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PrEP and PEP for preventing HIV infection

TotalGold

Gold Member
I've recently been researching PrEP and PEP options for HIV prevention. I'm not an expert on the subject but thought it'd be useful to share what I've learned and help prevent HIV infection in our community. If any of you have direct experience or expertise on the subject, please share. There's quite a bit of confusing and contradictory information about using PrEP especially for straight men as a lot of the research on it is for gay men. I'm trying to straighten it out (pun intended) and make it useful for more people. But hopefully this is useful for everyone including gay guys, bi guys, women, and straight guys who have sex with trans-women.

A lot of people (especially straight people) don't know that taking PrEP can significantly lower your risk of HIV even when you engage in riskier behaviours. According to this study it can be up to 93% effective at preventing HIV infection when used properly. Some other sources claim efficacy rates as high as 99% but that claim doesn't seem to have the same degree of scientific support.

"Just use a condom"
Now before anyone scolds me about condoms, I agree 100% that using condoms and engaging in safer sex options are the smartest ways to prevent STI's. But we all know that accidents happen. You might be thinking with the wrong head, or a bit drunk and do something silly. If you know that you're prone to riskier sex or you're planning a drunken romp through Thailand, Colombia, or Bali then you might want to get on PrEP. Also they're not mutually exclusive. You can do both.

For me, I know that I'm a bit of a dumbass and there have been a few times when I've done super risky things like banging prostitutes without a condom in Southeast Asia. So far, I've been lucky and the only STI I've ever had was Gono and it cleared up with an antibiotic in a few days. I always swear that I'll never do it again but at this point I know that I'm stupid and will probably make a dumb mistake again when I'm horny. If I can take a pill for a week before my next trip and prevent a serious illness then I'll do it. I'll try to do better with safe sex but I have a fucking devil inside me ok?

WTF is PrEP and PEP?
PrEP stands for Pre-exposure prophylaxis or in normal English, it's medicine that you can take before having sex that will stop your body from being infected with HIV. Ideally you will take it for 7 days before sex but there is also a protocol for starting to take it two hours before sex that will still reduce the likelihood of infection. (See below in the misinformation section for more info)

PEP stands for Post-Exposure Prophylaxis, English translation: Medicine you take after you've had risky sex so that you don't come down with HIV. You need to start PEP within 72 hours after exposure in order for it to be effective. So if you suddenly freak out after gaining post nut clarity and realise you've had unprotected sex, you can go to the a sexual health clinic or hospital the next day and get PEP and still be reasonably safe from HIV. PEP can reduce the chance of HIV infection by up to 81% if taken within 72 hours. You need to continue taking PEP for 28 days after exposure in order for it to be effective.

How do I get it?
You can get PrEP in Australia at any pharmacy with a doctor's prescription. There are also places where you can order it from overseas and some that don't require a prescription but they seem a bit sketch to me. This organisation has lots of resources for places to order PrEP online including from registered Australian pharmacies. There's apparently a bit of a shortage right now so plan ahead if you think you might need some.

You need to get PEP from a sexual health clinic if you need it. BTW it also works for needle-stick injuries and other forms of exposure to HIV.

The confusing and weird misinformation*
A lot of the info and research about PrEP and PEP is heavily focused on gay men. This is probably because the HIV infection rate for men who have sex with men (MSM) is much higher than for straights. According to this study MSM have HIV prevalence 100 times higher than heterosexuals! I had no idea it was such a huge difference.

As a result, there's a lot of info about PrEP for straight guys that is probably wrong.*

For example on the Prep Access Now website it says that gay guys can take two PrEP pills and then have sex with a dude two hours later and be safe as long as they keep taking PrEP every 24 hours afterwards. But it then goes on to say that this option is not available to straight guys who apparently need to take it for 7 days before it becomes effective. This makes no sense at all so I tried to figure out why they say that.

Apparently, it's just because this method has been researched for gay sex but not researched for straight sex. NYC health has a good two page explainer on the topic here.

If you don't want to read it all the bottom line is that it probably works for straight guys too.* But it's more effective if you take it for at least 7 days beforehand. If you're a cisgender woman then it takes about 21 days to build up in your system enough to be protective.


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*I might be wrong. Like I said, I am not an expert. This is not medical advice. I am not a doctor. I am especially not your doctor. I am, in fact, a dumbass who once got gonorrhea from having unprotected sex with a southeast asian prostitute. I have done lots of other stupid things in my life. Take everything I say with a grain of salt.
 
Prep On demand is the 2-1-1 method
Which as you've said is take 2 pills 2-24hrs before sex then 1 pill 24 hrs after then another pill 24 hrs after last one.

This is good so they say if you can plan your sex.
If you are spontaneous or are having sex a few times or most days of the week, taking it every day is the best method and up to 98% effective.

Yes I also thought it was weird that one obe hand it says after 7 days you are protected but with on demand method you are protected after a dbl dose then 1 after and 1 after that
 
Given the history (including some very recent) of pharma companies peddling medications that have horrendous side effects I'd be interested to know the health cost of taking these drugs. A quick google says potential kidney problems, inflammation, GI issues etc. Worth noting.
 
Given the history (including some very recent) of pharma companies peddling medications that have horrendous side effects I'd be interested to know the health cost of taking these drugs. A quick google says potential kidney problems, inflammation, GI issues etc. Worth noting.
Did have follow up test to see if any effects on my kidneys and other things.
 
Yes I also thought it was weird that one obe hand it says after 7 days you are protected but with on demand method you are protected after a dbl dose then 1 after and 1 after that
Very weird! That info sheet from NYC health that I linked to earlier kind of explains it though. Apparently there was a scientific study that showed ".....that taking PrEP on a 2-1-1 schedule reduced risk of HIV infection by 86% in men who have sex with men." but the same research hasn't been repeated for straight guys or women. It's reasonable to assume that it'll work for the rest of us as well but it hasn't been proven scientifically.

From the fact sheet:

"Few data are available on whether taking PrEP on a 2-1-1 schedule would be effective for people who inject
drugs intermittently; heterosexual cisgender women and men; and transgender persons. While there are
limited data on the efficacy of on-demand PrEP for transgender persons having anal sex, PrEP and gender-
affirming hormones have no known drug interactions. Intermittent dosing may be less protective for people
having receptive vaginal sex, as a study found that it takes more days of PrEP dosing to achieve protective
levels in cervical or vaginal tissue than in rectal tissue."


But logically, there's nothing magical about gay sex that makes a medicine work better.* Although for women it does take longer to build up in their bodies so that could also be part of the reason they don't recommend it as a total solution for straight couples

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*Again, I could be wrong. Maybe gay men have magical buttholes. I am not a frikkin' doctor.
 
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