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PreP bare- withdraw method risk

Aug 23, 2017

Hello Damon,

I'd like to calculate my risk as a gay man who is on Prep and has always/recently tested negative. Please know that I always prefer to use condoms even if on Prep- and especially if I am bottoming; however, last night I was the top and I inserted in the guy I was with without a condom (he claimed he was on prep also and that he was clean) - this was a hookup so I don't really know the guy but I don't have reason to doubt him other than the fact that he has to go in next week for his three month check up and he said he'll "let me know"- in all cases I was the top for a bit but withdrew and did not ejaculate in him- so what really are the chances of him being infected even if he is on prep and of me getting it as a top also on prep - or am I being paranoid? ( please note that shortly after I took a Truvada pill before going to bed and not on the regular time I usually take it (which sometimes varies also between morning and afternoon- I have been on prep since March) - I look forward to your answer-

Response from Mr. Jacobs

Hi there, I wouldn't say you're paranoid but I would assert you are one of millions who has been conditioned to believe that anal sex and pleasure must inevitably result in some punishment or adverse event. For most of the past 36 years gay and bisexual men have been taught only to fear barrier-less connections with one another. So now that tools like PrEP and Treatment as Prevention ("TasP") essentially erase risk of giving or receiving HIV, we are continuing to react to the paradigm of terror and panic.

So let's start with the facts. If are you are using PrEP consistently as directed, your risk of acquiring HIV, even if exposed, are less than 1% (http://www.natap.org/2016/ICAAC/ICAAC_02.htm). Condoms do not provide any additional significant protective benefit from HIV when PrEP is used daily. (https://www.robertmgrant.org/project/does-prep-work-if-condoms-are-not-used/).

At the same time when you are topping you are also significantly reducing any potential risk, as topping is approximately 90% less risky than bottoming (https://www.poz.com/article/HIV-risk-25382-5829).

So you've now taken a risk that is less than 1%, reduced that by about 90% (by topping). And if he is also on PrEP, then that brings down that risk to infinitesimal levels. You are literally more at risk of harming yourself hanging holiday decorations than you are of getting HIV under these circumstances (https://www.advocate.com/commentary/2016/10/26/sex-prep-life-never-without-risk).

The time of day you take Truvada is not as important as the consistency. In the efficacy trials, no one who took Truvada as PrEP acquired HIV when they took it consistently four times a week (https://www.hiveonline.org/bob-grant-and-damon-jacobs-talk-prep/). That tells us that you can take it at different times of day or night, it's just not wise to skip multiple doses.

So again, you are not paranoid, but I think are in the habit of being worried. Sex between two people, even a hook-up, can be a beautiful joining of bodies and spirits. Unfortunately, most gay and bisexual men have only been taught how to fear sex and anticipate catastrophic outcomes. But with the facts I hope you can allow yourself to enjoy the pleasure, play, and empowerment that sex can offer.

To learn more about PrEP's efficacy feel free to check out our resources library here at the Body.com: http://www.thebody.com/index/treat/tenofovir_prevention.html , or visit the international PrEP Facts Facebook group at https://www.facebook.com/groups/PrEPFacts



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