A Bit More Detail

Assorted Personal Notations, Essays, and Other Jottings

Posts Tagged ‘prep

[BLOG] Some Tuesday links

  • Bad Astronomer Phil Plait notes a study suggesting the Milky Way Galaxy took many of its current satellite galaxies from another, smaller one.
  • The Broadside Blog’s Caitlin Kelly talks of the importance of having dreams.
  • Centauri Dreams shares a study explaining how the debris polluting the atmospheres of white dwarfs reveals much about exoplanet chemistry.
  • D-Brief notes that the intense radiation of Jupiter would not destroy potential traces of subsurface life on the surface of Europa.
  • Dangerous Minds looks at the strange musical career of Vader Abraham, fan of the Smurfs and of the Weepuls.
  • Aneesa Bodiat at JSTOR Daily writes about how the early Muslim woman of Haajar inspires her as a Muslim.
  • Erik Loomis at Lawyers, Guns and Money notes how an influx of American guns destabilizes Mexico.
  • The LRB Blog looks at the American abandonment of the Kurds of Syria.
  • Marginal Revolution notes how many mass protests are driven by consumer complaints.
  • The NYR Daily has an interview with EU chief Brexit negotiator Guy Verhofstadt, on the future of sovereignty.
  • Strange Company looks at the Dead Pig War between the US and the UK on San Juan Island in 1859.
  • Towleroad features the defense of Frank Ocean of his PrEP+ club night and the release of his new music.
  • Understanding Society looks at the sociology of norms.
  • Window on Eurasia suggests Russia and Ukraine each have an interest in the Donbass being a frozen conflict.
  • Arnold Zwicky looks at the weird masculinity of the pink jock.

[BLOG] Some Friday links

  • Bad Astronomy identifies the most distant globular cluster known to exist around the Milky Way Galaxy, PSO J174.0675-10.8774 some 470 thousand light-years away.
  • Centauri Dreams looks at the strange ring of the Kuiper Belt dwarf planet Haumea.
  • Crooked Timber looks at an ill-constructed biography of Eric Hobsbawm.
  • D-Brief notes an experiment that proves antimatter obeys the same laws of quantum mechanics as regular matter, at least insofar as the double-slit experiment is concerned.
  • Earther notes that life in Antarctica depends critically on the presence of penguin feces.
  • Imageo looks at awesome satellite imagery of spring storms in North America.
  • The Island Review interviews Irene de la Torre, a translator born on the Spanish island of Mallorca, about her experiences and thoughts on her insular experiences.
  • Joe. My. God. notes a new deal between Gilead Pharmaceuticals and the American government to make low-cost PrEP available to two hundred thousand people.
  • JSTOR Daily looks at the many ways in which The Great Gatsby reflects the norms of the Jazz Age.
  • Paul Campos at Lawyers, Guns and Money is rightly critical of the Sam Harris suggestion that white supremacism is not an ideology of special concern, being only a fringe belief.
  • Tyler Cowen at Marginal Revolution solicits questions for an upcoming interview with demographer of religion Eric Kaufmann.
  • Russell Darnley at Maximos62 shares cute video of otters frolicking on the Singapore River.
  • Starts With A Bang’s Ethan Siegel asks when the universe became transparent to light.
  • Arnold Zwicky shares photos of his blooming flower gardens.

[ISL] Five #PEI links: PEI Greens, orchids, Sandstone Comics, PrEP, David Currie

  • The Guardian reports on the confidence of PEI Green Party leader Peter Bevan-Baker that the April election on PEI is for his party to win.
  • This guide to the wild orchids of PEI sounds very useful. CBC reports.
  • I wish the team at PEI comics group Sandstone Comics the best as they prepare their issues of original material. CBC reports.
  • The costs of anti-HIV drug regimen PrEP are now being covered on PEI for members of at-risk groups. CBC reports.
  • The Guardian features an interview with 80-year-old Charlottetown cobbler David Currie about his life and his career six decades long.

[NEWS] Five LGBTQ links: Tillie Walden, Trump, PrEP, Calgary, Omaha

  • Vice points readers to the queer SF comic Tillie Walden on a Sunbeam.
  • The New York Times reports on a prominent same-sex married couple, Bill White and Bryan Eure, who have become Trump supporters for what seems to be purely opportunistic reasons.
  • Inside Higher Ed looks at how American institutions of higher education are increasingly covering anti-HIV PrEP regimens on their health plans.
  • The Calgary Herald features an interview with author Kevin Allen about his book of Calgary LGBTQ history, Our Past Matters.
  • them features an article taking a look at the energy of the LGBTQ communities of Omaha, Nebraska.

[PHOTO] “Take Part in a Sexual Health Revolution”

My eye was caught when I saw, on a subway train somewhere in Brooklyn, this ad advertising PrEP.

"Take Part in a Sexual Health Revolution" #newyorkcity #newyork #subway #ad #prep #hiv #hivaids #hivawareness #latergram #preexposureprophylaxis

The preventative use of the drug Truvada to prevent HIV infection in HIV-negative people has come a long way. I first noted PrEP directly in a November 2014 post, that one reflecting on how far the idea of using anti-HIV medications to prevent HIV infection had come since I first heard of the idea in a 2005 article talking about how crystal meth users would take Truvada component tenofovir before heading off on drug-fueled orgies.

PrEP has gone far beyond those early days. It is now mainstream, approved of by the CDC and supported by the New York City Department of Health. Local health organizations like the Gay Men’s Health Crisis and the Callen-Lorde Community Health Centre can apparently set people up with Truvada at reasonable cost and in reasonable amounts of time. It’s even available in Canada, Truvada being covered since September under Ontario’s provincial drug plan. I’m considering the mechanics of getting on it myself.

And yet, here in Ontario and in Toronto, home to a MSM community surely as intrisically at risk of HIV infection as New York City’s, PrEP does not have nearly the same mainstream presence as in New York City. The biggest article I’ve seen on it on the non-LGBTQ media was Josh Dehaas’ oddly dismissive article. Straight people I’ve talked to about the drug here in Canada have been routinely amazed by the fact of the existence of PrEP. Shouldn’t Toronto, at least, try to change this?

Written by Randy McDonald

February 3, 2018 at 2:45 pm

[NEWS] Five LGBTQ links: Josh Weed, James McCourt, Upstairs Inferno, PrEP, Hall of Justice

  • NewNowNext notes the divorce of out gay Mormon Josh Weed from his wife, after they realized their marriage wasn’t working. To his belated credit, he seems to be quite upset at the way that his personal story was used to justify homophobia.
  • At The New Yorker, Michael LaPointe celebrates James McCourt’s 1993 novel about the AIDS epidemic, Time Remaining.
  • Towleroad notes the odd and harmful refusal of the Publix grocery store chain to let its insurance companies cover Truvada prescriptions, for PrEP.
  • Drew Rowsome reviews Upstairs Inferno, a recent documentary about a fire in a New Orleans gay bar in 1973 that killed dozens and its aftermath.
  • R.M. Vaughan reports for The Globe and Mail about the new Hall of Justice poster program in Toronto, aimed to popularize LGBTQ heroes.

[BLOG] Some Wednesday links

  • Bad Astronomy notes the literally cosmic homophobia of Louie Gohmert.
  • The Big Picture notes a Chinese factory set to make a fortune off of making masks of the American presidential candidates.
  • blogTO notes the raising of the Trans and Pride flags at Toronto City Hall, marking the beginning of Pride month.
  • Crooked Timber notes the racism that erased the genealogy of African-Americans.
  • Joe. My. God. notes that Britain’s NHS has rejected PrEP again.
  • Language Log notes the sensitivity of the local version of the name “Pikachu” in Cantonese-speaking Hong Kong.
  • The LRB Blog reports from the scene of an active volcano in Nicaragua.
  • Marginal Revolution notes that witchcraft apparently does hurt economic progress.
  • The Power and the Money’s Noel Maurer wonders why New Zealand and Uruguay, with such similar economies, saw such substantial economic divergence after 1950.
  • Peter Rukavina reports on an interesting Asian food store in Charlottetown.
  • The Russian Demographics Blog notes a Russian claim that condoms cause HIV transmission.

[LINK] On PrEP in Canada

Daily Xtra and The Homo Culture were among the first news sources in my Facebook timeline to announce the approval of Truvada for PrEP. Toronto’s Metro was among the many mainstream news sources to carry the news.

A drug that can stop the transmission of HIV is getting within reach of Torontonians who can’t afford its steep price.

Health Canada approved the use of Truvada on Monday as a prevention tool commonly called PrEP, giving people who can’t afford its $830 a month cost hope that they might be able to take it someday soon.

Until now, people using the drug for prevention have mostly been part of a “lucky minority” with “good, private drug insurance coverage,” said Dr. Darrell Tan, an infectious diseases specialist at St. Michael’s Hospital.

“That leaves people with the option of going without or purchasing it out of pocket —which is exorbitantly, prohibitively expensive for the vast majority of individuals,” he said.

Truvada was approved in Canada a decade ago as a management tool for people who already have HIV. Monday’s decision takes that approval further, extending it to include use by HIV negative people who are looking to stay negative.

At roughly the same time, there was also a news report noting the first verifiable report of PrEP failing to protect a user. Aidsmap described how a user in Toronto had the bad luck to get infected with a Truvada-resistant virus in a sexual partner whose HIV was suppressed.

During this time he came in for his regular HIV test and this showed he had acute HIV infection, with a negative test for HIV antibodies but a positive test for the HIV p24 antigen, which shows up sooner. His HIV viral load three days later was 28,000 copies/ml – rather low for acute HIV infection and suggestive that either his PrEP had ‘blunted’ viral replication without stopping infection, or that the highly drug-resistant virus was replicating weakly.

[. . .]

The resistance test showed that the patient had HIV that had no significant resistance to the protease inhibitor class of antiretrovirals. He had one resistance mutation to the first generation NNRTI drug nevirapine, and complete resistance to emtricitabine. He also had extensive resistance to the first-generation NRTI drugs like zidovudine (AZT) and stavudine (d4T), and these mutations also confer some resistance to tenofovir. However he did not have the so-called K65R mutation that confers high-level resistance to tenofovir, and it was estimated that the resistance pattern he did have only confers 1.3-fold resistance to tenofovir, meaning that drug levels 30% higher than those needed for non-resistant virus should have been enough to prevent infection – and he had much higher drug levels than this in the tests. Resistance, however is a complex process and some combinations of mutations can catalyse higher levels of resistance than they would produce alone.

Not relevant to the apparent PrEP failure, but to the spread of drug resistance, was the fact that this patient also had two resistance mutations to the integrase inhibitor drugs and complete resistance to the drug elvitegravir.

Transmission of HIV with integrase inhibitor resistance is very rare, and especially resistance to drugs other than raltegravir, the first integrase inhibitor. The pattern of resistance observed is compatible with the unnamed person who passed on the virus being on a failing regimen of Stribild (the two-class, four-drug combination pill of tenofovir, emtricitabine, elvitegravir and cobicistat). Given that four out of the five first-line HIV drug regimens recommended by the US Department of Health and Human Services are integrase inhibitor-based, and that this drug class is being investigated for use as PrEP, it would be of concern if more integrase inhibitor-resistant virus started to circulate.

The patient himself was put on a potent three-class regimen of dolutegravir, rilpivirine and boosted darunavir and became virally undetectable only three weeks after starting it.

This sort of failure is the sort of failure to be expected in an instance of PrEP failing. It does not undermine the utility of this technique.

Written by Randy McDonald

March 6, 2016 at 9:05 pm

[BLOG] Some Saturday links

  • Dangerous Minds shares one video club of David Bowie in London in 1967, and another of the controversies around the Cocteau Twins in 1985 Ohio.
  • The Dragon’s Gaze notes a study of the winds of hot Jupiter HD 189733b.
  • The Dragon’s Tales looks at the evolution of Titan’s atmosphere from an early date.
  • Joe. My. God. and Towleroad each note the failure of PrEP to protect a Toronto man against infection.
  • Language Hat links to a study looking at the spread of Austronesian languages.
  • Marginal Revolution writes on the economics, and the culture, of used book sales.
  • The NYRB Daily notes the problems with staging Wagner.
  • Savage Minds shares a list of new ethnographic texts.
  • Torontoist examines how Ontario’s cap and trade and other green initiatives could impact Toronto.
  • Towleroad and Joe. My. God. note the Australian government’s belated apology for the repression of gay demonstrators in Sydney in 1978, during the first Mardi Gras.
  • Window on Eurasia writes about the reasons for the support of diasporic Russian Jews for Putin’s Russia and notes the Russian government’s hostility towards open regionalism on its borders.
  • Arnold Zwicky shares and dissects a Japanese-style poem of his.

[BRIEF NOTE] On PrEP, and TaSP, and the imminent end of HIV/AIDS

The Thursday before last, I was interviewed as a subject in an ongoing research project, led by the University of Toronto’s Peter A. Newman and Carleton University’s Adrian Guta, examining the PrEP front in the ongoing fight against HIV/AIDS.

The PrEP choice project: Exploring PrEP users, non-users, and provider perspectives

Are you a man who has sex with other men, living in Toronto, and over the age of 18? We would like to talk to you if you:

1. You are currently using Pre-Exposure Prophylaxis (PrEP) and would like to share your experience and you are not currently enrolled in a clinical trial about PrEP.

2. You know about PrEP but you have decided it is not right for you at this time and you would like to share your experience.

As I explained in my enjoyable sixty-minute interview, I fall in the second category. My reasons for not taking PrEP have nothing to do with skepticism on my part about the science, or about taking medication. Rather, it relates directly to matters of cost: My drug plan at work does not cover PrEP, Truvada not yet having been approved by Health Canada as a drug that very effectively prevents HIV transmission, and I don’t know how I could get the funds to do so. I have very recently heard that some people have been able to access the Trillium Drug Plan, and this is definitely something I’ll be looking into in the New Year. For the time being, I feel as if I’m sitting in an uncomfortable place, looking at a medical revolution occurring outside Ontario–in the United States, in Québec, and most recently in France–and wondering how I’ll last.

It isn’t that I think I’m at especially high risk: I know what I do and who I do things with, I know what the actual risks are, and I think that if, one day, I ended up testing positive for HIV, I’d have legitimate reason to be surprised. The protocols of safer sex with condoms are protocols I have not had any problems following in my personal life. Were I to get PrEP, I don’t think that my sexual practices would change substantially–I certainly would not, as described in the 2005 Los Angeles Times article where I first heard of what might be called proto-PrEP, embark on crystal meth-fueled lost weekends. That sort of sexual behaviour is frankly uninteresting to me, much more of a problem than a source of relief.

In part, it’s a matter of my liking a belt-and-suspenders approach. Condoms work very well, used consistently. PrEP also works very well, used consistently. Why not combine the two to absolutely minimize HIV transmission? Truvada does have costs, financial and perhaps otherwise, but as noted by many even the costs of lifelong Truvada treatment are substantially less than the costs of lifelong HIV treatment. What’s wrong with a simple pill that can ward off a disease that is still life-changing? Or, rather, what’s not right with it? Not taking the drugs can be an issue, but that’s always the case with any medical regimen.

It also relates to deeper shifts in the nature of the epidemic. It’s starting to become a relative non-issue in ways I scarcely imagined when I first came out. At the same time that the PrEP revolution is ongoing, preventing HIV infections among HIV-negative people, the latest anti-retroviral treatments are not only keeping the HIV-positive in good health, they are radically reducing the chances of further infection. One thing widely reported in the media with varying levels of incredulity after Charlie Sheen’s self-outing as HIV-positive, in
Vox and Gawker and MacLean’s and New York Magazine, is that Sheen has undetectable levels of the virus in his system and cannot infect people. This was not just Sheen talking: This is the actual science. Multiple research projects, including the ongoing PARTNER study, have so far concluded that the chances someone HIV-undetectable could transmit HIV on to someone HIV-negative are trivial. The PARTNER study has not yet found a single instance of such a transmission happening, not with tens of thousands of sex acts in hundreds of couples in two years. TaSP, treatment as prevention, also works. The approach of systematic testing and universal treatment of HIV, pioneered in Canada in British Columbia by Dr. Julio Montaner, can break the back of the epidemic. Saving people’s lives also slows down the epidemic.

Take the existence of PrEP, to start. Throw in alongside PrEP TaSP, equally effective in preventing infections. Throw in alongside these two the existence of condoms, a technology that is also quite effective. I do not think that I am wrong to say that, in my particular First World environment, HIV/AIDS is starting to become a trivial threat. It makes my head spin as I think this, so contrary it is to what I learned and what I practiced, but fearing HIV is something that might be falling out of style. This is wonderful, but this is a shock with profound ramifications for me and others. Once, when I read psychotherapist Walt Odets’ In the Shadow of the Epidemic, I was struck by an exchange in which a gay speaker explained to a straight counterpart that, in the context of HIV/AIDS, every instance of sex, every moment of intimacy, was overshadowed by the possibility that something might go wrong, that someone might become infected with a lethal agent or (even worse) infect someone they loved with said. Not living under this fear would be such a relief, I can scarcely imagine what it would be like.

We need many things, here in Ontario at the end of 2015, here on this world, even. PrEP is one of them.

Written by Randy McDonald

December 21, 2015 at 11:59 pm