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Comment by nerdjon | Hacker News Reader

I have been debating on switching to the shot but Havnt yet.

Just to avoid the accidentally missing a dose or the chance interactions (lower efficacy) with dairy and many fiber supplements, this would be amazing.

Would be nice to never need to worry about that or think, hey I missed a dose is it actually true that it doesn’t matter or do I need to wait a full week. Half a week?

My only concern here though, if it’s in your system for 6 months what if you have an adverse reaction or just some unpleasant symptoms.

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The drug is cabotegravir and if you want to feel safer you can take the pill form of it first to test it out.

Any chance these will ever be self injectable (with Rx)?

Everything injectable is self injectable

I'm going to assume a bit and for that I'll apologize in advance. I'm assuming you're in a high risk group for HIV. Why not just use condoms? Is it because they aren't 100% effective?

> Why not just use condoms?

Why not just save money and not install those ECP brakes on your vinyl chloride freight train?

Why not just use one unshielded Raspberry Pi on that spacecraft instead of a 3-of-5 quorum from the output of 5 identical engineered-for-space systems?

Using/requiring condoms AND being on PrEP helps me live my best life with less fear-based inhibition and cognitive load.

The same reason why not everyone drives the safest car: cost and other negatives.

In case of a pill perhaps negative side effects.

I have no clue how often a person in high HIV risk has sex or behaves.

It should be fine to ask that question

> It should be fine to ask that question

It is. I interpreted the parent post as a neutral question, and I intended my reply to involve playful analogizing. I'm sorry that it didn't reach you as such through the side-channel-impoverished medium of text.

Isn't this like asking by do we have multiple methods of birth control? Pill, IUD, etc?

This is a great way of looking at it, thank you for that.

I'm not going to make such an assumption, but two reasons people prefer PrEP generally:

1. in sex work, "not using a condom" is an "extra" that clients will pay quite a bit for

2. people who "party and play" tend to be in an altered state of consciousness that biases against use of condoms

It’s not that complicated. A lot of people don’t like condoms, either wearing them or having a partner wear them. PrEP, to many, has rendered condoms unnecessary.

> in sex work, "not using a condom" is an "extra" that clients will pay quite a bit for

To me, that is such a weird thing.

People literally paying money for something that can damage them for life and may even kill them.

Though the same can be said of addictive things (smoking comes to mind), is this some form of that maybe?

> To me, that is such a weird thing.

i'm confused. are we acting like we don't full-well know that using a condom sucks for everyone involved? it's like wondering why people didn't like using a face mask during covid: because it sucks. that, of course, is independent from whether it's prudent, but if something sucks, it's no surprise when people avoid it, right?

> are we acting like we don't full-well know that using a condom sucks for everyone involved?

What do you mean "acting"? We all know it reduces the sensitivity. That's the trade off. You feel less pleasure, and your fucking doesn't get to kill you.

> it's like wondering why people didn't like using a face mask during covid: because it sucks.

Similar analogy. It sucked, but that was a similar trade off. It sucks a bit, but there's less chance it'll kill you or you'll kill others.

> it's no surprise when people avoid it, right?

I think those people would have to be fucking morons, but sure, morons exist.

There's that middle ground!

People have a risk level they're comfortable with, and sometimes people feel added excitement pushing right up to or past that level, and sometimes they're just happy to pay extra for something they feel is within that risk level if they enjoy it more.

We all choose to take risks all the time and often pay for the privilege, sometimes explicitly seeking out the thrill of a risk.

I'm guessing what makes this specific scenario weird for you is more likely that this risk doesn't seem worthwhile to you relative to what you get from it (and I agree with that - I've never had an appetite for taking risks with STDs)

>People literally paying money for something that can damage them for life and may even kill them.

You could say the same about sky-diving.

Yep, sure could. :)

Being horny also counts as being “in an altered state of consciousness that biases against use of condoms.”

As someone who took the condom off in a risky situation recently, there’s no comparison between the on and off feeling. It’s like licking a piece of candy vs crushing it with your teeth and sucking it all at once.

> As someone who took the condom off in a risky situation recently ...

With consent yeah?

Maybe you want the real thing. I get that, even though I have never had sex with a prostitute or fall into the risky sex category. I'm not going to go as far as to be childishly disrespectful and say I'd rather die doing the real thing, but I do understand the apprehension of using artificial barriers during the most intimate act know to humankind.

Risk always entails a premium.

Not generally, no. Driving that car with the sketchy suspension is cheaper than getting it fixed.

Incorrect.

When somebody else takes a risk for you, you have to pay them more than if they are not taking a risk. We pay soldiers more when they are at war than when they are not. People who want to raise money by selling bonds have to pay a higher interest rate if their credit is worse. Etc.

Prostitutes would consider unprotected sex more risky, and thus charge more.

A better analogy would be to buy a '60s sports car that predates nearly all modern safety tech at auction for $$$$$$ instead of just buying a 2024 Corolla with modern safety features.

The grand parent post said risk _always_ entails a premium.

They post you're replying to merely points out they're wrong, as there are examples of it not _always_ entailing a premium.

No-one's saying that there aren't examples of risks that do entail a premium.

it does, because the chances of you needing expensive medical care after using the sketchy vehicle go up

If you drive faster still in a car that also lacks crumple zones and airbags, your expected medical bill probably decreases.

Yes it's easy to strain metaphors.

This is obtuse. The intent of expressing that if you are paying someone else for a service, it predisposes them to demand a higher price if you're asking them to take additional risks if they have any negotiating power at all was pretty obvious.

The discussion was about the additional risk to the customer, not the vendor.

The comment above the one you replied to was. The comment you replied to was not, and it'd be reasonable to suggest it didn't really address what it replied to. But its intent was clear.

Yes but it feels good

Besides the other nice reasons people offered, because "stealthing" (when someone removes a condom during sex without the other person's consent or lies about having put one) is remarkably common, and not as easily noticed as you might expect.

Condoms are less effective at HIV prevention, but also they’re unpleasant and don’t prevent most STIs because of oral sex. Nobody’s giving or getting head with a condom. People who stay on top of preventative measures tend to not bother with condoms since PrEP became prevalent.

Preventative:

1. Gardasil 9 (vaccine against 9 strains of HPV, prevents genital warts and cancers caused by HPV)

2. Monkeypox vaccine

3. Meningitis ACYW vax

4. Meningitis B vax (35% effective against gonorrhea)

5. doxyPEP (two pills of doxycycline taken after sex, 90% effective against syphilis, 80% chlamydia, 50% gonorrhea)

6. PrEP (prevents HIV infections)

7. and the usual suite of vaccines against the rest like hepatitis A/B, mumps etc

Treatment of the bacterial ones (which transmit through oral too):

1. syphilis - butt shot of penicillin 2. chlamydia - 1 pill of an antibiotic 3. gonorrhea - a week of doxycycline pills or one butt shot of ceftriaxone

Remaining: HSV. Half of the population has it, so no big deal. Condoms dont prevent it either.

As for hepatitis: even though it requires blood contact and as such is not necessarily considered an STI, hepatitis c is curable these days thanks to DAAs taken over the course of 8-12 weeks. a/b have vaccines.

> 5. doxyPEP (two pills of doxycycline taken after sex, 90% effective against syphilis, 80% chlamydia, 50% gonorrhea)

Preventatively using antibiotics is a horrible idea, for one it increases the risk of creating resisitant strains, and we are already running out of antibiotics (especially broadband ones). Moreover, antibiotics in general are known to mess with you gut biome whose importance we are just beginning to understand (we know it plays a role in many physical and mental illnesses for example). Then there are the side effects which for doxycyline include diarrhea, increased risk of bowel cancer, higher sensitivity to the sun (and associated risk of skin cancer).

This all feels really general—precipitated on the idea that there’s one Right Way for everyone to use these drugs, about which the doctors and public health professionals recommending doxyPEP are somehow uninformed.

Suppose you’re immunocompromised. Wouldn’t it be worth the diarrhea to avoid infections your body couldn’t fight off?

Suppose you’re in a situation where you’re having lots of opportunities for infection. Whether you can or can’t control that situation, the end result is the same: you know your body is going to be challenged by infectious disease frequently in a way that most people’s bodies aren’t. Isn’t it plausible that the infectious agent may have less opportunity to evolve if you didn’t contract it as frequently?

Different forms of therapy might be both individually and collectively optimal for people in different situations. What’s right for a person who isn’t at risk isn’t the same as what’s right for a person who is at risk.

Doxy is already prescribed in the US as a treatment regimen for acne, so if that’s going to be allowed STI prevention seems way more useful.

The overuse of antibiotics is mostly in farm animals, which represent 73% of global antibiotics use, and 90% of American antibiotics use.

Thanks your professional healthcare research expertise will really come handy to all the researchers studying effects of doxypep and routine anti-acnne doxycycline prescriptions.

antibiotics are toxic in general, likely affecting way more than bowels. many are ototoxic for example.

Been taking it every day for 15 years with no problems and actually I seem to look 10 years younger than everyone in my age group.

The problems are for humanity not for you, with spurious use of antibiotics. Resistant strains can kill everyone.

The people responding to this seem to assume you’re doing so for funsies, which might be true. But that’s not what you said. So for their benefit, it’s worth pointing out that daily doxycycline is a pretty normal therapy for a range of chronic stuff—malaria prophylaxis, rosacea and skin that’s prone to infections, I’m sure there’s more.

If loopdoend’s doing this, it feels like a good bet that there’s a doctor in the mix judging that it’s medically appropriate for them.

This is really surprising to me since there is a lot of evidence that oral antibiotics can mess up your gut flora, creating all sorts of bad side effects. Do you have any digestive issues?

Please tell me this is a joke / satire

No, there are many many people who are this entitled.

> Nobody’s giving or getting head with a condom.

In the early days of AIDS (wasn't called HIV back then) the recommendation was to use a condom or dental dam (depending on the hardware of the recipient). That's how I learned what a dental dam was. Later it was suggested that plastic food wrap would work (the jokes just write themselves).

Sadly the ubiquity of paper toilet sheet covers in US bathrooms dates back to the 80s due to straight paranoia over AIDs + widespread and overt anti-gay prejudice, so every time I see one of those dispensers I grit my teeth.

Reminds me of the early days of COVID (not the anti-gay part, but the weird practices when nobody really had yet a good theory of what's going on).

HIV (human immunodeficiency virus) is the virus, AIDS (Acquired Immune Deficiency Syndrome) is the syndrome caused by untreated HIV. Everybody with AIDS has HIV, but not everyone with HIV has AIDS.

The reason for the reversal in terms is treatment options. When HIV was first found, there were no treatments so AIDS was inevitable. Nowadays, medication can permanently prevent HIV from progressing to AIDS, so AIDS is much less common than HIV.

> In the early days of AIDS (wasn't called HIV back then)

You might be thinking of “GRID” (gay related immuno deficiency), the original name of AIDS when it was believed it only affects gay people. Once the virus causing the illness was identified it was called HIV.

PreP actually reduces the chances of acquiring other viral STDs to varying degrees.

Although we have to admit the moral hazard element too: by altering the risk calculus, it does seem to have helped weaken cultural norms around condom use and risky sexual behavior. Business is booming for bacterial infections.

Personally I’d say that’s a pretty good tradeoff: fear, stigma, and death for a different problem that’s more an annoyance than a mortal threat right now.

I think another overlooked portion is that we shouldn't be using meds (for infectious diseases) to enable fun (which seems common with sex). Eventually those meds will lose effectiveness, that's just evolution. Then the people who really do need them will be out of luck.

>Condoms are less effective at HIV prevention

lol what

https://www.cdc.gov/hiv/risk/condoms.html "condoms are highly effective in preventing HIV"

https://pubmed.ncbi.nlm.nih.gov/9141163/ 1997, "reexamination of HIV seroconversion studies suggests that condoms are 90 to 95% effective when used consistently"

https://www.cdc.gov/hiv/prevention/condoms.html "Most condoms are effective in preventing HIV and certain other STIs"

Nobody said condoms were not effective, only that PrEP is MORE effective than condoms, which appears to be true.

https://www.cdc.gov/hiv/risk/prep/index.html

>PrEP reduces the risk of getting HIV from sex by about 99%.

Last I checked 99 was greater than 95.

He didn't say "less effective than PrEP", he said "less effective", and PrEP wasn't the hereditary context of his statement.

Yes it was. The person I responded to is asking why the person considering switching to injectable PrEP doesn't “just use condoms”

You need to improve your reading comprehension.

What do you need me to explain to you?

I want you to explain how condoms are less effective at preventing HIV transmission.

They are indeed less effective than PrEP which is what the entire comment chain is about.

"doxyPEP (two pills of doxycycline taken after sex, 90% effective against syphilis, 80% chlamydia, 50% gonorrhea)"

This is how you end up with super STD's

...And your odds of making it through that pharma-minefield with zero side effects are not encouraging.

Worse still--large scale casual sex is a great way to introduce new, novel and un-contemplated STDs into the population. STDs are opportunistic that way, just ask Mr. triple-resistant Gonorrhea.

It's decidedly not the way I want it to be, but that's just how it works. For casual sex to be safe I think its more like "Hi, please spit into this tube so we can get busy" and red means HIV, Green means Monkeypox, comprehensively.

It's not just about casual sex though is it. There are many people in long term monogamous relationships with a partner who has an STD, but who don't want to catch it themselves. Vaccines and medications can allow them to have active sex lives while staying healthy and in some cases even help women go through pregnancy and childbirth while preventing the spread of an STD to the child. For these people minor side effects (and at times even more severe ones) can be entirely worthwhile.

Or perhaps maybe a future for occupational health. My wife is a nurse. Needle sticks happen. When it does, she has to get tested, full works. The hospital pays for that and the treatment. Maybe with a shot that lasts a year rather than the current 2-3 months(?), hospital staff can just opt that route then the test and treatment. Apparently the treatment is rather gnarly.

The odds are perfectly fine lol. If you think spitting into a tube before sex is preferable to being immune, I think you have a huge misunderstanding of casual sex

Inefficacy against HSV is interesting. I had no idea. Why is it ineffective?

I looked through the literature and it seems that condoms are quite effective at preventing HSV infection when used, especially from male to female (on the order of 99%), and less so for female to male (around 60-70%). I would suspect the reason for failure is behavioral. People probably don't apply the condom until after most of foreplay is over and HSV-2 can be transmitted during "outercourse".

HSV-1 and -2 transmit through contact from skin location to skin. Including through asymptomatic shedding. Only sometimes is that location covered by a condom - in location and in timing.

See also: Wrestlers' "Herpes gladiatorum" which is just HSV-1. Which demonstrates how HSV-1 survives for transmission far more easily or broadly than just genital contact. Is there "HSV-2 gladiatorum"? Apparently it's usually HSV-1 but probably yes - neither HSV-1 or HSV-2 are really location specific.

Oral sex is a big reason. Michael Douglas got tongue cancer* from HPV.

Actually it appears the 9-polyvalent HPV vaccine protects against multiple cancers but insurance won't pay for it once your outside the age window.

* originally he said "throat cancer" at the advice of his agent!

[edited: wityl pointed out I’d typed HSV for some reason]

You are thinking of HPV, HSV is herpes.

There is no vaccine, it doesn't cause cancer (that we know of, at least not like HPV), and spreads via skin contact on the genital area.

Since fluids are not required for HPV or HSV and it's present on the area that a condom won't cover, condoms aren't effective for either.

Yes it was a brain fart — fixed!

Pardon my puritanism, but this seems like an awful lot to put your body through to get your rocks off and engage in this sort of indulgence.

The vaccines are just common sense for everybody. If you’re worried about “putting your body through” vaccines I suggest asking yourself what exact you are worried about on a molecular/cellular level. PrEP blocks HIV’s transcription to DNA so that it can’t take hold - it is cleared by your kidneys like a zillion other molecules in your body. DoxyPEP is the most broad acting, and least popular, item on the list.

Have you had sex wearing a condom vs not? Its gotten better in the last twenty years but it is still noticeably worse

this might be news to HN, but condomless sex feels significantly better

moreover, condoms can have numerous issues like tearing or stealthing

People lie and condoms break.

Why not just not have sex unless trying to procreate? It's amazing in 2024 this line of discussion is happening.

We all know exactly at a individual level what to do and not. We can keep asking "Why not just use a condom?" and see how far that gets us, or actually understand psychology and use patterns and work with what people actually do (good or bad).

Same can be said about (illicit) drugs, why not just not do drugs? Simple!

> Same can be said about (illicit) drugs, why not just not do drugs? Simple!

It is actually simple. Just not easy. Same with losing weight - consume fewer calories than you burn.

I guess you aren't assuming to be around when the osteoporosis kicks in?

What are you implying, if I have sex without a condom I'll die sooner?

They can break, so multiple protective elements is better.

Who prefers to chew gum with the wrapper on?

It’s because they’re no fun.

Condoms aren't perfect, and PrEP is cheap and has basically zero side effects. Plus, rapists don't use condoms, no matter how nicely you ask.

Edit: lmao touched a nerve? I will never understand why folks here get so prudish when we talk about sex... "Just wear a condom!" is remarkably insensitive, as though 100% of HIV transmission is your own fault, and not, say, someone else who has bad intentions.

Some of us prefer to enjoy sex as a beautiful act of human connection and condoms detract from being in the moment of joy.

This is like saying to someone killed in a motorcycle accident why didn’t you use a car. It’s a reductive, unempathetic and frankly unproductive take. Please think before asking this again.

From my understanding they make you do it in pill form for a bit first to see how you react

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