So a few updates on my quest to try out PrEP…

First, PrEP is going to be a bit expensive. The insurance company is a bit weird. They won’t say how much the drug is going to cost until AFTER it ships, but based on their cost estimator it looks like it’s going to cost me about $225 per month – and that’s with them covering 81% of the cost.

The costs in the graphic above are for a 3 month supply. If I were poz Gilead, the maker of Truvada, would cover my out-of-pocket cost of Atripla. But since they’ve got the only approved drug for PrEP they’re not quite so generous for neg guys – according to their website they’ll only cover the cost for guys who are completely uninsured. Personally I think they need to address the issue of cost issue if they want PrEP to really catch on. I can probably afford the cost, but my boyfriend is already complaining about it. So we’ll see if I continue after 3 months…

Second, PrEP really does have to be taken daily. My initial reading of the data I saw was that there was decent protection when taken every other day (or 4x/week), but my understanding of things was incomplete. The Maverick Men guys referred me to someone in Boston who’s been working in HIV research for 10 years now and currently involved in a study on PrEP. I’m just going to quote his response since he says things more simply and eloquently than I can…

You’re spot on in terms of 42% being the total protection which included people not taking their drugs.  The difficulty with the >90% protection is that those numbers come from post hoc (after the fact) analysis.  To achieve those numbers in the real world, we would have to enroll people, watch them take the medication every day, and see what the results are, which is clearly not possible.

As it stands now PrEP is only authorized for daily use. In the future that may change, and it is possible that you would receive some benefit from dosing every other day, but to achieve maximum efficacy it would make sense to take the medication daily.  Additionally, infrequent dosing could potentially lead to lingering GI side effects such as nausea or changes in bowel habits.  From a side effect standpoint, Truvada was chosen for PrEP because it does have such a great safety profile; less than 5% of people on Truvada experience any side effects, and for most of those people they resolve within a matter of weeks.  The two more concerning side effects – changes in kidney function and changes in bone density, would be monitored for by your doctor, and if they occur are reversible by simply stopping the medication.  More importantly, it is generally easier to incorporate a daily medication into your routine than an every other day.

In terms of going on and off PrEP, Truvada has a long half life so missing a dose here and there will not leave you completely unprotected.  However, if you choose to start and stop taking the medication, it is possible that you could experience ongoing startup GI side effects.  To avoid these, it is advised to take the medication daily.

That’s a pretty good explanation of why daily PrEP is the way to go. I’m not 100% happy about that – I’d prefer a more casual / less intensive relationship with the PrEP meds, but it sounds like that may be problematic. I mean I don’t feel like I have to have “maximum efficacy” – I’m OK with “pretty good efficacy” – but the thing is that the study that implies decent efficacy when taken 4x/week isn’t based on direct data. Hell, the efficacy of daily PrEP is based on the same study and may not be nearly as good as people think – there’s a long way between 42% and >90% and it is just a regression model. It’s probably right, but there’s no guarantee.

So daily PrEP it is.

[BTW, the guy in Boston recommended two more documents for people interested in knowing more about PrEP. This one is a little dense because it’s aimed at medical providers, but you may find it an interesting read if you like details. Meanwhile this one is more of a simplified version for patients.]

My pills should arrive end of the week or beginning of next week. So I’ll be starting soon…

I’m in rather desperate need of an assistant who can work 30+ hours per week. BUT given what I can afford to pay this is really only something for someone who’s in a place like Latin America where the standard of living is much lower. What I pay is probably poverty level in the US, but a very solid middle class wage outside of places like the US and Europe. I’ve hired enough guys over the years to know that I want someone working for me who’s motivated and happy with what I’m paying them. I have a track record of keeping guys working for me for years when the circumstances are right. I’m looking for that type of person – someone who will stick with me and grow with my business.

I’ve also hired enough guys who said “I can work 10-15 hours a week” to know that they usually are just being hopeful – they don’t actually have the time. By saying 30+ hours what I’m getting at is that I want my work to be your primary focus – which is why I want you to be happy with what I’m paying you.

The work will be varied but the three primary tasks will be 1) writing blog posts for porn blogs, 2) managing tube sites (uploading things as necessary and writing descriptions, tagging, etc.), and 3) some social media work on Tumblr/Twitter/Facebook, etc. Then there’s a bunch of odds and ends that I’ll ask you to do.

An ideal candidate will 1) be comfortable and competent writing in English, and 2) not be scared of simple technical tasks, and 3) have (or be able to get) a decent internet connection. There’s a lot more to the job, but if you meet those criteria the rest can be learned on the job.

If you’re interested please contact support@studio3x.com. HungLatinDom (my current assistant who’s been with me for 3 years now) may be the first person to respond to you, but I’ll be monitoring the emails.

The folks who are doing the study at Columbia University never called me back.  🙁  The more I thought about it the less enthusiastic I was about being in a study anyway – I want more control over how I take PrEP. So I went to see my doctor today. Actually he was a new doctor – the nurse practitioner I had been seeing was leaving, so I needed to change to someone else. This new guy was pretty decent when we discussed PrEP. I’ll be his 3rd patient to go on it.

One thing that surprised me a little was how resistant he was to any option other than taking PrEP daily. He was adamant that it wasn’t proven effective for anything other than daily use. That’s the treatment plan the FDA has approved and the only one he wanted me to consider. It didn’t seem like he was aware of the study that showed decent efficacy when taken 4x/week.

I’m seeing him again in a little under 3 months (checkups every three months are required when you’re on PrEP), so during that time I’ll do my own research and see what’s actually been empirically proven when it comes to efficacy of less than daily usage. If I find a source I trust more than my doctor, then I’ll consider doing something other than the daily plan he’s recommending. Though I’ll probably do as he asks at least until I see him next. In the meantime I’m mailing him a copy of the study… Maybe he’ll soften his position a little – we’ll see.

I’ve sent an email to the guy up in Boston that the Maverick Men guys mentioned who apparently is actively doing research on PrEP. I’ll see what he says (and what his qualifications are).

Anyway, the prescription for Truvada has been faxed off to the mail order pharmacy my plan uses for reoccurring/major prescriptions. I should have my pills in a few days.

And oh yeah… They gave me yet another HIV test – just the regular rapid test – not an RNA test. And I was wrong in my previous post – the regular tests are fine when you’re on PrEP – though they may not catch a recent infection which would be bad if you’re going on and off and not taking PrEP daily. If you don’t catch HIV infection quickly you could become resistant to the two drugs in Truvada.

Three and a half years ago when I first heard of PrEP I had an almost visceral negative reaction to it. I mean I really hated the idea on a number of levels. And when the issue came up on Breeding Zone (my forum site) a year later I was still really opposed to it. And then it came up on the forum a year after that and I went on a bit of a tirade against it. In one of the discussions on Breeding Zone a while back the guys raised points that made me realize some of what I thought about PrEP might not be quite right. And over the last few weeks I’ve learned additional stuff that’s changed my thinking on PrEP to the point where I’m actually considering going on it. That’s a huge change for me. So you’re probably wondering what’s changed…

But first… if you’re not sure what PrEP is, it boils down to HIV negative guys taking Truvada (an combination HIV drug) in order to avoid getting HIV. The idea is that drugs that can control HIV in poz guys can ward off HIV in negative guys when they’re exposed to HIV.

When I first criticized PrEP I didn’t really think things through completely. One of my mantras was “what’s the point of going on meds for the rest of your life in order to avoid going on meds for the rest of your life?” And, related to that, I figured that a person on PrEP could become meds resistant if they didn’t take their PrEP consistently – since that’s the case with poz guys who aren’t consistent with taking their meds. But I had that all wrong. It’s not that your body becomes meds resistant – it’s that the HIV in your body becomes meds resistant. If you’re neg you don’t have HIV in your body, so you can’t become meds resistant (though more on that in a moment). Because meds resistance isn’t a big issue, that means neg guys can have a very different relationship with HIV meds than poz guys. Neg guys can go on and off meds. For example, if you’re going on vacation with your mother and you know you won’t have sex during that time, then it’s OK to go off PrEP while you’re on vacation…

The potential for intermittent PrEP use was probably the biggest factor in my change in thinking. For 20+ years I had doctors tell me I had a brain tumor (when I actually had a scar), and those same doctors told me because I had a brain tumor I needed to be on Dilantin – an anti-seizure medication that’s been around for over 100 years. The side effects of Dilantin are very well known and even when I started having problems with my gums they wanted to keep me on the meds. My neurologist (who was very senior at an incredibly well respected cancer hospital) said if I wanted to go off the meds then I needed to find another doctor (which is exactly what I did). Unfortunately, I no longer trust doctors as a result of that, and a few other, experiences. (Doctors now have to earn my trust).

Point is, I’m overly sensitive to doctors telling me to go on meds for the rest of my life. Most meds have side effects and I’d rather just not go there. When I thought PrEP meant daily mandatory meds for decades that just rubbed me the wrong way. It seemed like a scheme by the drug companies to pad their profit margins. Now that I see PrEP can be somewhat intermittent that changes things drastically. Side effects from medications are generally less of an issue when the doses are lower and the meds aren’t taken every day.

So last week it started sinking in that I was wrong on some fundamental points about PrEP and I started wondering whether I should go on it. After all, if I’m honest with myself, I’ve got maybe 10 more years of an active sex life after which things are going to start slowing down considerably. 10 years of intermittent PrEP seems a lot better than the maybe 35 or 40 years of daily HIV meds if I become poz. [Note, if you’re an 18 year old those numbers will be very different. So each person has to decide whether PrEP makes sense for them personally.] My boyfriend and I went to Callen-Lorde for STD tests on Saturday and my bf talked to his care provider about PrEP for me and came out with some flyers for studies. I started thinking that I would indeed go on PrEP.

Then yesterday I started validating what I had heard through the grapevine and the numbers didn’t match. The study that the CDC references for gay men on PrEP showed that PrEP was only 42 to 44% effective. I had heard people throwing around efficacy numbers in the high 90s. So my initial reaction was WTF? I started doubting what I had heard and started going back to my “this is rubbish” stance. Some of what I had heard was from my friend who had talked to the guys from Maverick Men. [Just for visual interest, here’s a pic of one of the Maverick Men guys in action…]

When I drew the Maverick Men guys into a discussion on Twitter they were kind enough to give me links to more detailed analyses of the study data.

Apparently the 44% is low because some of the guys in the study weren’t taking their meds like they said they were. Only 3 of the 34 guys who converted during the study had meds in their system when they came in with signs of initial HIV infection. [If you’ve taken the meds in the last 7 to 14 days the meds should show up in your blood.] That means 90% of the guys who got pozzed while “on PrEP” weren’t actually taking their meds and hence couldn’t really be considered “on PrEP”.

When the researchers did models that factored all of that into consideration they concluded that if you take PrEP twice a week you’ll have 76% protection (with the bottom of the 90% confidence interval being 56% protection). If you take it basically every other day you’ll have 96% protection (with the bottom of the 90% confidence interval being 90% protection), and if you take it every day you’ll have 99% protection (with the bottom of the 90% confidence interval being 96% protection). If you want to see a summary of the study look at this PDF (particularly page 11). And if you want to see the full study, look at this PDF. [There are now studies underway to validate and replicate those numbers.]

Of those options – every other day sounds pretty good to me. I’m willing to sacrifice a little efficacy for fewer side effects from the meds. After all condoms are only about 90-95% effective – so that seems like a reasonable benchmark to me. But if people want more protection then they can go with daily meds. And if they want even more they can do daily meds plus condoms and/or closely screening their sexual partners (which is what the Maverick Men guys are doing). Personally, I don’t mind a little risk in my life, but each person is different.

Now, I mentioned that things weren’t quite clear cut on meds resistance. The issue is that, of the guys who converted in the study, a fair number of them did become meds resistant to Truvada. The bottom line is that if you go on PrEP you have to take it seriously, and you need to be regularly checked by your doctor to see if you’ve become poz (among other things). And realize, if you have Truvada in your system those at home HIV tests won’t work – you have to see a doctor for an accurate HIV test. [I was wrong when I first wrote that last sentence. However, if you take PrEP intermittently and you become poz you could become drug resistant. An RNA HIV test can detect infection more quickly and is more likely to help you avoid drug resistance.]

So there we have it… Who’d have figured, but I’m actually looking into going on PrEP. Apparently you can just have a doctor write a script for it – insurance companies can’t tell the difference between Truvada for HIV treatment and Truvada for PrEP. Or you can join a study – there are several under way. I’ve made a call to the the one being run by Columbia University and some other sites (Adapt – HPTN 067). I’m waiting to hear back from them.

And before I decided to look into doing PrEP the first question for me was whether I was still neg. After all, that is the #1 requirement for going on PrEP. I didn’t get a test on Saturday ’cause I had done an at-home test on March 6th – I didn’t think it was necessary. But I was a bit of a whore a couple weekends in March, so I did another home test today and it came back neg (see pic to the right). Those slutty weekends were 3 and 6 weeks ago, and while I’ve been sick a lot since then it hasn’t been with “flu like” symptoms, so the test is most likely correct – though it would probably be smart to do an RNA test before I start PrEP.

I’ll give updates on what happens as I try to get into the Adapt trial (or, if that fails, when I get a doctor to prescribe Truvada).

Today I got inspired to start a petition to end condom use in gay porn. I mean – why not? I was watching some really hot videos off Sean Cody – videos where the tops would cum deep in the bottom’s ass and then it would leak or squirt out of the bottom’s hole. I was thinking if someone as mainstream as Sean Cody can go that far – really getting into bareback breeding fetish – the why can’t every one else just at least ditch the condoms and go raw?

I mean it costs about $20 per HIV test. If producers are worried about their models becoming poz – just test them when they come in for the shoot. It’s not like $20 is cost prohibitive. And models who are taking a lot of loads and a little worried – they can go on PrEP until their sex life calms down. There really isn’t a good reason to keep using condoms. I guess there’s the “routine” STDs – but (at least for now) they’re all pretty much curable. And life isn’t zero risk… If a guy wants a zero risk life – then maybe he shouldn’t be a porn star.

Anyway, I assume you guys are all in support of porn being bareback – so check out the petition and sign it… If you’re a blogger or have an adult-friendly Twitter or Facebook account – please ask your friends and followers to sign the petition. The short URL you should use is http://bit.ly/117R0YK

I’d love to see 10s of thousands of guys sign. If I can get a lot of guys signing I’ll push the survey within the porn industry to see if we can get some producers to think twice about rubbers.

I’m a little late doing this, but just thought I’d do the year end wrap up for last year and look forward to 2013…

So last year I had 68 hookups and gave about 60 loads. In a couple of those cases I wasn’t absolutely sure I came, but I strongly suspect that I did. That means I had a failure rate of 12%, which is really good for me. Even if you said I only gave 58 loads, that’s still just a failure rate of 15% – which is still good.

60 loads makes 2012 the 2nd best year since I started keeping records. 2008 was slightly better with 67 loads given.

46 of the guys that I fucked I’d never fucked before, and 34 of the loads I gave were into holes I hadn’t seeded previously. If those numbers don’t quite make sense – imagine a sex party. I may fuck 5 guys I’ve never fucked before, but only give 1 load.

In the grand scheme of things 60 loads is not all that many. I mean there’s one bottom on Breeding Zone who is trying to get 2013 loads in his ass this year – he’ll need 5 or 6 loads every day to achieve that goal. That’s a lot of loads!

My goal for this year is go give 100 loads. It seems like a goal I could achieve. However, I’m behind my goal so far in large part because I started the year off sick and then couldn’t manage to cum with the muscle cub I fucked so much at MAL. If I don’t pick things up I’ll only mange to give 70 loads this year. But I think I can pick up the pace a little 😉