SirBillybob

There is a lot of easily accessible research on comparing both the effectiveness, and MSM consumer reasons/preferences, for daily versus OnDemand/intermittent/pericoital PrEP.
 
The guidelines for on-demand are a little more specific than the OP represented, based on his summary of his MD's description. This option is far more commonly utilized in Europe and Canada compared to USA.
 
I take the on-demand course, though I have the same very low cost burden for either method.
 
I think somebody mentioned donating their unused/stockpiled Truvada to a poz person that might be in need. NEVER make this call. Truvada is not used as a solo agent for HIV treatment. That is why routine testing is recommended for PrEP users. If seroconversion occurs, a different standard of medication is used for viral suppression and to prevent the complexities of drug resistance.

Part 3 Consumer Information - see the paragraph on "do not take with ... NSAIDS".
Gilead Sciences Product Monograph for Truvada, July 5 2018
 
Me: Ibuprofen may perhaps be a NSAIDS with lower nephrotoxicity than some others but it can be easily switched out for Tylenol or Aspirin? Some people pop such pills like candy, and my health care providers may be framing taking Advil (or Methocarbamol with Ibuprofen for muscle relaxation) as a prohibition rather than a caution?

You can't post pictures directly into the Forum. They have to be hosted on another website. Then you can post the URL using the picture icon in the header of the posting box to show the picture. If they are your own pictures that you want to post, you need to upload them 1st to a server like Dropbox.
 
If they are lifted off the web-well I'm assuming if you are using an iPad that your main web browser is Safari. I can't find web URL's for pictures using Safari either. That's why when dealing with pictures, I use the GOOGLE Browser. If you see a picture on the web using the Google browser, usually you can get its URL by holding your finger on it. If you do that on Safari, it usually only gives you the option to save it to your picture folder.
 
Gman

I think everyone should get and accept that public aircraft are now playgrounds with off-leash privileges.

In general, people will often debrief with a trusted friend prior to going to a Clinic. If you have a confidante, they may help assess the decision to pursue screening. Many folks attend PEP screening with someone they know.
 
A lot of guys paying for sex do not have a reliable non-judgemental "tribe" member. The forum may not be the optimal debriefing place, but in the absence of ... the above ...
 
In addition, many guys hiring commercial sex providers are mortified about disclosing this practice, notwithstanding that a clinic is likely accustomed to serving this population. I still wince when transparently verifying this theme at PrEP follow-ups.
 
The OP was cryptic, but readily invited private input as surrogacy for a real-world confidante. OK in my books.
 
Some people have a lower threshold of anxiety and may experience an isolated transmission phobia following behaviour that others view as negligible or zero risk. Someone may have AIDS phobia, have some insight into their "panic" state, and be self-conscious about pursuing transmission assessment or psychological help. I am not saying this is the case, but there must be some reason for the vagueness.
 
Let's face it, fear of transmission is a motivator for protection. Fear can thus be productive but also take on an extreme shape.
 
I think that what kept this thread ticking along was curiosity about what really occurred. My sense is that the OP got some advice behind the scenes that was useful if not technically formal.

In general, people will often debrief with a trusted friend prior to going to a Clinic. If you have a confidante, they may help assess the decision to pursue screening. Many folks attend PEP screening with someone they know.
 
A lot of guys paying for sex do not have a reliable non-judgemental "tribe" member. The forum may not be the optimal debriefing place, but in the absence of ... the above ...
 
In addition, many guys hiring commercial sex providers are mortified about disclosing this practice, notwithstanding that a clinic is likely accustomed to serving this population. I still wince when transparently verifying this theme at PrEP follow-ups.
 
The OP was cryptic, but readily invited private input as surrogacy for a real-world confidante. OK in my books.
 
Some people have a lower threshold of anxiety and may experience an isolated transmission phobia following behaviour that others view as negligible or zero risk. Someone may have AIDS phobia, have some insight into their "panic" state, and be self-conscious about pursuing transmission assessment or psychological help. I am not saying this is the case, but there must be some reason for the vagueness.
 
Let's face it, fear of transmission is a motivator for protection. Fear can thus be productive but also take on an extreme shape.
 
I think that what kept this thread ticking along was curiosity about what really occurred. My sense is that the OP got some advice behind the scenes that was useful if not technically formal.

Just wrapping up a nice four-day visit to Montreal. I arrived on Saturday morning and am at the airport now to head home. I went to Stock on Saturday, Sunday, and Tuesday nights....and to Campus only on Monday since Stock is closed on Mondays.
 
Being Memorial Day weekend, Stock was packed on Saturday. Lots of tourists from the US visiting. Anyway, a great selection of dancers available for fun at Stock: Body builder Franco. Sexy new body builder dancer Zack. Huge-cocked Tyler. Smaller Asian body builder Kid has returned as has daytime construction worker Dave. Honduran cutie Enrique is back as well. Clearly he has been spending lots of time at the gym during his time away from
Stock. Lot's of fun all three nights. Good to see Stock particularly well-attended by customers on Saturday and to somewhat lesser of an extent on Sunday. Stock has re-opened the back-bar by the shower-show area. It was closed for about 4 months during the slower winter period.
 
Campus was surprisingly busy with customers on Monday night. It was not packed but it had a steady stream of customers coming and going during my 3-hour stay. Only four dancers working on Monday night which is probably to be expected for a Monday. Three of the dancers were totally forgettable...at least for me. Other customers were taking them back for lap-dances but I wasn't the least bit interested in them. Thankfully, the forth dancer was a gorgeous, masculine muscle stud. He seemed totally out of place at Campus compared to the other dancers. He is JC and I have never seen him before. A real body-builder who competed in a competition on Saturday (as did several other Stock current or former dancers). JC says he has two daytime jobs so he dances inconsistently due to his work schedule. Anyway, we did some lap dances. It was well worth it. I hope others get a chance to see him sometime. I wouldn't be surprised if he eventually moves to Stock. I think he would be a better fit there. For me, Campus has a somewhat seedy vibe which JC doesn't really fit into with his stellar looks. What body. Those calves! Those glutes! That chest! Those arms! and a handsome face to match. He is a local but speaks excellent English.
 
Even though it was rather cool for part of the weekend in Montreal, the village is coming alive for the summer period. Nice to see.
Anyway, I only ate at one Village restaurant during my stay. I went to Mozza Pates et Passions on Tuesday night. I've been several times before and it is my favorite in the village. It has Italian food with a bit of a French flair. Mostly pastas as main courses. All meals come with a small Caesar salad to start followed by an appetizer. You can choose between the minestrone soup, the appetizer of the day, or the escargot of the day. I always go for the escargot….which is delicious. The place is always crowded with locals even when other village restaurants have few patrons. A little bit pricey but worth the extra cost. It's BYOB so be sure to bring your own wine if you want to imbide.
 
The entire city seems to be under construction starting with the road in from the airport. During my Saturday taxi from the airport to downtown, part of the freeway is actually completely closed so there had to be a lengthy detour to get into town. Also, all over downtown there is road and building construction.

In general, people will often debrief with a trusted friend prior to going to a Clinic. If you have a confidante, they may help assess the decision to pursue screening. Many folks attend PEP screening with someone they know.
 
A lot of guys paying for sex do not have a reliable non-judgemental "tribe" member. The forum may not be the optimal debriefing place, but in the absence of ... the above ...
 
In addition, many guys hiring commercial sex providers are mortified about disclosing this practice, notwithstanding that a clinic is likely accustomed to serving this population. I still wince when transparently verifying this theme at PrEP follow-ups.
 
The OP was cryptic, but readily invited private input as surrogacy for a real-world confidante. OK in my books.
 
Some people have a lower threshold of anxiety and may experience an isolated transmission phobia following behaviour that others view as negligible or zero risk. Someone may have AIDS phobia, have some insight into their "panic" state, and be self-conscious about pursuing transmission assessment or psychological help. I am not saying this is the case, but there must be some reason for the vagueness.
 
Let's face it, fear of transmission is a motivator for protection. Fear can thus be productive but also take on an extreme shape.
 
I think that what kept this thread ticking along was curiosity about what really occurred. My sense is that the OP got some advice behind the scenes that was useful if not technically formal.

Having spent a great deal of time in Brazil, you cannot judge overall level of national attractiveness based on a slice of the population selling their attractiveness. My straight friends base their desire to visit Brazil on Victoria's Secret December TV show.

Cedric the enter-me-tainer

Well, this is a can of worms, so I guess I will pitch in with my contrary self, so I should say up front the following is my personal opinion. For sure, you will likely find no end to people who are willing to offer a plan, usually for money, without regard to its suitability for you (or anyone, for that matter ). To be clear, this is what you have asked for. I'll explain a little bit why I say that, and why my opinion is this is likely not a good approach for most people, which would include you.
 
As you mention, there is no single answer, but I think it's important to highlight why that is. The reality is that long term success or failure depends on each person coming to grips with the reality of their own particular physiology and psychology, and how these two things interact, something that for all practical purposes is unique to each person, and then each person identifying a fitness strategy that fits their unique characteristics. This means not only diet and exercise strategies that are safe, sustainable, and effective for each person, but also strategies that each person can, and will, adhere to. Without this, success will be extremely difficult.
 
It seems like most people are not in touch with this at aspect at all, they have no idea what their personal characteristics are. I don't think this is a problem or an obstacle, we all have to start somewhere. As long as they realize this is something they will need to figure out as they go on their journey and stay alert, this will likely work itself out.
 
But this is why I would say no one here can really prescribe a solution for you, we simply aren't ever going to know enough to be able to make an informed recommendation, if we are even qualified to do so (I'm not). We don't' even have the most basic info about your characteristics (a/s/l? ) like current fitness status, fitness history (including limitations), and available resources like time and money), so that leaves only the most generic guidance.
 
My favorite description of the advice giver/advice seeker relationship was to think of yourself as an airplane pilot, talking to ground control. You can solicit all the advice you want, and it's very rare for people to not offer something, but ultimately, if you crash the plane, it's your ass, not theirs.
 
Aside from people who go all in too early and get frustrated and quit, the personal fitness world is littered with the human wreckage of people who blindly followed strategies that were never suitable for them. Take care to not be one of those people. If you will be applying your strategy on your own, this is particularly important. Don't be fearful, but do you own research. Don't follow a strategy just because it worked for someone else, but also, don't hesitate to incorporate elements that suit you into your own strategy.
 
I concur with @Rudynate about having a mix of physical activity, and to not ignore your diet. While you need a strategy that is custom for you, there are still truths, like you can't out-train a bad diet.
 
For some context, I have been enjoying the Shredded Sports Science channel on youtube, he has been doing a good job debunking BS, which you will encounter a lot of, no matter where you look:
 
https://www.youtube.com/channel/UCXrqErU_TjqiHAHJkzITAvg/featured
 
I particular like his ongoing emphasis on individual characteristics.
 
For bodyweight exercises, there is an entire plan over at the subreddit /bodyweightfitness
 
https://www.reddit.com/r/bodyweightfitness/wiki/kb/recommended_routine
 
Since this includes progressions, it can be tailored to each person. But this is just one place to look as part of your research.
 
Edit to add: Generally I would recommend not comparing yourself to others, for a lot of reasons, particularly people on the net, many of whom are trying to make a living off of social media stardom. Think in terms of your own potential and how you can acheive that.
 
Good luck, you can have a lot of fun, it's not all drudge work.

----
I went to Thermas about 8 times this month over a few weeks visit. Tried to hit every night of the week. There was no real difference among the nights.
 
It was generally awful for selection or for doing a few guys consecutively. There was 1 max 2 guys each time worth hiring. Otherwise, the dozen or so escorts were surprisingly unattractive and out of shape compared to my previous visits 2012-2016, and compared to Rio, Salvador Bahia, São Paulo, etc.
 
If it had not been for the few guys who appealed to me ... a stroke of luck that there was one each time (otherwise I'd have been flushing cash down the drain for the entrance) ... it would have been a total bust.
 
The VIP room (€15) was decent. Junior (mentioned), a newbie friend of his from Rio Grande do Sul state, and an in-demand stud from Paraguay were highlights and made the trip worth it.

As I have written on this thread I don’t totally share the effusive enthusiasm for the place. It suffers by comparison with the Brazilian saunas. Having said that if I return to Barcelona I will return to Thermas. I’m off to São Paulo in 2 weeks. Lagoa here I come!

Yes, I realized that after having boned up on some of the reading this week. You have a good eye.
 
I might have walked off with misinformation or misinterpretation. In any case, I now stick to Tylenol.
 
I am going to go over it again with a walk-in to the PrEP clinic pharmacist soon because my PrEP follow-up with the nurse is a few months away.

Some of the confounders comparing daily versus demand related to the reduced distinction between the sexual patterns of the two groups. More frequent sex among some in the demand group amounted to up to an average of 25 doses per month. This is analogous to taking continuous PrEP substandardly in the context of a frequency of anal intercourse that would ordinarily call for the daily regimen.
 
Therefore, a lot has to do with taking the chosen course appropriately ... not news.
 
In contrast, in the substudy of demand PrEP compared to demand placebo, each group's average pill dose frequency was about 15 per month ... equivalent to about 3-4 sex cycles based on, give-or-take, two simultaneous pills before followed by one pill on each of two subsequent days.

As suggested I did go back and checked about the information my physician gave me. I did make a huge mistake when I wrote what he had told me. What he told me was that the efficacy of daily dose Truvada is equal to taking a single dose for 2 days before intended sexual activity followed by a single dose for one or two days after sexual activity takes place. I for some reason write that a single dose for two days before was sufficient and equal in efficacy. That was a very serious misquote and I am sorry for it.
 
As with any other medical information you receive here, you should speak with your physician before changing your behavior or regimen, particularly regarding HIV. My purpose was simply to provide information that was different than that usually provided and that that I did not know about. Moreover, it was from a person who I believed was a competent source. My doctor has worked with HIV/AIDS patients in a large city for the last 30 years or more. But PLEASE consult with your physician prior to any change in your regimen.

As suggested I did go back and checked about the information my physician gave me. I did make a huge mistake when I wrote what he had told me. What he told me was that the efficacy of daily dose Truvada is equal to taking a single dose for 2 days before intended sexual activity followed by a single dose for one or two days after sexual activity takes place. I for some reason write that a single dose for two days before was sufficient and equal in efficacy. That was a very serious misquote and I am sorry for it.
 
As with any other medical information you receive here, you should speak with your physician before changing your behavior or regimen, particularly regarding HIV. My purpose was simply to provide information that was different than that usually provided and that that I did not know about. Moreover, it was from a person who I believed was a competent source. My doctor has worked with HIV/AIDS patients in a large city for the last 30 years or more. But PLEASE consult with your physician prior to any change in your regimen.

There is a lot of easily accessible research on comparing both the effectiveness, and MSM consumer reasons/preferences, for daily versus OnDemand/intermittent/pericoital PrEP.
 
The guidelines for on-demand are a little more specific than the OP represented, based on his summary of his MD's description. This option is far more commonly utilized in Europe and Canada compared to USA.
 
I take the on-demand course, though I have the same very low cost burden for either method.
 
I think somebody mentioned donating their unused/stockpiled Truvada to a poz person that might be in need. NEVER make this call. Truvada is not used as a solo agent for HIV treatment. That is why routine testing is recommended for PrEP users. If seroconversion occurs, a different standard of medication is used for viral suppression and to prevent the complexities of drug resistance.

The 86 percent effectivenes in a study was found in this article: https://www.poz.com/article/IPERGAY-CROI-26854-6956

There is a lot of easily accessible research on comparing both the effectiveness, and MSM consumer reasons/preferences, for daily versus OnDemand/intermittent/pericoital PrEP.
 
The guidelines for on-demand are a little more specific than the OP represented, based on his summary of his MD's description. This option is far more commonly utilized in Europe and Canada compared to USA.
 
I take the on-demand course, though I have the same very low cost burden for either method.
 
I think somebody mentioned donating their unused/stockpiled Truvada to a poz person that might be in need. NEVER make this call. Truvada is not used as a solo agent for HIV treatment. That is why routine testing is recommended for PrEP users. If seroconversion occurs, a different standard of medication is used for viral suppression and to prevent the complexities of drug resistance.

... and provide more photos, on request, of his visit to the dentist.

Cohort and longitudinal studies are very common in medical research. Researchers acknowledge the limitations of such studies but recognize that they are the only ethical way to get information about health outcomes over time. One such longitudinal cohort study is the Framingham Heart Study that basically provides the scientific basis in the medical field for understanding how factors such as cigarette smoking, obesity, genetics, exercise, etc. play into risk factors for heart disease. This study has been going on for more than 70 years and has been used as the basis for more than 1,000 medical papers.
 
It is true that randomized, controlled studies are the "gold standard" in medical research and must be used when you are trying to test new medications and treatments. But we are long past the time when it was considered ok to randomly give people syphilis just to see what happens.
 
That's why this meta-analysis study of douching is pretty solid in my opinion. It takes data from 24 other studies (going all the way back to 1970) and looks at trends over time using statistical analysis that even takes into account other risk factors. If a doctor of a gay man was asked by his patient, "Does douching increase my risk of STIs?" The only ethical answer would be, yes. Just as the same doctor would use the Framingham Heart Study to tell the patient that smoking or eating fatty food, or not exercising is bad for your heart. We all get to choose what risks we want to take or not, but the evidence here is clear that douching very likely increases your risk for STIs and we do not need a randomized, controlled study for medical professionals to make that call.

Still, the idea of a "controlled" prospective study is challenging.
 
Randomized has been mentioned, but chaps interested in participating would already have been predisposed to douche or not douche based on preferential behavioral patterns. Douchers might grudgingingly agree to freestyle if scooped (against pre-established behaviour) into the residual-poop group but would possibly alter their receptive anal intercourse style.
 
Also, when I started to try douching I did not like it and found it made no difference according to my needs and tolerances, so randomly imposing douching is fraught with complexity.
 
Also, a point of clarification about double-blind. Assholes have eyes, so there would be no possibility of maintaining ignorance about the independent variable ... unless an anal douche is developed in suppository form with one a placebo version (here you may detect I am taking this to the ridiculous).
 
The only possible visual impairment when I am getting royally shtooped is when my eyes roll back in my head or I am proverbially fucked blind.
 
This discussion reminds me of the 1980's era when a mysterious syndrome emerged among queers and IVDU. Being gay was associated with thIs killer illness. Unique among gay men was a high preponderance of anal exposure to jizz.
 
The 'retrospective' trends were enough to have me pause and alter my sexual behaviour. Others perhaps were sticklers about the disease manifestations and related presumed factors meeting all of the necessary and sufficient assumptions about causal directionality. Logically, I did not think that getting sick and dying made you a queer taking it up the arse. In contrast, without the need of a prospective design, I logically thought that being a queer taking it up the ass causally predicted morbidity and mortality.
 
There may be 'just enough' evidence now about douching. Additionally, douching (or not) is non-stigmatized and either of them cannot be easily appropriated against us by the douche-y religious right in any way. Not douching also deflates pharma profit margins.

Such a study would likely never pass an institutional review board especially if your hypothesis is that douching is harmful to health. You can't knowingly ask someone to do something that could cause them a life-threatening illness. That is why you do these meta-analysis studies because you can get around the ethical issues that a double-blind study like this would present. So instead you try to pull several studies and their data and do statistical analysis to find out of there is an association between rectal douching and STIs and that association is significant even when you put in other potential factors in the statistical modeling.
 
This study was published in the British Medical Journal, a peer-reviewed journal that takes less than a quarter of its submissions (https://sti.bmj.com/pages/about/). I'm pretty confident that if the data was crap, it wouldn't have been published. The data is good and suggests that douching increases your risk of getting STIs.