PrEP?

Where are you and why do you think it will be useful?

Are you somewhere where the HIV prevalence is high enough amongst the groups that you want to be sexual enough to be worth it?

I'm male, bisexual and in the UK. If I was sexual with a random man, there's a somewhere between 5ish% and 12ish% chance of them having HIV (higher in the larger cities, lower in rural areas). But a) if they do, it's quite likely that they're being treated for it and have an undetectable viral load = no HIV risk to me, and b) my favourite sexual act is oral, so the risk is miniscule anyway.

That means even though I might be able to get it for free - the availability of that currently depends on where you are in the UK - I'm not looking to take it.

If I were having anal with random men, especially if that were sometimes without using a condom, I may well think differently. (Or I might say 'I'll use condoms and have PEP - i.e. post exposure prophylaxis - if there's a condom failure'.) I might also think differently if I were somewhere where the infection rates were higher and the treatment rates lower.

Everyone has their own place on the risk and reward continuum, and you've found yours. Great.

The criticisms include the cost, the 'well I don't need to use condoms' aspect, and that for many people it'd be unnecessary. It sounds to me like you can afford the (generic) cost - and with a reliable supply, one cheap batch of the drugs should be the same as an expensive batch - and will continue to use condoms for the casual partners, and that you're in a position where it could be.

How much do you trust your regular partner(s) to tell you if they do something outside your agreed boundaries for sex with other people?

Well, if PrEP is more effective than condoms as people claimed that to be the case, it'd be safer to be on PrEP without condom then having a condom without PrEP.

PrEP does not protect against infections that are much more common (e.g. chlamydia and gonorrhoea) or potentially more dangerous (e.g. hep B and C) than HIV.

The focus in sexual health is on HIV but that disease really is only one part of a much bigger picture.

As a side note, I wonder how long it will take before we see HIV develop resistance to Truvada as more people are taking it on an ad hoc (i.e. long-term but inconsistent) basis.

I know. But they're also transmittable via oral sex and some of the very infectious anyway. I'm vaccinated against HPV and Hep A/B.

From what I read, the only concerning way HIV develops resistance towards the strains Truvada targets is if people start taking it after they've gone positive. Apparently, inconsistent intake of it doesn't really lead to that, perhaps due to its high effectiveness even after a week of not taking it.

Truvada might be more effective in preventing HIV but, overall, condoms are surely safer. Perhaps an even better strategy would be a mutual trip to the GUM clinic for testing before unprotected sex? This might not be a romantic gesture but then neither is taking an HIV drug before you get started...

I'd do both. But just because my partner isn't with any STDs in the beginning of our relationship, doesn't mean he will get nothing afterwards.

I guess that's true but with that level of cynicism perhaps it should be GUM check + condoms + PrEP!

PrEP does not protect against infections that are much more common (e.g. chlamydia and gonorrhoea) or potentially more dangerous (e.g. hep B and C) than HIV.

The focus in sexual health is on HIV but that disease really is only one part of a much bigger picture.

As a side note, I wonder how long it will take before we see HIV develop resistance to Truvada as more people are taking it on an ad hoc (i.e. long-term but inconsistent) basis.