Condomless with GPs in Brazil

[babybear2]

5 hours ago, floridarob said:

You wouldn't believe how many times the local clients are  direct, so fucking direct....no mincing words.

I let them know to "close the deal"...now power, no money....some I tease that if they can't get hard, they'll be the bottom.......

If guys know that they have performance issues, they'll already have their remedio, to take care of that deficiency .....

DON'T accept subpar performance.....that is all 😉

 

what you said about local clients, makes total sense to me.

I often observe local clients spend 30+ minutes chatting and teasing with garatos before sealing a deal, and I suspect they also pay less than gringos, maybe 100R only 

well, it is their country, they speak portuguese, and they go a few times every week, they deserve better 

[Canadianbtmguy]

On 4/19/2024 at 10:02 AM, Riobard said:

AFAIK Descovy, in contrast to Truvada, is not indicated anywhere for on-demand / event-driven 2-1-1 HIV PrEP either formally or off-label, as corroborated by NYC Health, IAS, CATIE, etc.

....

If the guy were to eventually seek PrEP formally he might reveal that a visiting gringo had provided a controlled prescription-dependent drug not ANVISA-approved in Brazil and with an incorrect dosing regimen instruction to boot. 

I wanted to acknowledge the accuracy of the first paragraph that while both Truvada and Descovy, are approved for PrEP generally, only Truvada is approved for on-demand/2-1-1, and I did not know that. 

That being said, my PrEP prescriber said it was not approved "yet" and he did not see any reason why this very similar medication would not be eventually approved; he said that if someone was going to have sex and did not have Truvada it would not be an inappropriate choice. (Grated the GP and my situation was not exactly that: the doctor's example was that someone was going to have sex regardless; ours was that he would provided that he had PrEP) 

As to the third paragraph, I'm not really sure of the harm of such a revelation. To him: is there any doubt that patients regularly reveal taking drugs that are not only not-ANVISA-approval but illegal? To me: dispensing non-ANVISA approved medications without a pharmacy license? 🤣

 

[Riobard]

3 hours ago, Canadianbtmguy said:

I wanted to acknowledge the accuracy of the first paragraph that while both Truvada and Descovy, are approved for PrEP generally, only Truvada is approved for on-demand/2-1-1, and I did not know that. 

That being said, my PrEP prescriber said it was not approved "yet" and he did not see any reason why this very similar medication would not be eventually approved; he said that if someone was going to have sex and did not have Truvada it would not be an inappropriate choice. (Grated the GP and my situation was not exactly that: the doctor's example was that someone was going to have sex regardless; ours was that he would provided that he had PrEP) 

As to the third paragraph, I'm not really sure of the harm of such a revelation. To him: is there any doubt that patients regularly reveal taking drugs that are not only not-ANVISA-approval but illegal? To me: dispensing non-ANVISA approved medications without a pharmacy license? 🤣

 

Your intentions were good but I was just wondering what the impact on the fellow would be in terms of his views about you if a local clinician were to later reflect that the drug and dosage of his initiation was incorrect. In actuality, he might be more inclined to seek PrEP at this point and that is not a bad thing. He might not know enough to realize the medication disconnect if and when Truvada is dispensed. Anyway, as you indicate, now you know.

It’s certainly not egregious to sub one for the other in a pinch according to the idea that having some prophylaxis is better than none. 

However, the prospects for eventual on-demand Descovy appear slim. There is no registered trial assessing its non-inferiority to event-driven Truvada. There is minimal interest in additional innovative on-demand regimens and the strategy of trading off specific drug toxicities in reduced uptake may be less paramount.

One proposed study has not achieved  lift-off. Even if it gets off the ground the endpoint is about 2028.  It is no longer feasible ethically to have placebo-control arms, so how to approximate a gold standard method is more complex. Although the Descovy comparator is Truvada, the control group idea is substituted with background HIV incidence in non-recruited MSM. That itself reduces the analytical rigour. Moreover, the methodology described is the usual Truvada 2-1-1 but Descovy 1-1 (reduced lead-in dose loading as well as absent the final post-intercourse ‘for good measure’ dose), counterintuitive relative to the logical assumption of equal number of tablets one would expect in study arms. Demonstrating daily Descovy for vaginal intercourse PrEP efficacy is probably of greater importance.