms will think they are home free and bareback like there's no tomorrow (and there won't be - for them - eventually). If I remember right when this was first being introduced, the effectiveness is approximately 64%. Not good enough odds for me.
- r23, I'm not so sure about that. I think the people who bareback will continue to do so. I don't think this would encourage guys who currently use condoms to dispense with their use. I think these guys would continue to bag it, by which, and let's face it, there's still the remote chance of seroconversion. For this population, using the drug would just reinforce the preventive measures they're already taking with condom use. My 2 cents.
- [quote] If I remember right when this was first being introduced, the effectiveness is approximately 64%. Not good enough odds for me.
It was 75% reduction for heterosexual couples and 44% reduction for gay men, but the authors of the two studies felt that the straight couples complied with medication protocols. For the period where compliance was strongest, the gay men had a near-zero change of conversion.
The Voice of the Night
- [quote]he authors of the two studies felt that the straight couples complied with medication protocols
Sorry, complied more consistently.
The Voice of the Night
- Damn, gurlfriend has quite a puss on her. Wad up with the pouty duck look?
And how about the side effects of this drug? Do you get the runs? Liver damage? Unless you're a porn star, this treatment sounds very iffy. Oh wait, Lady Lucus is a porn pup.
- It is something to think about.
Clearly guys are suffering 'condom fatigue' or something. Maybe this is a good idea.
- Maybe all porn actors should do this.
- Wonder how many people will get sick or die because of this "advice"?
- Maybe, just maybe a little bit of impulse control could be a good thing. Is the right message really "I'm ??? Years old, and yes, the 2000th cock I'll take is worth putting my long term health at risk plus 16,000 a year." Live it up Peter's Pan.
- My bf is negative, but in his college days he fucked around without condoms. Yes, he mostly topped, but there was some risk. He knows it was wrong, but he had a lot of straight friends who were fucking random chicks without condoms. They didn't really care about STDs and were more concerned with pregnancy, which they depended on the girl to handle. For him it was essentially, if my straight buddies aren't going to use condoms, then neither am I. When you're 20 and don't contemplate your mortality, you can easily fall into that mindset. Again, luckily he never caught anything. He's still pretty much a top, and I'm neg as well, but we always use condoms, even though were monogamous. I do wonder that now that we've become so integrated into mainstream society and making het friends, that notion of "if they're not bagging it, neither am I" is an issue.
- Look, there's already a fool proof preventative measure...it's called a LATEX CONDOM. 99 percent effective, and the 1 percent is USER failure.
I'm so tired of assholes saying, "Oh , he's being honest, everyone slips up now and then". That's a sleazebag with a drug and alcohol problem talking.
There is NO reason a guy can't wear a condom everytime he has anal sex. NONE.
- A lot of tops claim they feel no friction when fucking with a condom. I'm sure that's a valid point, but is that really worth risking your long-term health?
- R32...BULLSHIT. Total bullshit. When was this? 25 years ago?
Stop spreading propaganda. Kids today know what HIV/AIDS is, even in our twenties. Yes, there are guys who take chances, usually because of drug and alcohol problems. But stop talking about the past.
- [quote] I don't think this would encourage guys who currently use condoms to dispense with their use.
- Except human nature, R33. Many guys aren't wearing condoms. It's just a fact. Calling people assholes or sleazebags doesn't really change things.
No one can credibly claim that they don't know that condom usage will prevent the spread of HIV. There has been advertising campaign after advertising campaign. And yet...
- R34...that's in their heads. There's been so much propaganda about that BS. But a recent blind study showed that, when guys are anonymous and being honest, they actually are fine having sex with condoms. It's just laziness, stupidity, drunkenness that make guys take stupid chances.
- R37...are you talking to me from thirty years ago? To say that "many" guys don't wear condoms is just bullshit. Maybe among older men who can't adjust. But younger guys wear condoms.
As for calling people sleazy, it IS sleazy. You're not just endangering yourself, you're endangering others. It's grotesque.
We can't keep blaming society. People know the score. It's a matter of taking responsibility, not just for your health and safety, but for that of your partners as well.
- This TRUVADA shit decimates the users' livers. Hepatic liver syndrome within 18 months is not at all uncommon with this toxic mess.
Taking these pills daily is truly dangerous. (It's like having RAD-therapy to prevent a potential tumor.)
So Lucas, a known whore, is just whoring for some drug company because, gee, no one wants to wear a fucking rubber. I can't wait to see the pig begging for new organs.
- I'm not blaming society, R39. But you're ignorant of human behavior. 1000 young men under the age of 24 are being infected every month.
The fact that HIV transmission rates remain as high as they are is evidence that 'many' guys don't wear condoms. It's just a fact.
And R40, liver damage from Truvada is actually rare.
- RE: Liver damage R41, says WHO?
My doctor is an acclaimed specialist in HIV/AIDS treatment, and she said that taking that mess daily is POISON. I think I'll trust a doctor who was in the trenches before the "miracle" drugs came along.
Me, I'll use condoms, and I'll likely stay negative and healthy. Plus I'll be able to keep all that money for the things I enjoy more than being a trashy pass-around party bottom. (Not my thing.)
- "So Lucas, a known whore, is just whoring for some drug company"
His indescribably icky "boyfriend" is probably a stockholder in truvada. ML certainly wouldn't do something because it's the decent thing to do, there has to be a profit motive.
He's the scum of the Earth.
- So your doctor won't prescribe Truvada, R42? And she's an acclaimed HIV specialist?
What is her name?
- He doesn't make bareback porn, but he hires actors who do, e.g., Rafael Carreras.
- Why do people like R42 make these claims that are obviously false?
Your doctor is an an acclaimed specialist in HIV/AIDS treatment - and you are HIV neg? Makes no sense. It's like saying you have an acclaimed cardiac-thoracic surgeon as your primary care physician. If by some chance it is true you are wasting her and your time. You want a PCP who has seen enough cases of the latest flu to know if what you have is that flu or something more serious.
For all you idiots who think a condom is the solution - I suggest you crawl out from under whatever rock you live under and take a look at the real world.
For public health reasons we need a method of HIV prevention that isn't tied to the actual sex act. For obvious reasons animals have an overwhelming desire to procreate. The pleasure and desire for sex is an advantageous mutation - which has survived and flourished due to natural selection.
If you have never found yourself in a situation where you didn't think a condom would be needed and then all of a sudden you find yourself with an overwhelming desire to sit on some guy's cock or have him sit on yours - then I think you have missed on how just how great sex can be.
Am I proud of the times I've had unprotected sex - no. Am I lucky - hell yes. Still HIV negative. Was I drunk or on drugs - nope.
If you think for a minute sex with a condom is as good as sex without - you don't know what you are talking about.
You condom freaks sound like the abstinence only folks.
- i think condoms have numbed us entirely on the pleasures of sex
Dear, we have the capacity for critical thinking and reasoning, unlike other animals. To suggest that people can't 'control themselves' is actually a VERY conservative argument.
Condoms ARE the answer for now. It's weirdos like you who are constantly agitating against them that are responsible for a lot of illness and a lot of deaths.
You're marginally retarded. And, I suspect, an old dinosaur. Shut the fuck up. Safer sex is what will save lives, not you BULLSHIT rationale for unsafe sex.
There will be no cure or vaccine, perhaps ever. It's complete bull to think otherwise. Perhaps genetic engineering holds the key, but that's fraught with all kinds of other issues and potential problems.
Grow up. No one's interested in your bullshit 'free love' adolescent thinking anymore.
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- Alrighty Mikey... bend over and take my load then, I'm just naturally bony.