Load 2014-27

Once again today I got hard really easily. It’s been 3-4 days since I took a Cialis – I’m starting to think maybe going to the gym is helping in that department too. Which would be great if it’s true.

Anyway, I figured I’d see if there were any cumdumps available for a quickie load (since I needed to get back to work). This 20-something in my neighborhood hit me up. He wanted a dark room, blindfolded sort of scene. His profile said he was neg, but poz friendly since he was on PrEP. He gave me his address and said to be there in a half hour.

I know one other anonymous cumdump bottom who advertises he’s neg – but he’s actually poz. In the past if you liked being an anonymous cumdump you just had to accept that you were going to become poz (if you weren’t already) – it just came with the territory.

But things are different now – neg guys are discovering that they don’t have to be so inhibited. If they just get themselves on PrEP they can be the kind of pig they always wished they could be. I can’t say if the guy is actually neg and on PrEP (I didn’t go through his medicine cabinet), but I suspect he is. Gotta say it’s great for tops like me – expands the field of good, willing bottoms.

I get there right when I said I’d get there and the front door of his building was wide open. I go in, ring his doorbell and he comes and unlocks it and leaves it ajar (but doesn’t open it). I’ve done this scene enough times to know that means I need to wait a sec before going in. When I do open the door, I see him with his back to me, turning down the brightness of the light and bending over the bed.

I went over, took off my coat and just unbuttoned my pants. It was a pump-n-dump and taking my clothes off and then putting them back on again could double the amount of time I would spend there.

I got down and started rimming him. His hole was a little stubbly, but I did that just long enough to get hard enough to fuck. Then I got up and tried to push in. My dick missed his hole. Tried again. Then finally had to feel where his hole was and use those fingers to guide my cock. But my cock still wouldn’t go in! For an anonymous cumdump he was surprisingly tight.

I did finally get in. His hole felt good. It was at that point that I noticed he was blindfolded. I always love that 😉 He started getting a little verbal, but not so much so that it was a turn off. I had come less than 24 hours before, so I was little worried I might not be able to cum. I could feel my orgasm building, but was still worried it might a “dry” orgasm. I wasn’t completely convinced I was going to be able to give him a load. About that time he starting saying stuff like “give me that big load”  and I was just hoping I could give him any load.

But the load did finally come. Probably not my biggest load, but I could feel 2-3 good squirts go up his hole. Then I stood up, checked my dick for “dirt” and shoved my cummy cock back into my jeans and I was on my way…

He’s relatively close to me. Hope I can make him a regular…

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…

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).

If you’re not familiar with PrEP you should read the article in The Daily Beast. The guy who wrote the article contacted me a couple weeks ago, but I didn’t have much of anything interesting to say other than the fact that I’m completely against it…

If you’ve never heard of PrEP here’s a little history… It comes out of the concept of PEP (Post Exposure Prophylaxis) where they give people who are exposed to HIV drugs for a month after exposure to prevent HIV from taking hold in their bodies. It’s a particular mix of the same anti-retroviral drugs (ARVs) that people with HIV take. It was proven effective in hospital workers and then they started giving it more broadly to guys who had guilt after a night of raw sex.

Well, PrEP takes that a step further and thinks if ARVs are good after exposure then maybe negative guys who are barebacking regularly should just be on ARVs all the time. It’s PRE Exposure Prophylaxis.

Let me put this bluntly – you should only take powerful drugs like ARVs when you have a serious medical problem and you have no other option. Taking highly toxic drugs when you don’t need to take them is just stupid. Think about all the side effects and the damage they can be doing to your body. Developing a resistance to ARVs before you need to be taking them is stupid as well. Don’t be stupid.

Personally I think that PrEP is a product of guilt and fear. Guilt from having unprotected sex, and fear of HIV. It’s never smart to make decisions based on guilt or fear. You need to live a life where you don’t regret your decisions. If you’re going to bareback (especially if you’re bottoming), be honest with yourself and accept the risks. Barebacking is a risk/reward situation like all of the others you encounter in your life. If you can’t deal with the risk, don’t bareback. It’s really that simple. If you’re living a life you’re ashamed of, taking loads and then regretting it the next day – then I pity you… You should be getting off on the loads that are leaking out of your ass… 😉

It’s really a choice of a long life filled with fear and shame or a somewhat shorter life where you feel good about yourself and your choices, and you make the most of every moment – including every moment of your sex life. To me it’s not even something I have to think twice about. I’d rather live to 70 and enjoy the moment than live to 85 and feel like I missed out.

I’ve heard poz guy after poz guy say that becoming poz changed them for the better. While they wish they were still negative, finding out they were poz changed their outlook on life and they get more joy out of their life now than they did when they were neg. My boyfriend who died of AIDS years ago had a note on the fridge that said “Don’t Postpone Joy”. That is how you should be living your life – whether you’re neg or poz.

For some of you a life of no regrets means a life using condoms. That’s fine if that works for you. For the rest of you – embrace the risk (don’t fear it), and understand that it’s what comes with the reward of a fulfilling sex life – find the right balance of risk and reward, go forward and don’t look back… And for god’s sake, don’t fuck up your health by taking toxic meds you don’t actually need when there’s nothing wrong with you (other than guilt).