A Man Stopped Thousands of People Becoming HIV-Positive | Hacker News Reader

A Man Stopped Thousands of People Becoming HIV-Positive

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180 pointsrb2e48 comments

I'm a 30-something gay dude on PREP. I primarily take it because I'm in a sero-discordant relationship with my boyfriend who is HIV+, but also as a safety precaution for when I was single and hooking up.

PREP has the potential to completely turn the tide on HIV infections. I live in a mid-sized midwestern city where between 10 and 25% of gay dudes in my dating pool are HIV+, many of them unknowingly and therefore continuing to spread it. There is a big push from the local public health department to get gay guys at risk of contracting HIV on PREP and it is starting to pay off.

PREP also is helping reduce the stigma of having HIV. Many people who are HIV+ live with a huge mental health burden of dealing with feeling like they are going to be rejected as a romantic partner because of their HIV status. With PREP as an option this helps reduce that burden. I'm not necessarily proud of this but I'm not sure if I would be dating my current boyfriend if PREP were not available because of the risk it could present to my health. He's an amazing guy and having this issue out of the way for us has been very helpful for us.

That's not to say that it doesn't have side effects and that it should be carefully considered but it really needs to be publicized more as a preventative treatment option in high risk populations.

I really wish more people knew about PEP as well. It seems equally important (in both the gay and straight communities), but it seems to get even less publicity than PrEP

Definitely. PEP, which for people who aren't familiar with it is a course of drugs which can be taken within 72 hours of a potential exposure to HIV to prevent becoming infected with HIV. It's not 100% effective, but it is an important tool to prevent the spread of HIV.

> I'm not necessarily proud of this but I'm not sure if I would be dating my current boyfriend if PREP were not available because of the risk it could present to my health.

Personally, I don't think that's a sentiment to be proud of or ashamed of. It's a practical reaction to the lay of the land. I hope you don't beat yourself up about it.

Having a large group of people who don't know they have HIV is shocking.

Yes, it is, and obviously this makes it difficult to prevent it from spreading. It can be asymptomatic for months to years.

HIV testing needs to be a part of the annual physical check up, just like blood sugar testing for diabetes. Hep A/B/C testing should be as well. If I was forced to be infected with HIV or HepC, I would take HIV over HepC. C is some nasty shiat and there is no vaccine unlike the A and B varieties.

HIV is a pretty rare disease. About 1 in 300 people in the USA. So I don't understand 1 in 4 gay men are HIV+.

About 2% of men are HIV positive. So just blindly using 1/4 you get 1/200 people are HIV positive. Assuming that the place discussed is a little bit above average, and you get a number that is consistent with the population having a 1 in 300 HIV rate.

https://en.m.wikipedia.org/wiki/HIV_and_men_who_have_sex_wit...

The CDC reports that in 2009, MSM accounted for 61% of all new HIV infections and that MSM who had a history of recreational drug injection accounted for an additional 3% of new infections. Among the approximately 784,701 people living with an HIV diagnosis, 396,810 (51%) were MSM. About 48% of MSM living with an HIV diagnosis were white, 30% were black, and 19% were Hispanic or Latino. Although the majority of MSM are white, non-whites accounted for 54% of new infections HIV related MSM infections in 2008.[7] A recent study estimated that for every 100,000 MSM, 692 will be diagnosed with HIV. This makes MSM 60 times more likely to contract the virus than other men and 54 times more likely than women

I didn't mean to imply that 1 in 4 gay men are HIV+ but in certain populations the rate of HIV infection is that high unfortunately.

I'll second the call to donating:

https://www.iwantprepnow.co.uk/about-us-donate

> “I’m thinking, ‘You don’t know I have to walk sometimes because I can’t afford my Oyster [the London bus and tube pass]. You don’t know that I’m literally eating once a day because I’m so broke, and I’m sleeping on someone’s sofa because no one is going to pay me to do this,’” he says. “I am no different to how I was when I was a sex worker.”

> Donations will never be paid to an individual, only ever put back into the running costs and expansion of the website.

Just fyi. This does not mean that you should not donate.

Thanks, I hadn't seen that. Although, honestly, that only sounds like more reason to donate..

What a great guy and group of people.

I've emailed offering to help out if I can. Their costs of running the site should be zero to them, if I can help make that so then great.

The NHS has recently announced an expansion of the trial: https://www.england.nhs.uk/2016/12/hiv-prevention-pregramme/

There was some confusion about who should be paying for this preventative treatment. Both sexual health and prevention is normally part of Public Health and not the NHS, but public health weren't paying. This is because funding to local authorities has been slashed. Remember this when conservative supporters tell you that funding for health care has increased: they're not including the cuts to public health.

This is explained a bit here: https://www.england.nhs.uk/2016/11/update-on-prep/

A statement from public health: http://www.adph.org.uk/wp-content/uploads/2016/11/ADPH-PrEP-...

A statement from earlier NHS: https://www.england.nhs.uk/2016/08/august-update-on-the-comm...

There was some confusion about who should be paying for this preventative treatment.

This is the part I really don't understand. I suppose its a consequence of big bureaucracies.

This is a clear case of "an ounce of prevention is worth a pound of cure". It is so much cheaper to pay for the PrEP than to pay for treatment of HIV.

And in the UK the HIV treatment is "free", i.e. part of their national healthcare, right? So wouldn't it make so much sense for them to flood the country with PrEP, giving it at very low cost to anyone who expresses an interest?

It's incredibly frustrating to me too.

Firstly, this is only for England. Health is devolved in Scotland, Wales, and Northern Ireland.

Preventative stuff and a lot of sexual health stuff (STD screening, free contraception) is paid for by "Public Health", which is part of local government.

Treatment is paid for by the NHS, which is sort of nationally funded by NHS England to local Clinical Commissioning Groups.

Sometimes you'll have "joint commissioning" -- for example in Gloucestershire there's joint commissioning across public health and the NHS for Mental Health.

But yes, it's stupid bureaucracy and budget holding and it's caused harm.

One consequence of gay organizations deciding to focus all of their energies on punishing rubes in flyover country via gay marriage campaigns has been a significant de-emphasis on HIV education / treatment / prevention. The latter has actually done us significant amounts of good and it's a shame to see it wasted in favor of spite.

Last time I checked on my insurance it was going to be somewhere in the neighborhood of $1K/mo for PrEP. Now minimums would be met soon enough but still way too expensive. The website mentioned in the article appears to sell it for ~$54/mo which is crazy.

It's an inspiring story. I can't wait to see the movie adaptation.

The real issue is simply that the cost for Truvada oral tablet (100 mg-150 mg) is around $1,564 for a supply of 30 tablets. In the US, the patents expire in 2021.

No, $1,564 is the price when bought through US pharma. They're available via the site recommended by https://www.iwantprepnow.co.uk/buy-prep-now for $80. So, presumably the cost is more like $20 or so.

What makes you think this spammy affiliate marketing site is sending you to online pharmacies that will actually send you the drug, rather than take your money and send you nothing?

This "spammy affiliate marketing site" is neither spammy, nor does affiliate marketing. It saves hundreds, if not thousands of lives. Read the linked article.

too bad these companies don't have an affiliate program.

https://www.iwantprepnow.co.uk/buy-prep-now

I often use the same legal mechanism to buy modafinil, and have reached out to my supplier about affiliating. They don't do it either. I have to wonder if there's some kind of risk or law working against them.

Isn't the sale and import of modafinil restricted? I would think that becoming an affiliate would introduce legal risk

It's legal for personal use. You can import prescription only medication from abroad, you just can't buy it domestically.

Modafinil is Schedule IV in the US. The law may or may not be enforced with respect with to Modafinil, but possessing that drug without a prescription is illegal.

The article was about someone from the UK, and I'm also from the UK. That's the circumstance I was speaking from.

It was sad to see he's still struggling financially. Of course he isn't in this for the money but he's selling potentially 12,000 * £50 of medicine per month and sleeping on friends couches...

Edit: Actually, having clicked the link it certainly looks like he's making money now. Well done to him.

Presumably because the UK only allows imports for personal use. It's a shame he didn't (or couldn't) get financial support from an HIV or LGBT charity.

I wasn't suggesting importing for resale, but rather earning referral fees. It looks like he's being paid for the top spot now.

This is sloppy reporting:

"In the space of 12 months, the number of gay men in London being diagnosed with HIV had dropped by 40%. Across England it was down by a third."

The New Scientist article they link to has it correct -- this is a drop in reported new infections, not a drop in infected persons. It still hasn't been corrected.

being diagnosed, as in new diagnoses.

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