i’m not sure how widespread non-latex condoms are. There are two kinds: Polyurethane, as far as I know, are not approved for preventing STD’s. Polyisoprene, as I understand it, are. They are fairly new, introduced in 2008.

To be honest, I haven’t looked into this. It had always been drilled into my head to use only latex condoms for so many years. I have my “favorite” brand, and like most consumers, once you pick a brand of anything, you tend to stick with it. Which is why I actually wasn’t aware of the non-latex option. So thanks for the learning opportunity.

I don’t think that it is entirely correct that a condom has no side effects.

For most men (I believe) there is a loss of sensation in use of most condoms. While there is some “it’s not sexy” or “it’s not convenient” causes for inconsistent use, I suspect that for most men who do not adhere to a strict condom usage regimen, it is the decrease in sexual pleasure that is the reason. That is not some insignificant reason.

To complicate matters, in some men, there is great difficulty in finding condoms that fit properly. This is less a problem than it once was, but still many men cannot stop in to their local CVS to pick up a condom that is big enough – or, alternately, snug enough – to work as intended.

Taken together, these two problems with condom use can result in erectile disfunction in some men. In any other circumstances, ED would be considered a medical condition and a side effect.

I enjoyed and agreed with your breakdown of the issues. Yes, efficacy is indeed tied to compliance rates.

Here’s an article on POZ.com that breaks down the science and real-world application for Truvada as PrEP.

Dr. Mayer of Callen-Lorde does and excellent job of laying out the type of person who might benefit from this PrEP.

http://www.poz.com/articles/hiv_prep_questions_401_22701.shtml

I include the relevant grafs here:

QUESTION: But what about condoms? Won’t guys on PrEP forget about safe sex and start barebacking—and won’t that increase their HIV risk, especially if they’re missing daily PrEP doses?

ANSWERS: In the PrEP trials, participants actually reduced their risk-taking actions, but they also received free condoms and lube as well as counseling and screenings for sexually transmitted infections—and they didn’t know whether they were taking an effective medicine or a placebo. Additional studies are now needed, Liu says, to look for changes in risky behavior when PrEP is implemented in the real world.

But some critics are also saying that men who can’t use condoms regularly will not succeed in taking PrEP daily. “I think that will turn out to be wrong,” Mayer says. “Adherence to medication that has almost no side effects can be achieved by incorporating [Truvada] into life’s other rituals. Brush your teeth every morning? Leave your PrEP by your toothbrush and you’ll be less likely to skip doses.

“In contrast,” he says, “using a condom is a complex social interaction. For those who haven’t found a way to incorporate it seamlessly into their sex lives, it may involve two people interrupting a pleasurable experience to remind themselves of an unpleasant reality. You may also have to convince a partner to use it or let you use it, stay hard while putting it on, and then find a way to resume the sex where you left off.

“Despite all that, every day thousands of people use condoms successfully to prevent HIV infection. Because it’s so effective, has no side effects and is so cheap, a condom is still the best way to prevent HIV infection. But I reject the idea that people who can’t use condoms consistently will categorically be unable to adhere to taking PrEP daily. I would even say that those who struggle with condoms and feel bad or anxious about failing to use them correctly, may have tremendous motivation to use PrEP correctly.”

Mayer continues: “Someone who is using condoms consistently and has good safer-sex practices does not need PrEP with Truvada. However, let’s consider the person—call him Joe—who is struggling with condom use, which is true for many men in the gay community. Joe doesn’t want to become infected with HIV but only succeeds at using condoms 50 percent of the time, whether because of drug use, depression, peer pressure or whatever. Currently, Joe is risking HIV infection the other 50 percent of the time. Joe is probably very anxious about acquiring HIV [and is] an excellent candidate for PrEP. Once on daily PrEP, [provided that he uses it daily as prescribed,] he is going to be over 90 percent protected against HIV even when he doesn’t use condoms. So even if his condom use drops to 20 percent because he feels protected by PrEP, there is still a far lower HIV infection risk for him, and in turn, for all Joe’s partners, than without PrEP. But the key is consistent use, which is why it’s important to discuss adherence with Joe and to follow him closely.

“Importantly,” Mayer says, “we should also explore the reasons Joe is having trouble with condoms. If it’s depression, we should also treat Joe’s depression. If it’s drug or alcohol use, we should provide Joe with substance use treatment. We should be aiming to help Joe with the problems he’s having using condoms and working toward the day when Joe won’t need PrEP anymore.

“But I also know that many gay men are having unprotected sex as a personal choice, and not because they’re depressed or have a drug problem. Those men are generally trying to avoid HIV by other strategies: having unprotected sex only with partners who claim to be negative (serosorting), having unprotected sex only when they’re the top (seropositioning), having unprotected sex only with partners they trust, and so on. All those strategies have been proven time and again to be far from fail-proof, and that’s why we see so many gay men becoming infected with HIV. For those men, PrEP could be enormously helpful.

“Do I think a person on PrEP will use condoms less frequently? The studies don’t show that they do, but real life might be very different, and I think some will inevitably use condoms less. But I also think that using PrEP correctly will still be more protective, even with less condom use. Only time will tell.”

If I read secondary sources correctly, the efficacy was tied to the compliance rate. I believe (though could be mistaken) that those who used the drug properly had a 100% rate of non-convergence.

And, as its patent as a treatment is about to finish, the new use as a prophylactic will allow the manufacturer (and/or the drug company that bought the previous drug company) to eke out a little further profit.

AHF is not just demanding testing. I have no objection to requiring testing as part of the risk management. From the best I can tell, AHF and Weinstein oppose the use of Truvada as a preventative medication altogether and have led a campaign to oppose it being made available as such.

If a bottle of Truvada still requires a perscription (not sold OTC), then I see no reason NOT to require testing before the doctor signs that script. Do you not know the dangers of going on monotheropy when one is already HIV positive?

Granted Truvada is already a mix of two drugs, but if you’ve already sero-converted this still needs to be taken with a combination of other drugs. If not, the risk of developing a drug resistant strain is high. Let’s not even mention how many people this person may infect with a virus resistant to two classes of drugs before they even get to start their first line of treatment.

Sorry, this just smacks of ignorence. It is not an invasion of privacy, nor a self-rightious judgment, if your doctor runs a preliminary test before supplying you with a drug. These aren’t M&Ms.

You say you think everyone should be tested; but how do you expect that to happen when you think required testing before even a perscription drug is administered is some kind of governmental overreaching? You contradict yourself.

And in regards to your comment about the banning of bareback porn. YIKES! You seem to think this too is some sort of governmental invasion of privecy at best and an economic disaster at worse. Crazy talk.

If a chemicicals company wanted to start a business in CA and was only willing to do so if they were allowed to pay their employees a little extra to go without a haz-mat suit two days out of their work week, would you be for that too? Exposing someone to an occasional dose of radiation is no big deal, right? The city needs the money.

This is the most moraly corrupt defence of capitalism I’ve ever heared. And I am FAR from a bleeding liberal.

These adult entertainment actors are not in the privacy of their own home, there at work in front of a camera. How many porn companies provide health insurance for their employees? I’m guessing few, if any. With the cost of HIV meds averaging $24,000 a year per person, most of these poor saps that get infected on the job will likly have to go on a state funded pharmacutical program. That shoudn’t tax an already bankrupt governmental agency too much, right? So what if a few of these former actors (and the average career of an adult performer is remarkably short) have to go on a waiting list, while a deadly virus feeds on their immune system; the city coffers will have a few extra bucks to work with.

I’m sorry if I come accross as harsh, Tim. I almost always admire and enjoy your posts. Of all the contributors to this blog, I feel the most affinity with you. But in this case, I can hardly believe you wrote it.

I’m franky, appalled.