[drewmassey]

For me the biggest surprise in the article is that there are 180,000 men in the United States on Prep. Given a back of the envelope calculation of 4.8m out gay men in America (3% of population) that means adoption is itself around 3%.

Somehow I imagined truvada was more widey adopted but perhaps it is just heavily marketed on the east coast.

[dnsco]

Anecdotally, usage is highly regionalized, and is generally met with cultural resistance leading into exceptsnce per area. I started using it in San Francisco I’m 2013, before it was completely normalized. It has spread from major metropolitan centers and is going through the process of acceptance in smaller towns. A (somewhat sarcastic) call to put truvada in the municipal water supply is generally appreciated in the bay, but when I visit smaller mid-western cities these days there is still a lot of anti-prep sentiment. It has however achieved a reasonable amount of acceptance in regional hubs.

[jschwartzi]

There are side-effects of PrEP for long-term use. It can cause kidney damage. So it's not an entirely risk-free magic pill.

It's still much safer to only have sex while in a monagamous relationship where you and your partner have been tested for HIV. And checking test results before having sex with someone is also a very safe practice that is really common. But in the end if you're often sleeping with people who you don't trust, PrEP can be worth the risk.

[chimeracoder]

> It's still much safer to only have sex while in a monagamous relationship where you and your partner have been tested for HIV. And checking test results before having sex with someone is also a very safe practice that is really common. But in the end if you're often sleeping with people who you don't trust, PrEP can be worth the risk.

Please stop spreading anti-PrEP misinformation.

Statistically, it is literally safer to be on PrEP and have multiple partners of unknown status than it is to be in a monogamous relationship and not be on PrEP.

[jschwartzi]

Actually I've been googling around since you've said this, and I can find WHO and CDC booklets indicating that PrEP is generally safe. In fact, the WHO indicates that PrEP is as safe as placebo in the populations that have been studied.

http://apps.who.int/iris/bitstream/handle/10665/197906/WHO_H...

It's interesting because some of the gay men I spoke with about PrEP seemed to think there were significant risks of kidney damage from long-term use. I wonder where they got their information from.

[thisiszilff]

There is risk for some men, but at least here, you go in regularlynfor checkups to ensure there are no problems. Only a small number have the side effects, and these discontinue treatment.

[metildaa]

In the US, there is big money to be made bilking insurers and citizens for as much money aas possible with crazy drug prices. This is what funds most of the ads we see for PreP, and also makes this treatment inaccessible to those who need it most.

[chimeracoder]

> In the US, there is big money to be made bilking insurers and citizens for as much money aas possible with crazy drug prices. This is what funds most of the ads we see for PreP, and also makes this treatment inaccessible to those who need it most.

This is wrong on so many levels.

Most of the ads you see aren't funded by Gilead, or by any pharmaceutical company at all. They're funded by local agencies and nonprofits tasked with HIV prevention efforts.

Secondly, Gilead (the manufacturer of PrEP) pays for the copay of the drug, up to a pretty high cap which is actually hard to reach under all non-catastrophic health insurances. That means that most people in the US who are on PrEP are eligible to pay literally $0 out-of-pocket. In other words, PrEP is literally cheaper for most Americans than it is for people in other countries, because every other country charges at least a nominal fee for the drug.

[metildaa]

> Most of the ads you see aren't funded by Gilead, or by any pharmaceutical company at all. They're funded by local agencies and nonprofits tasked with HIV prevention efforts.

This differs significantly from what I see, the local agencies in my area are focused on providing testing, care and treatment, not funding advertising.

In the latter half of your comment, you literally described how this is set up to scam insurance. If one has insurance, everything is great, otherwise they get stuck without medication they need.

[chimeracoder]

> This differs significantly from what I see, the local agencies in my area are focused on providing testing, care and treatment, not funding advertising.

Sounds like your local agencies either aren't doing their jobs or aren't spending their money appropriately. Public service announcements are an important part of public health in every country. Dissemination of public health information and knowledge of what resources are available doesn't happen by magic.

> In the latter half of your comment, you literally described how this is set up to scam insurance. If one has insurance, everything is great, otherwise they get stuck without medication they need.

"the copay with insurance is less than the out-of-pocket expense without insurance" is not, in se evidence or a description of a scam.