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Comment by nerdjon | Hacker News Reader

> If you are not doing risky sex it isn't for you.

That blanket statement I very much disagree with. Sure there are side effects but that is part of why you also get tested every 3 months for liver issues (not that it is the only side effect, but still).

Instead of it being a blanket statement it should be a conversation with your doctor about the pros and cons.

You can still get HIV even if not engaging in risky behavior. Same with people getting pregnant when they did not intend too.

I am thinking college kids that are still figuring out their sexuality and exploring new things. You're going to make mistakes so having a conversation about prep with your doctor is a really good idea.

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You are extremely unlikely to get HIV from anything other than risky sex. That's what "risk" means: it's another word for "probability," just a probability of negative outcomes. These probabilities are known: https://www.aidsmap.com/about-hiv/estimated-hiv-risk-exposur...

Some of that table is already mitigated: we test blood for HIV, so transmission by blood transfusion is unlikely. Transmission by pregnancy is less likely simply because few women have HIV: 80% of new cases in the US are male, 20% female.

The real question is whether "having a conversation about prep with your doctor" is going to lead to someone caring enough to pursue a prophylactic course of medication when that same person doesn't care enough about his own health or others' to avoid risky sexual encounters. Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen? Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place. A "really good idea" depends on a level of self-control that some people obviously lack.

> You are extremely unlikely to get HIV from anything other than risky sex.

Yes because it is such a fantastic idea to just ignore that there is still a risk regardless of what we call "risky" sex just because it doesn't fit in your puritanical views of sex.

If someone can get HIV the first time they have sex than your entire argument is moot.

Just have the conversation with your doctor and protect yourself and stop trying to push your views on others.

This is such a simple thing to say, talk to your doctor. Thats it. If doing so stops one person who is not engaging in anything that we would deem being risky from getting HIV, that is a win. There is nothing in your world that would stop someone who is having sex with someone that maybe they have been going on several dates, from getting HIV from that person if a mistake happens.

And yet, you seem to think that we are saying that you should be going to an orgy every other day.

Oh and let's not ignore that there are monogamous couples that one may have HIV and they need to also protect themselves.

Are you arguing that all sexually active people should take prep?

I am arguing that all sexually active people (except maybe those in a fully confirmed monogamous relationship) should at a minimum have a conversation with their doctor about it and their doctor should bring it up.

Maybe it isn't worth it for you in the end after that conversation, but we should also not assume that the only way you get HIV is through "risky" behavior. That is irresponsible.

At least you would know it's an option and you can make the decision yourself, I know a lot of straight people that do not know prep exists because it just isn't talked about. Or maybe they have heard about it but they don't really understand what it is. That is a problem.

In developed nations like the US, health economic models estimate that deploying PrEP across generalized heterosexual groups costs anywhere from $150,000 to over $1 million per single HIV transmission prevented.

I would be very curious if that cost was before or after Truvada went generic.

Through cost plus a month's supply is $14 (which means without insurance): https://www.costplusdrugs.com/medications/emtricitabine-teno...

Yes there is the additional costs of the tests on top of that, but people should already be doing regular STD testing if they are sexually active.

Regardless, nothing about that changes that you should still be having this conversation with your doctor if you are sexually active. I do not understand how this is an argument, a conversation about prep or doxy should be in the same conversation about condoms and your general sexual health.

The worst that is going to happen from that conversation is that you don't take it, but at the very least you are educated on its existence and that decision is made between you and your doctor based on your risk factors.

Edit:

In fact, the CDC backs up this opinion: https://www.cdc.gov/hivnexus/hcp/prep/index.html

> Inform all sexually active adult and adolescent patients about PrEP.

> Prescribe PrEP to anyone who asks for it, including sexually active people who do not report HIV risk factors.

> Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?

Yeah, me. What a wild statement to make. It’s a big world out there, my friend.

You may have missed the word likely.

Did I also miss the part where “likely” was shown to be grounded in anything other than a prejudice about people who have “risky” sex?

I dunno man if you want to answer claims about probability with single a data point that's up to you, but nobody can take that seriously, whatever the topic.

“Is someone irresponsible enough to drive a car (the second leading cause of accidental death) also likely to be responsible enough to comply with seatbelt laws?”

The word likely doesn’t make this argument any less dumb

Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?

Anecdotally, very much so - at least among the gay/MSM community.

The thing is, people generally quite like having sex. That comes with some level of risk, which can be mitigated in various different ways - and PrEP is one of those tools.

All humans engage in some level of risky behaviour; evidence suggests that moralising about “responsible behaviour” or “self control” is rarely effective at mitigating that risk.

> Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?

Yes, it's the exact reason that it is widely available on the NHS. 20,000 people took it, adherence was high, HIV rates dropped significantly.

> Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place

Shaming people has been tried for centuries, maybe millennia and famously _does not work_. We have ample evidence that PrEP does.

> Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?

Er, I mean, a decent portion of gay men in the developed world, honestly. (I say this as a gay man in the developed world.)

I don't see how you are disagreeing. We are both saying that a lot more people are having risky sex than think they are.

I guess it depends on what we call risky, I mean if someone is actively trying to get pregnant are we considering that "risky"?

Someone could be taking the necessary precautions and a mistake happens, a condom breaks, whatever. Someone could have sex with one person in their life and they got it from that person. I would not consider that "risky" in any real sense of the word.

Any sex carries some amount of risk, and the key is being risk aware and not assuming that just because you are not engaging in what is generally deemed "risky" that you are safe. Instead you should be having that conversation with your doctor and determining what your risk tolerance is.

That is where I disagree, how many people are positive that never considered themselves engaging in risky behavior.

To me it is very dangerous, and leads to the situation we are in now, to just say only even consider prep if you are engaging in risky behavior.

Someone trying to get pregnant is most likely to be low risk since odds are good they have a specific partner in mind and are having enough sex that they don't care to stray. Not always but in general

There are many pregnancies that result from one night stands and those are high risk, but only rarely was pregnancy a goal.

Also HIV spreads most often from anal sex. Someone trying to get pregnant is less likely to get HIV just because of how they are having sex and so lower risk. (Not zero though, don't rely on statistics with your life of your partner has HIV)

The topic here is HIV risk. Obviously getting pregnant requires unprotected sex, but the risk of HIV is about sex with someone who has it.

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