Time to bring PreP to Ireland?

Annasopra

The Irish Times has an opinion piece today arguing against PREP.

http://www.irishtimes.com/opinion/anti-hiv-drug-removes-personal-responsibility-1.3054235

On the other hand the Gay Health Network has asked the HSE to bring it in

http://theoutmost.com/news/gay-health-network-urge-hse-make-prep-available-free/

http://www.gayhealthnetwork.ie/assets/files/pdfs/reports/Community%20Statement%20on%20PrEP%20Availability%20GHN%20February%202017.pdf

I think this is an argument coming down the line that gay and bisexual men need to face and have an honest discussion about.

Any thoughts?

gizmo81

I have spoken to Dr Lyons from James' about this. I have emailed successive Minsters of health. UCD/Mater are running a trial so hopefully. Movement is slow.

Two years ago men were accessing PEP to use as PrEp. Now though I worry about the men accessing PrEp online through advocacy sites like Prepster. Many Dating profiles seem to advertise themselves as being on PreP or some confusing 'treatment as prevention' to describe their status.

From what I heard medical professionals are unsure of how to administer it, will there be a charge etc

I believe it should be available to any man that feels they want it. It should be free or heavily subsidised.

The gay scene in Dublin has exploded in the last 5 years, diagnoses are up, we have a 'Chem' problem. We need a dedicated community led organisation to advocate and educate.

Joeytheparrot wrote: »

The Irish Times has an opinion piece today arguing against PREP.

http://www.irishtimes.com/opinion/anti-hiv-drug-removes-personal-responsibility-1.3054235

On the other hand the Gay Health Network has asked the HSE to bring it in

http://theoutmost.com/news/gay-health-network-urge-hse-make-prep-available-free/

http://www.gayhealthnetwork.ie/assets/files/pdfs/reports/Community%20Statement%20on%20PrEP%20Availability%20GHN%20February%202017.pdf

I think this is an argument coming down the line that gay and bisexual men need to face and have an honest discussion about.

Any thoughts?

Manion

What shape would the honest conversation take? That there is a growing trend towards unprotected sex? That perhaps putting your faith in condoms alone to protect you is not a great idea? That gay and bisexual men have a high risk profile than straight men and women? That a lot of sexual health education is simply pushing one agenda or another ?

L1011

If people assume PREP makes bareback safe, they're idiots babasically. Just as we got Hep C mostly curable we've got fully resistant bacterial infections

That does not mean it shouldn't be available. Accidents happen, and you aren't going to precent people doing dangerous things when drunk, ever

Manion

Prep isn't for accidents though, that's PEP. Prep is for people whose lifestyle choices make them more likely to be exposed to HIV on a predictable and continuous basis. What is safe and unsafe when it comes to sex? Is sex with someone of known status but who is undetectable safer than sex with someone who claims to be HIV negative. People in general are terrible at make assessments of risk, not just when they are drunk.

Goodshape

What are the effects / side-effects of taking PREP?

"It might make people more promiscuous" is a horrible sex shaming argument and I'm surprised to see it even remotely entertained as a valid point of view.

Personally I by no means have too much or too risky sex but I am single and I do, occasionally, when I'm lucky, have sex with other single people. HIV is a constant background worry to be honest. I could do without it!

Is PREP something that would be taken routinely or would it only be on those days you are expecting to get off with someone? How safe or unsafe is it?

HamsterFace

Is PREP really going to prevent a certain proportion of a demographic from catching HIV if it needs to be taken every day?

What I mean is, if a certain number of people are going to be negligent in remembering to use a condom, can the same portion of a demographic be relied upon to be so diligent when it comes to remembering to take this pill every day? If not, I think money would be better spent on condom awareness. Again.

Manion

Prep must be taken routinely. Once someone starts taking it, there is a period of time before it will be effectively. There doesn't seem to be a huge amount of information available about how effective it is. I read recently that it has very limited impact with regards newer more virulent strains of HIV. But someone would want hard numbers before deciding. There are also a number of potential side effects from taking Prep. It's doubtful that it would have an noticeable impact on peoples levels of Promiscuity. Those debates were put to rest when discussing birth control. Think of it similar to hepatitis A and B vaccination.

I don't think people who are contracting HIV in Ireland are condom unaware. This narrative of HIV transmission through broken condoms or failure to remember to use them is temping but I think missleading. Sex without condoms is a better experience than sex with condoms. I think acknowledging that as a starting point is important. We for decades now have put a lot of faith in condoms. Thrust condoms more than you thrust yourself, thrust them more than the person you love. The newer generations of gay and bisexual men appear (based on statistics ) not to be responding to that message, so perhaps a new one is in order.

Edit:
With regards making Prep free or heavily subsidised. It is an extremely expensive treatment and all medical services are resource limited. Morality shouldn't really enter it. But money should be spent where it does the most good.

wordofwarning

Manion wrote: »

Prep must be taken routinely. Once someone starts taking it, there is a period of time before it will be effectively. There doesn't seem to be a huge amount of information available about how effective it is. I read recently that it has very limited impact with regards newer more virulent strains of HIV. But someone would want hard numbers before deciding. There are also a number of potential side effects from taking Prep. It's doubtful that it would have an noticeable impact on peoples levels of Promiscuity. Those debates were put to rest when discussing birth control. Think of it similar to hepatitis A and B vaccination.

I don't think people who are contracting HIV in Ireland are condom unaware. This narrative of HIV transmission through broken condoms or failure to remember to use them is temping but I think missleading. Sex without condoms is a better experience than sex with condoms. I think acknowledging that as a starting point is important. We for decades now have put a lot of faith in condoms. Thrust condoms more than you thrust yourself, thrust them more than the person you love. The newer generations of gay and bisexual men appear (based on statistics ) not to be responding to that message, so perhaps a new one is in order.

Edit:
With regards making Prep free or heavily subsidised. It is an extremely expensive treatment and all medical services are resource limited. Morality shouldn't really enter it. But money should be spent where it does the most good.

There is a lot of misinformation in this post. PrEP is not like the pill, where you need to take it daily at the same time. PrEP is effective even if it is only take 4-5 times per week. Although daily make it most effective.

There is a lack of info on how effective PrEP is??? There is a ton of info it in fact. Plenty of studies on it.

https://www.nytimes.com/2014/07/17/upshot/is-truvada-the-pill-to-prevent-hiv-99-percent-effective-dont-be-so-sure.html?_r=0

Where did you read it has a limited impact on new strains? There has literally only been one case of HIV from someone on PrEP who took it religiously. They got it off someone who has on meds, but not undetectable yet. PrEP was not effective against the strain they had. It is effective against most strains of PrEP. The fact they were on PrEP meant they were tested every 3 months and were put on meds immediately. If they were not on PrEP, they may have waited months, maybe years to get tested.

HIV rates fell by 40% in London last year. They are falling in NYC too. It is due to PrEP

Ah, the usual 'young people never lived through the AIDS crisis and therefore don't use condoms' comment... Yet if you look at stats from the HSE, you can see HIV rates by age. There is a lot of 40-60 year old guys getting HIV. Most of whom lived during the AIDS crisis.

There is plenty of research in the US, that condom use has stayed about the same from the early/mid 2000s onwards. So even when as treatment for HIV has gotten better, condom use is not fallen in proportion.

Telling people to use condoms will not eliminate HIV. We have been telling people to use condoms to prevent HIV for the last 35 years and we still have HIV. People need PrEP, there is no way around it.

Manion

Hi,

I don't think there is any misinformation in my post. 4 to 5 times a week every week is routinely. The article you linked to outlines the benefits of Prep being taken daily versus semi regularly. I understand there is a single major study on the effectiveness, the one referenced in the article from 2014, it is now 2017. I'm aware of the statistics for new HIV transmission in Ireland. Gay and Bisexual men in Dublin between 30 and 39 years of age, followed by those aged 20 to 29 years of age. Again I did not state this was only a concern for young people. I also didn't make the comment you have attributed to me about the AIDs crisis. Lastly I explicitly made the point that faith in condoms alone as a solution is not something I believe in.

You're all but short of accusing me of posting fakenews despite the fact that on pretty much all the points we appear in agreement. You ask why I think it's so hard to find good information of Prep and Pep, it's because of this. Imagine someone coming here to this thread looking for clear information. You could make a point without making stuff up about posters or being needlessly argumentative. I've zero intention of engaging with you in a discussion on the points with which we may have differing views.

References:

http://www.hpsc.ie/A-Z/HIVSTIs/HIVandAIDS/SurveillanceReports/File,15862,en.pdf

wordofwarning

Manion wrote: »

Hi,

I don't think there is any misinformation in my post. 4 to 5 times a week every week is routinely. The article you linked to outlines the benefits of Prep being taken daily versus semi regularly. I understand there is a single major study on the effectiveness, the one referenced in the article from 2014, it is now 2017. I'm aware of the statistics for new HIV transmission in Ireland. Gay and Bisexual men in Dublin between 30 and 39 years of age, followed by those aged 20 to 29 years of age. Again I did not state this was only a concern for young people. I also didn't make the comment you have attributed to me about the AIDs crisis. Lastly I explicitly made the point that faith in condoms alone as a solution is not something I believe in.

You're all but short of accusing me of posting fakenews despite the fact that on pretty much all the points we appear in agreement. You ask why I think it's so hard to find good information of Prep and Pep, it's because of this. Imagine someone coming here to this thread looking for clear information. You could make a point without making stuff up about posters or being needlessly argumentative. I've zero intention of engaging with you in a discussion on the points with which we may have differing views.

References:

http://www.hpsc.ie/A-Z/HIVSTIs/HIVandAIDS/SurveillanceReports/File,15862,en.pdf

When are you supposed to take a tablet daily. Taking it every second day is not routinely IMO.

So you agree there is info on the effectiveness of PrEP then? Because you said there is not a lot of studies on the effectiveness of it. Although there is an article from 2016, that states there has been 18 studies on PrEP.

https://www.ncbi.nlm.nih.gov/pubmed/27149090

True you did not say poor condom use is just for young people. But you did make the point they need to be educated on condom use. You did not say young people just need to be educated on condoms, but you emphasised it.

HamsterFace

routine

noun
1.
a sequence of actions regularly followed

Manion

Definition of word routinely

http://www.dictionary.com/browse/routinely

I stated there is not a lot of information, this is a subjective statement. To you 18 studies is a lot. To me when compared with other medical treatment or even pep it is not a lot. How many of these studies are widely recognised? Again I understand that there is only one major clinical study and from that much of the information available is derived. What you're doing is false equivalent. It's the type of thing anti vaxxers do.

Lastly, no i did not state young people need education on condoms. I stated that I do not believe that the problem is that people are unaware. That said I do think anyone sexually active should be full informed of how to best protect themselves.

I'm actually amazed at how much you read into a rather simple statement.

jimdublin15

I think PrEP in Ireland would be a great idea.

With the patent expiring on Truvada and people working with GP's for check-ups and than sourcing the generic version themselves in the UK for only 45 to 60 euro per month, the cost is not huge at all. Allowing people to import the generic for personal use and being supported by the GP's is not something we allow in Ireland unlike the UK but perhaps that should be changed as well.

Anyhow point being the cost if the HSE next year was to buy the generic version in bulk would only be a fraction of the cost than buying the brand product. This with the raising HIV infection rates makes this a great time to start working towards allowing this drug to be used as PrEP.

How effective is it, well nothing in life comes with a guarantee but since the US in 2012, approved Truvada as PrEP, to prevent getting HIV, its real world success rate has been, very measurable and near perfect. By 2016 more than 40,000 people were taking it in the US and only 1 person acquiring HIV whist taking PrEP as prescribed. Personally I think that is pretty awesome as far as HIV prevention goes. (1 & 2)

Further analysis of 32 studies has been concluded finding that those who contracted HIV had undetectable or very low levels of the drug in their bodies at the time, meaning they had stopped PrEP when they were infected. People not taking the meds is always a risk with any prescription, its not the drugs fault.

So real life and more than 32 studies have shown to yield the same high level of effectiveness and prevention and a few Truvada pills to gain an additional layer of HIV Prevention in high risks groups is going to be way cheaper than having to treat people in the long run.

As for irregular usage well it have been looked at however most PrEP guidelines do remain to take it daily, except in France, this following the
Ipergay studies (3 & 4) France now offers both the daily regime and the Ipergay option were men and transgender women take two Truvada pills one day to two hours before they anticipate having sex. If they actually did have sex, then they take another pill 24 hours after having sex and a fourth pill 48 hours after it. So the period of taking PrEP would cover two to three days.

All in all
Statistics and studies aside, I think giving people who are sexually active the choice and tools to reduce HIV risks and enabling people to make informed sexual health choices, such as adding an additional layer of protection against HIV is a great and logical step and from my personal view I have not seen any valid reason or argument against not allowing people to protect themselves additionally and make that choice of how they conduct their personal risk avoidance. Someone wanting to take or have the option to take PrEP is a personal choice and discussion with a doctor, and should not be a public one.

I find it somewhat odd seeing the number of opinion pieces in newspapers recently from straight people discussing gay health and HIV prevention, and why PrEP should not be available, its clutching at straws, misinformed and the tone to me is clear its simply because don't like it as they have "moral" issues that HIV prevention somehow means more gay sex. Its none of their business, and next they will be wanting the pill and condom out as well, -- oh no they won't as i forgot that's for straight people as well, so it must be okay than. Phff they in fact know jack s**** about the subject if you ask me.

http://www.independent.ie/opinion/comment/the-pill-prevents-hiv-but-it-wont-cure-behaviours-that-caused-crisis-35645782.html
http://www.irishtimes.com/opinion/anti-hiv-drug-removes-personal-responsibility-1.3054235

Jim

1) https://www.poz.com/article/meet-man-got-hiv-daily-prep
2) https://www.poz.com/article/major-prep-studies-underline-importance-adherence
3)Ipergay studies: http://www.aidsmap.com/Pre-exposure-prophylaxis-also-stops-86-of-HIV-infections-in-Ipergay-study/page/2947854/
4) http://www.aidsmap.com/France-approves-PrEP/page/3016707/

Annasopra

Mod

Can we tone down the discussion a little and move away from getting upset and narky at each other in this thread please?

J_E

I'm not comfortable with the general attitude towards PrEP and it's use. I feel like it's going to cause potentially worse problems with STD transmission if used in the way people think it can be used. It still doesn't replace a condom and for most people, there is no reason a condom shouldn't be worn, even with PrEP. 'it feels better without' is a lame excuse for what is a serious problem of complacency leading to higher HIV transmission rates recently.

jimdublin15

J_E wrote: »

I'm not comfortable with the general attitude towards PrEP and it's use. I feel like it's going to cause potentially worse problems with STD transmission if used in the way people think it can be used. It still doesn't replace a condom and for most people, there is no reason a condom shouldn't be worn, even with PrEP. 'it feels better without' is a lame excuse for what is a serious problem of complacency leading to higher HIV transmission rates recently.

yeah, I fully agree STI's are concerning.

Its clear people take risks today and I know they will continue to do so with or without PrEP. So at least with PrEP its gives them a real level of HIV protection.

My view is simple we have rising HIV & STI rates so clearly the current method of prevention, education and regular screening does not work - It has failed miserably, its been done and tried, it does not wok not only for MSM but also the heterosexual community when we look at STI's & pregnancy .

PrEP however is not claimed to resolve any of that. Its a stupid but effective tool in prevention of HIV nothing more, nothing less. Just like the "pill" vs pregnancy under heterosexuals. When we see that, we, Ireland, and our HSE has serious testing gaps, treatment + educational gaps compared to other EU nations than our poor results do not surprise me one bit. (1)

So in regards to STI's generally we need better and more STI testing as routine, condom promotion and distribution, free condoms and health promotion and behaviour change interventions, including awareness raising and harm reduction, and sexual education. Years of neglect and/or low level prevention strategies is not going to be fixed with a PrEP pill. Also sex too often is a taboo subject and people need to more open (particularly healthy providers and spesificly GP's) about the topic for any prevention strategy to work, changing this mindset takes time and the only good thing about the PrEP debates if i am honest is that at least people are talking, can't wait for PrEP to be here and i hope it gets people engaged on "safer sex" topic even more.

None of this should however should be a reason for people not to be more enabled today to have a choice to start protecting themselves additionally how they choose to. Be it PrEP, condoms, pill, TaSP or a combinations of all options.

Jim

(1) http://ecdc.europa.eu/en/publications/Publications/Status-of-HIV-response-in-EU-EEA-2016-30-jan-2017.pdf

wordofwarning

J_E wrote: »

I'm not comfortable with the general attitude towards PrEP and it's use. I feel like it's going to cause potentially worse problems with STD transmission if used in the way people think it can be used. It still doesn't replace a condom and for most people, there is no reason a condom shouldn't be worn, even with PrEP. 'it feels better without' is a lame excuse for what is a serious problem of complacency leading to higher HIV transmission rates recently.

The first world currently has a situation where HIV rates have been flat among gay/bi men for about 15 years. Cities such as NYC have realised that they are going to fall without the likes of PrEP. HIV rates are down 40% in London due to people using PrEP that they purchased online.

With PrEP you have to get tested every 3 months to check for a HIV infection and to see if PrEP is damaging your liver ( it causes reversible liver/kidney damage in some people). Some GPs are in LA and NYC are noticing few causes of other STIs as their gay patients are getting tested religiously every 3 months. Where if they have STIs they are treated immediately. Without PrEP they might only see their Doc once every 6-18 months for a STI test

The elephant in the room re HIV rates rising is people from Latin America. More Latinos are testing positive for HIV in Ireland, than men born in Ireland. Maybe we should consider getting a test for HIV a prerequisite for a student visa like the way Australia requires a HIV test for their visas.

https://www.facebook.com/ACTUPDublin/posts/1835246553386419

jimdublin15

wordofwarning wrote: »

The elephant in the room re HIV rates rising is people from Latin America. More Latinos are testing positive for HIV in Ireland, than men born in Ireland. Maybe we should consider getting a test for HIV a prerequisite for a student visa like the way Australia requires a HIV test for their visas.

https://www.facebook.com/ACTUPDublin/posts/1835246553386419

I don't think that is the elephant in the room, the elephant in the room in we don't test people enough for STI's & HIV period.

The reports show born abroad but that also includes other first world nations and EU neighbours. It still leaves a mean 2015 29.9 % in 2015 born in Ireland and a 22% in 2016 * with 27% we did not record where they where born. Also where they were born does not automatic equal they acquired HIV abroad.

Migrants perhaps should be part of screening however part of a wider testing of people no matter where they are from and treating them, and educating to prevent reinfection and further spread. This is also been shown as the gaps area's for Ireland in EU reports as well.

On STI's well 10,673 STI's notifications in 2016 is a 10% increase, and under our 15-24 year olds they accounted for almost half of all chlamydia cases and 43% of herpers and 37% of gonorrhoea cases in 2016. That increased that has been going on for years under both MSN and Heterosexual populations in not due to a few Latino migrants. 1)

The elephant in the room on HIV rates is we don't test enough, don't treat enough and don't educate people enough (no matter where people where originally from) hence also the large number of late diagnosis. As you linked to 2015 data on the act up page, ill highlight this:

Of all people diagnosed with HIV in Ireland in 2015, 45% were late presenters (where information on CD4 count or AIDS defining illness at diagnosis was available). This was slightly lower than the proportion presenting late in 2014 (47%) and 2013 (49%). The proportion of people who presented late was much lower (31%) among those who had a previous HIV
diagnosis abroad compared to those who did not (52%).

wordofwarning wrote: »

With PrEP you have to get tested every 3 months to check for a HIV infection and to see if PrEP is damaging your liver ( it causes reversible liver/kidney damage in some people). Some GPs are in LA and NYC are noticing few causes of other STIs as their gay patients are getting tested religiously every 3 months. Where if they have STIs they are treated immediately. Without PrEP they might only see their Doc once every 6-18 months for a STI test

https://www.facebook.com/ACTUPDublin/posts/1835246553386419

Yeah, I agree.

PrEP comes with more awareness and testing and healthcare intervention. It also by allowing people to treat STI's early prevents the forward spread and with anonymous notification service it means the source (i hate calling it that) can also be notified and treated thus even further reducing forward transmission. All in all good stuff in terms of reducing STI rates under the population.

However testing every 6-18 months without PrEP in the US sure and look i am sure we are all responsible adults on the boards.ie and test for STI's frequently as well . But when I am in the US its not a problem to get a STI test, hell I can test for HIV at walgreens pharmacy (Not that i need it I know the results) in the US whilst buying my cigarettes, however I still hear too many people being turned down for basic STI or HIV testing at GP's in Ireland as the GP feels they are too low risk or the GP is uncomfortable with the subject, this needs to be addressed as well and is also part of the problem.

Jim

1)
http://www.hpsc.ie/A-Z/HIVSTIs/SexuallyTransmittedInfections/Publications/STIReports/LatestSTIReports/
http://www.hpsc.ie/A-Z/HIVSTIs/HIVandAIDS/SurveillanceReports/

Annasopra

wordofwarning wrote: »

The first world currently has a situation where HIV rates have been flat among gay/bi men for about 15 years. ]

What?
What on earth do you mean by "the first world"
Where are you getting this information from? What is your proof?

Edit - a quick 5 minute google lead me to numerous pieces of data from reputable sources disproving your statement above.

https://www.avert.org/professionals/hiv-around-world/western-central-europe-north-america/overview

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032460/

https://www.google.ie/url?sa=t&source=web&rct=j&url=http://www.eacsociety.org/files/2016_march_9_sti_and_hiv_epidemiology_report_final.pdf&ved=0ahUKEwiu9qKn9MvTAhVoLcAKHZU5CIM4FBAWCCYwAw&usg=AFQjCNGrDX3FbtM3V9Se2E-Jma2wkv9qnw


https://www.google.ie/url?sa=t&source=web&rct=j&url=http://ecdc.europa.eu/en/publications/Publications/hiv-aids-surveillance-report-Europe-2013.pdf&ved=0ahUKEwjv-_fA88vTAhWsJsAKHdNoAaUQFggnMAI&usg=AFQjCNEjO05H8H8zZ46OVHSCUIgkl_beew

wordofwarning

jimdublin15 wrote: »

I don't think that is the elephant in the room, the elephant in the room in we don't test people enough for STI's & HIV period.

It would be lovely to get a HIV test whenever you want. But if you go to James, they are generally turning people away as they are short staffed. I went once and they had one regular Doctor and another from an agency who was clueless. If you go to Baggot St, they are so short staffed that they are turning people away every time I have gone.

It is great the HSE hangs signs all over buses and in bars telling people to get tested for HIV etc. It would be even better if they made it possible to get tested. I went to tested back in Autumn. They told me it was 9 months since I last got tested. I did not think that was possible as I try to go every 3/6 months. Then I realised I went to the GMHS 3 weeks in row and got rejected 3 weeks in a row as they had no places.

IMO if free clinic have to turn you away, you should get a voucher to tested for free in a private clinic. Getting a STI test in Dublin should not be a lottery

jimdublin15

wordofwarning wrote: »

It would be lovely to get a HIV test whenever you want. But if you go to James, they are generally turning people away as they are short staffed. I went once and they had one regular Doctor and another from an agency who was clueless. If you go to Baggot St, they are so short staffed that they are turning people away every time I have gone.

It is great the HSE hangs signs all over buses and in bars telling people to get tested for HIV etc. It would be even better if they made it possible to get tested. I went to tested back in Autumn. They told me it was 9 months since I last got tested. I did not think that was possible as I try to go every 3/6 months. Then I realised I went to the GMHS 3 weeks in row and got rejected 3 weeks in a row as they had no places.

IMO if free clinic have to turn you away, you should get a voucher to tested for free in a private clinic. Getting a STI test in Dublin should not be a lottery

Fully agree, except for the voucher on private clinic part.

Testing is one of the area's the EU report as linked in my previous posts shows that we are lacking in testing, this is a common concern for years. It does not change next to other things that should be changed, access to PrEP is needed and this is included in both the EU and WHO the recommendations for HIV prevention strategies.

On a side note, GP's can do STI testing, they have the facilities to collect and send off the samples and in fairness some do offer the service, but a lot don't or simple seem to tell people to go a GUM clinc, just like your own experience, I've had that experience as well and heard the same from others trying to test. But should be standard to be able to have an STI test and having to travel to Dublin for an outreach program or to visit HIV Ireland or one of the few GUM clinic's is simply off putting and not realistic for most and an unacceptable level of prevention & care service from the HSE & GP's, if you ask me.

This all simply compounds the high levels in Ireland of late HIV diagnosis and the forward transmission of HIV & STI's unknown to the person infected.
PrEP and more access to testing for the general population, including education would be great. However PrEP and education that comes with it for the users of PrEP on its own would be an excellent start and at least in general it has and will have people will be talking about the subject of HIV & STI prevention. Who knows this might also increase the demand for improvements in services such as STI testing. I will say my local GP started offering STI and sexual awareness services 2 months back and has posters hanging up, so its great to see a improvement no matter how small.

Jim

SILVAMAN

Joeytheparrot wrote: »

Mod

Can we tone down the discussion a little and move away from getting upset and narky at each other in this thread please?

Clearly people are passionate about the subject and have strong opinions. It's not as though there are daggers literally at each other's throat.
As Heghel said "Nothing great in the world has been accomplished without passion".
Youth today has no idea of the horrors of HIV. The interminable diarrhoea, violent cramping, Kaposi's Sacroma blighting the skin and internal KS causing mayhem, cryptococcal meningitis(soil borne fungus), thrush, Lymphoma. Those are the common diseases. When you watch your acquaintances wither and die, become like old men, lose so much weight that you can lift them with one hand....that is the face of AIDS that this generation is wilfully ignorant of.
Add to that the aftermath of your friends parents and siblings grieving and often times unable to come to terms with the loss of someone in the prime of their life.
Reading through the lines of some of these postings, it's clearly not a debate akin to how many angels can dance on the head of pin, but rather a passionate desire to prevent a return to those hopeless days.
Fierce passion drove GMHC and ACTUP and other organisations and they focused public and political will on the issues. They screamed and howled and threatened, because they were fighting for their lives, and the slogan was that silence equals death.

Best to debate a question without settling it than to settle a question without debating it.

Annasopra

SILVAMAN wrote: »

Clearly people are passionate about the subject and have strong opinions. It's not as though there are daggers literally at each other's throat.
As Heghel said "Nothing great in the world has been accomplished without passion".
Youth today has no idea of the horrors of HIV. The interminable diarrhoea, violent cramping, Kaposi's Sacroma blighting the skin and internal KS causing mayhem, cryptococcal meningitis(soil borne fungus), thrush, Lymphoma. Those are the common diseases. When you watch your acquaintances wither and die, become like old men, lose so much weight that you can lift them with one hand....that is the face of AIDS that this generation is wilfully ignorant of.
Add to that the aftermath of your friends parents and siblings grieving and often times unable to come to terms with the loss of someone in the prime of their life.
Reading through the lines of some of these postings, it's clearly not a debate akin to how many angels can dance on the head of pin, but rather a passionate desire to prevent a return to those hopeless days.
Fierce passion drove GMHC and ACTUP and other organisations and they focused public and political will on the issues. They screamed and howled and threatened, because they were fighting for their lives, and the slogan was that silence equals death.

Best to debate a question without settling it than to settle a question without debating it.

Mod

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wordofwarning

jimdublin15 wrote: »

Fully agree, except for the voucher on private clinic part.

I can see what you mean. But if you want to get tested, it should not be a lottery in the GMHS or St James. If you have tried several times to get tested, the answer should not be keep coming back until we have a free appointment. At some stage, you should be given a affordable alternative. A private test will not be cheap for the taxpayer, but it might be cheaper than people with HIV not getting tested and spreading to others, as they can't get an appointment

I know a lot of GPs will do STI testing. But most people are not comfortable discussing it with their GP (I know even my liberal one has said some questionable things, that were not condescending, but a bit ridiculous). I don't feel I should have to pay €60/70 to get a STI test from a GP as the HSE can't seem to find enough funding for STI clinics. Even if you go to get an STI test as a student in College, UCD charges €70. Private STI testing is not an option for a lot of people.

It seems so bizarre the HSE can spend hundreds of million on high tech drugs each year with limited benefit, but can't actually fund a decent STI clinic in the capital city

IMO there is no way PrEP can be rolled out here. If you can't actually test people from STI going the odd time. Our STI testing services will not cope with thousands of men going every 3 months

jimdublin15

wordofwarning wrote: »

IMO there is no way PrEP can be rolled out here. If you can't actually test people from STI going the odd time. Our STI testing services will not cope with thousands of men going every 3 months

Let be honest about this, people are taking PrEP now and testing and i doubt it will be 1000's when its legal here. If it is 1000's or even 10.000 good to be honest and I am sure many are willing and capable of paying for the STI tests themselves, just as they are having to right now already with or without PrEP.

So let them have legal access to PrEP - I don't see the fact that "free" testing is a joke in Ireland or it would not suit all as a barrier to not allowing thous that can and want the access to PrEP now to provide them with an additional layer of HIV protection. If we continue to look at our services and say yeah but its not perfect or it might not suit all than nothing will ever change, and change it must. Its about time it did and so PrEP is a great place to start and hopefully it will be making people more aware and also the services (HSE) more aware of what we need from them is good, PrEP can't change everything given but it could be next to providing that additional HIV protection provide a push of change.

Ill be honest personally I do think we live in the dark ages when it comes to general sexual services/education in Ireland, including HIV prevention and services, and i am glad to see in very recent years more people taking to PrEP I just wish we would support them by having it legalised, and allowing more people to benefit.

Jim

wordofwarning

jimdublin15 wrote: »

Let be honest about this, people are taking PrEP now and testing and i doubt it will be 1000's when its legal here. If it is 1000's or even 10.000 good to be honest and I am sure many are willing and capable of paying for the STI tests themselves, just as they are having to right now already with or without PrEP.

So let them have legal access to PrEP - I don't see the fact that "free" testing is a joke in Ireland or it would not suit all as a barrier to not allowing thous that can and want the access to PrEP now to provide them with an additional layer of HIV protection. If we continue to look at our services and say yeah but its not perfect or it might not suit all than nothing will ever change, and change it must. Its about time it did and so PrEP is a great place to start and hopefully it will be making people more aware and also the services (HSE) more aware of what we need from them is good, PrEP can't change everything given but it could be next to providing that additional HIV protection provide a push of change.

Ill be honest personally I do think we live in the dark ages when it comes to general sexual services/education in Ireland, including HIV prevention and services, and i am glad to see in very recent years more people taking to PrEP I just wish we would support them by having it legalised, and allowing more people to benefit.

Jim

You can buy PrEP online and get it delivered to here for less than €40 per month. So many people are using it in London from buying it online, that they are doing the regular PrEP screening ie checking liver and kidney function etc. Plus AFAIK the patient on the brand is expiring pretty soon. The HSE should be able to buy generic PrEP in a few years.

If the PrEP is not going to fund it here. They might consider offering the screening for PrEP like they do in the UK

jimdublin15

wordofwarning wrote: »

You can buy PrEP online and get it delivered to here for less than €40 per month. So many people are using it in London from buying it online, that they are doing the regular PrEP screening ie checking liver and kidney function etc. Plus AFAIK the patient on the brand is expiring pretty soon. The HSE should be able to buy generic PrEP in a few years.

If the PrEP is not going to fund it here. They might consider offering the screening for PrEP like they do in the UK

Correct and the version that is being purchased online today is generic version of the drug. In the UK GP's and clinics are supporting users of this and that is great, its excellent even.

Technically speaking it might be legal to import this otherwise prescription drug for personal use in the UK - However I don't believe that is the case here in Ireland, still many of course do it or have it shipped to the UK and bring it across. I think that this should change and it should become legal and the follow-ups with GP's supported for users of this particular drug just like the UK. - What I mean is that PrEP users should be encouraged to tell there GP's if they are taking this without having to have concerns.

jimdublin15 wrote: »

I think PrEP in Ireland would be a great idea.

With the patent expiring on Truvada and people working with GP's for check-ups and than sourcing the generic version themselves in the UK for only 45 to 60 euro per month, the cost is not huge at all. Allowing people to import the generic for personal use and being supported by the GP's is not something we allow in Ireland unlike the UK but perhaps that should be changed as well.

Anyhow point being the cost if the HSE next year was to buy the generic version in bulk would only be a fraction of the cost than buying the brand product. This with the raising HIV infection rates makes this a great time to start working towards allowing this drug to be used as PrEP.

Manion

J_E wrote: »

I'm not comfortable with the general attitude towards PrEP and it's use. I feel like it's going to cause potentially worse problems with STD transmission if used in the way people think it can be used. It still doesn't replace a condom and for most people, there is no reason a condom shouldn't be worn, even with PrEP. 'it feels better without' is a lame excuse for what is a serious problem of complacency leading to higher HIV transmission rates recently.

Excuse implies you're accountable to someone for your sexual choices, you're not. What you're describing and others as well is the moral hazard argument. Basically that once people are aware there is something available that will mitigate the consequences of their risky actions, that they will take more risks. The same argument can and has been used against condoms, birth control and abortion. When we talk about "other" people we always put them in a category that is somehow not as smart as we are. I personally think the best approach is to make all the options available to people and educate them on those options so they can make an informed decision. Would you really support the idea of restricting availability of Prep because of a potential behaviour change which may cause increase general STI transmission? The definite consequences of that decision would be people contracting HIV who otherwise wouldn't have.

wordofwarning

jimdublin15 wrote: »

Correct and the version that is being purchased online today is generic version of the drug. In the UK GP's and clinics are supporting users of this and that is great, its excellent even.

Technically speaking it might be legal to import this otherwise prescription drug for personal use in the UK - However I don't believe that is the case here in Ireland, still many of course do it or have it shipped to the UK and bring it across. I think that this should change and it should become legal and the follow-ups with GP's supported for users of this particular drug just like the UK. - What I mean is that PrEP users should be encouraged to tell there GP's if they are taking this without having to have concerns.

My understanding is that if you take it, there is a very small chance you will get liver or kidney damage. So if people are taking it here, they need testing to ensure their kidney/liver is reacting ok to it. The risk of reversible damage is something like 1 in 100/200 people. But it is still something people need to be aware of

AFAIK you are right about the UK being OK about you buying prescriptions online. But it is a different story here.

jimdublin15

wordofwarning wrote: »

My understanding is that if you take it, there is a very small chance you will get liver or kidney damage. So if people are taking it here, they need testing to ensure their kidney/liver is reacting ok to it. The risk of reversible damage is something like 1 in 100/200 people. But it is still something people need to be aware of

AFAIK you are right about the UK being OK about you buying prescriptions online. But it is a different story here.

Yeah hence the story need to change, make it legal. It does need to be measured/monitored correct, hence it would be good for GP's to support ( some do already) and it to be legal such as it is in the UK. However you can get the test done for liver/kidneys even at current.

1 in 200 sorry how did you arrive at that number? Taking Truvada for PrEP has been shown to be safe and yes it causes reversible increase kidney's and liver stress for some key being reversible hence needs to be monitored by a doctor, Now what is true is beforehand be aware and check with a GP as always as people with pre-existing kidney problems and they should not take it, they are at risk. Its simply not suited for everyone but what is?

http://www.aidsmap.com/Modest-kidney-function-decline-in-people-taking-iTruvadai-for-PrEP-supports-need-for-monitoring/page/3040983/
http://www.thebodypro.com/content/73971/truvada-as-prep-does-not-cause-kidney-damage-study.html
http://betablog.org/new-research-at-croi-2016-how-prep-changes-kidney-function/

Anyhow I am bailing from this thread, just did not want to drop without mentioning it.