What Are the Parallels Between Birth Control and PrEP?

Comments

Nature rewards heterosexual behavior with pregnancy, thus allowing the species to continue.

Nature punishes male homosexual behavior with STDs, some of them fatal.

Do you see the difference between the two?

on November 14, 2014 at 9:45 AM

If birth control fails and you get pregnant, you still have options.

If PrEP fails and you contract HIV, there's no medical procedure to undo that.

However both are poor ways to protect yourself if you're having casual sex with multiple partners since there are plenty of other diseases out there. PrEP only takes care of one and birth control doesn't protect against anything.

janebean21 on November 14, 2014 at 9:46 AM

And why be outraged at all? Teenagers do stupid shit. It is part of the maturing process, and from where I sit, far better to take some steps to prevent something catastrophic--take Uber to the party, take birth control before the party, take Truvada before the party, because you know what? Six drinks in, you might not be making the best choices. Should you be drinking Red Bull and vodka at an underage rave? No. Should you die because you did, or become a parent at 17? Absolutely not. And yes, the slut shaming of gay teen boys is the same as the slut shaming of teenage girls. Quinto is wrong.

Princess Assburgler on November 14, 2014 at 9:49 AM

protected sex is safer epidemiologically

Fistique on November 14, 2014 at 9:51 AM

That's so .... Spock like, very logical and reasoned. He must have attained Kolinahr

Cato the Younger Younger on November 14, 2014 at 9:56 AM

What @2 said, but with the observation that condoms are a form of birth control that also protects against STDs.

Also, it seems that gay men have a lot more casual sex than straight women in general, further undermining the validity of the comparison. But I'm not sure if the latest studies support that or if it's a generally discredited stereotype now.

Matt from Denver on November 14, 2014 at 10:04 AM

BTW, @2 is the only unregistered comment worth reading. Don't unhide any of the others, it's just the same old shit.

Matt from Denver on November 14, 2014 at 10:06 AM

I hit refresh and nearly all the votes for "important difference" disappeared? WTF? For the record: Option B has at least 20 more votes than it shows here.

David Schmader on November 14, 2014 at 10:15 AM

The distinction being that young Gay men are more promiscuous than young straight women.

Keekee on November 14, 2014 at 10:16 AM

Pregnancy isn't HIV.

Sam Levine on November 14, 2014 at 10:18 AM

The idea that taking a prophylactic therapy such as PrEP is wrong begs the question of why scientists should continue searching for an HIV vaccine, wouldn't immunity against the disease be seen as a green light for debauchery? PrEP is only one aspect of sexual health, as others have commented. and should be taken by men who have sex with men to avoid HIV infection but condom use should still be the norm to protect against STDs. Drug resistant gonorrhea and syphilis are a serious threat to health. Young men should also get HPV vaccinations, which are also vilified by slut-shamers as promoting promiscuity.

thatsnotright on November 14, 2014 at 10:22 AM

Seconding @2

Plus, the act of fertilization isn't a virus. Using birth control irresponsibly won't cause your uterus to morph into another form that can go against birth control and then spread that type of uterus into other uteruses (uteri?). Using PrEP irresponsibly (by which I mean irregularly) can cause you to be infected and may or may not create a PrEP resistant form of HIV. Other diseases haven't gone drug resistant just because.

I'm supportive of PrEP, but hesitant in the long term results. Who cares about the slut factor? The only reason the slut factor matters is if the drug trials prove to be wrong, or if HIV morphs.

TheMisanthrope on November 14, 2014 at 10:24 AM

@13 If you're young and male and have health insurance, get the HPV vacciene if you don't already have it.

Insurance only covers it until you're 28 or something. After that, it's pricy.

TheMisanthrope on November 14, 2014 at 10:27 AM

The difference is that birth control is also important in a purely monogamous relationship. PrEP is only important in non-monogamous relationships or monogamous relationships with HIV positive partners. Of course, many ostensibly monogamous relationships actually aren't, so in those cases PrEP is well-advised insurance against cheating partners.

on November 14, 2014 at 10:27 AM

Be wary of this comment and all that has come before.

Slogger JonnoN has spoken, sayeth the lord.

Its official, slog is 100% trolls.

Posted by JonnoN http://www.backnine.org/ on November 14, 2014 at 10:28 AM

dnt trust me on November 14, 2014 at 10:35 AM

I guess there's a difference in that the PrEP is medicinal in nature while the other disease-protecting birth control (condoms) is not.

There are lots of people haunted by a vague sort of moral anxiety at the notion of people getting away with something. They really want to find a harm being caused but they can't articulate it because the harm is illusory. I think that's what's going on with this Quinto guy.

Alden on November 14, 2014 at 10:39 AM

@12: Ooh, "The Truth"? Is that your nickname? I bet you get SO MUCH PUSSY at parties if that's how you introduce yourself.
If "Homosex is innately inherently dangerous, unhealthy and irresponsible. always. [sic on all of that]" please explain how any of those adjectives accurately describe a guy blowing another guy if both of them have tested negative for all STDs in the past month and have had no sexual contact with others since.
Shave your neckbeard. Go get a job. Stop thinking about gay sex so much. Have a little self-respect, you bewilderingly pathetic assclown.

venomlash on November 14, 2014 at 10:53 AM

The problem is not that people use PrEP or birth control, the problem is that they use it INSTEAD of condoms. This is a problem since birth control and truvada each protect against one unwanted outcome (AIDS or pregnancy) but leave them exposed to every other STI out there. Think of it like a person who stops wearing their seatbelt because their car has an airbag: yes, the airbag will provide a lot of protection against a head on collision, but it does little to nothing for all other accidents (e.g. side impact/getting t-boned, roll overs, etc.). In the same way that PrEP can protect against AIDS, it does nothing about the other STI's. And with increasing anti-biotic resistance, those previously treatable STI's are becoming more dangerous.
Finally, as Dan has pointed out, the actual loss of sensation to condoms is pretty small. Ergo, wear the damn condom.

unknown_entity on November 14, 2014 at 11:05 AM

@14: I'm not a virologist or anything, but I wouldn't worry too much about HIV evolving resistance to reverse transcriptase blockers. Most of HIV's tendency to mutate comes from the step of reverse transcription, where its RNA is transcribed into DNA and then spliced into the host's chromosomes, since the viral reverse transcriptase is kind of wonky and tends to introduce errors. If that transcriptase is blocked from acting, you're not really going to get any mutations because there won't be any processes capable of causing them*. The only real danger at first glance is if a resistant form somehow arises in someone infected with HIV and then they just so happen to have unprotected sex with someone on PrEP. It's extremely unlikely just because of the degree to which such vital enzymes tend to be conserved.

*Viruses generally need some transcription/replication step to introduce mutations. Truly living organisms can often mutate through faulty repair of damaged DNA, but viruses don't have the ability to repair their genetic material at all, and cellular proteins tend to be geared less towards repairing viral RNAs and more towards degrading them 'on sight'.

venomlash on November 14, 2014 at 11:06 AM

I would say that it is like birth control pills - and that birth control pills can have all orts of negative side effects. Don't take them (birth control or PrEP) unless you absolutely need them.

Schweighsr on November 14, 2014 at 11:19 AM

Uh. You don't catch pregnancy from a pregnant woman when her birth control fails. And if you did there is low probability you will fucking die from pregnancy nor spread pregnancy to the next person.

Why the fuck should this have to be explained?

Jesus. Quinto was spot on.

tkc on November 14, 2014 at 11:46 AM

There's nothing wrong with being a slut; there's something wrong with being a careless slut.

@7,

Discredited stereotype? There aren't a lot of straight women seeking sex in public bathrooms, and there are barely any straight equivalents to bathhouses. The closest thing, swingers clubs, usually have to impose a no single men policy or it turns into a sausage fest.

Women don't want as much anonymous casual sex as men do, period.

keshmeshi on November 14, 2014 at 1:01 PM

It is important to combat homophobia and slut shaming.

That said, how much of this conversation would we be having if it was people using PrEP in lieu of clean needles?

on November 14, 2014 at 1:03 PM

I am an advocate for PrEP as one effective way to prevent HIV infection among gay and bi men and also women who have a positive partner.

Birth control is a helluva lot cheaper than a month of Truvada (around $1000) and it requires medical vigilance, regular lab monitoring and such.

Neither birth control nor Truvada protect against other STDs.

Until there's something more reasonable, Truvada is the best there is aside from condoms and abstinence. Kinda like in the 60s when people were outraged about the pill, with all the side effects and unsavory implications of people having sex for reasons other than procreation... so maybe i should change my vote!

CityByTheSea on November 14, 2014 at 1:05 PM

The difference is that pregnancy did not in living memory kill hundreds of thousands of people in the prime of their lives in this country.

That HIV is no longer a death sentence does not change that it was. And while another future AIDS may be unlikely, some people will continue to exercise precautions that kept them alive until now. I think it's reasonable for some people to make a different risk assessment, but I don't think those that are more cautious should be attacked for that view unless they are calling people Truvada whores or otherwise being assholes.

Cascadian on November 14, 2014 at 1:51 PM

@ 26, I seem to recall someone mathematically demonstrating that polls showing men getting laid a lot and women not so much to be impossible. But even so, I personally believe what you say is true. I'm just keeping open to other possibilities because I'm not up on what the latest studies show about male and female promiscuity. That's all.

Matt from Denver on November 14, 2014 at 2:09 PM

The only difference is that PrEP has not, as of this moment, improved my skin tone or complexion. :-(

LukeJoe on November 14, 2014 at 2:20 PM

@21 I'm not a virologist either, but I am a geneticist. The very first anti-HIV drugs developed, like AZT, were in fact reverse-transciptase inhibitors. I'm not sure how Truvada differs from the older class of RT inhibitors, but HIV quickly developed resistance to AZT, which is why a drug cocktail targeting RT along with other components of the virus was ultimately necessary. Non-compliance with taking the medication was the major contributor to development of resistance.

So while I don't know much about Truvada, I wouldn't be at all surprised to see a resistant strain of HIV eventually arise. But it also might take a while, because prophylaxis is obviously not the same as treating active infection.

raggeddog on November 14, 2014 at 2:23 PM

@1 - "More humans" is no reward. That you exist is evidence.

thelyamhound on November 14, 2014 at 3:08 PM

Because you can get rid of a pregnancy, but you can't get rid of HIV.

Not to mention, unprotected non-monogamous sex puts you at risk for other scary STDs, including gonorrhea, some strains of which are now drug resistant. Acknowledging reality is not slut shaming.

Escapee from S. Idaho on November 14, 2014 at 4:02 PM

34

now now

who pissed in your bean curd?

on November 14, 2014 at 4:19 PM

The question presupposes that people are recommending that women use birth control pills as an insurance policy against nonmonogamous unprotected sex. This is false. People recommend that women use birth control to prevent pregnancy, monogamous or not. Women need to be using condoms if sexing with multiple partners to prevent STIs. This is pretty obvious.

ams_ on November 14, 2014 at 5:06 PM

@36 - Oh, I'm an omnivore. Nothing I like better than a nice slice of grilled, free-range peckerwood.

thelyamhound on November 14, 2014 at 5:12 PM

Others have said it, but I'll say it too. One prevents pregnancy, which is a potential consequence of sex, but not an irreversible one, and the other potentially prevents the spread of a virus. Neither protects against any number of other lovely diseases, so neither should be used alone. Condoms, always. No matter what else you happen to be taking. (Unless you're in a committed relationship and yadda yadda.)

sanguisuga on November 14, 2014 at 5:46 PM

What 37 said. Also, for centuries, pregnancy and childbirth was a huge killer of women, and birth control treats other medical problems for some women.

sf gal on November 14, 2014 at 8:36 PM

@32: Good to know. As usual, medication non-compliance (lower effective dose at any given time) results in selective pressure towards resistance. (We're seeing it today in staph aureus and tuberculosis, among others.) Hopefully today's better-informed climate on HIV will keep that to a minimum.

venomlash on November 14, 2014 at 8:50 PM

1. Once pregnant, it's imminent you will become no longer pregnant.

2. Once pregnant, there is no real danger you can pass your condition on to others.

If I use two kinds of birth control (drugs and condoms), what's so hard about using two kinds of infection control (drugs and condoms)?

Steed Denim on November 15, 2014 at 12:58 AM

41

Right.

Today's 'better-informed climate' that sees HIV rates among homosexual males continue to climb? and climb?

If only we could do pubic education and outreach.....

you are so precious.

on November 15, 2014 at 4:25 AM

40

yeah

fuck childbirth and pregnancy

lucky today's woman has abortion as an option

revenge is sweet.....

on November 15, 2014 at 4:29 AM

@32 and @41

truvada.com/treatment-for-hiv

TRUVADA is a type of medicine called a nucleoside analog reverse transcriptase inhibitor (NRTI) that is used to treat HIV-1 infection in adults and teenagers (12 and older).

TRUVADA is a combination therapy because it has 2 medicines in 1 pill– emtricitabine and tenofovir disoproxil fumarate. TRUVADA is always used with other anti-HIV medicines to treat HIV-1 infection because TRUVADA alone is not a complete treatment.

Understanding HIV:

HIV infects important cells for fighting infection called CD4 cells, or T cells. Once HIV enters the body, the virus multiplies inside these cells. These new viruses are released into the blood and infect other CD4 cells.

How TRUVADA can help:

When used with another anti-HIV-1 medicine, TRUVADA helps make it harder for HIV-1 to multiply by blocking an enzyme in your body called reverse transcriptase

By helping to keep HIV-1 from multiplying in your body, TRUVADA helps lower the viral load, which means decreasing the amount of HIV in the blood

TRUVADA may also help increase the number of CD4 cells when used with another anti-HIV-1 medicine

on November 15, 2014 at 7:24 AM

Very well played @34

sperifera on November 15, 2014 at 8:53 AM

Pregnancy's ability to spread is fairly contained. Albert has sex with Brenda, Brenda gets pregnant. But now if Brenda has sex with John or Cindy, she can't get either of them pregnant on account of her being pregnant. To think HIV and pregnancy are the same thing would be a false equivalency. Yeah, they are both potential results of unprotected sex, but the way they each work, the options involved, and the actual consequences of both are very different.

tabathalphabet on November 15, 2014 at 9:27 AM

Holy shit venomlash is one total fucking ignorant about virology, diseases, and evidently pathogens in general

just goes to show you how dangerous one or two facts can be for a person who doesn't really know the difference between one regurgitated fact and actual knowledge of a subject

Dirtclustit on November 15, 2014 at 10:25 AM

fuck the hive mentality, anybody who thinks that the virus that causes aids has quickly become resistant to drug treatment or as ignoramouslash puts it

"...medication non-compliance (lower effective dose at any given time) results in selective pressure towards resistance..."

not only has a fatally flawed understanding of the many mechanisms that are the actions in how medicines work, but he doesn't understand basic principles of evolution such a Dawkins understanding of evolution which is little more than the few plagiarised half-truths Darwin used to claim his fame

Dirtclustit on November 15, 2014 at 10:38 AM

@48/49 Sharing from your obviously vast wealth of knowledge rather than just flaming might give you a little more credibility. But you know, go on calling people idiots without actually making any case for what (you think) they have so wrong.

raggeddog on November 15, 2014 at 1:20 PM

@50: dirtclustit is ignorant of biology in general. In a thread about the wage gap, he attacked me for mentioning that human embryos start out morphologically female and then, if SRY is expressed, experience a suite of changes that push them to the male phenotype. He's really just an idiot. On that note...

@49: Here is how medication non-compliance leads to selective pressure towards resistance:
Suppose the pathogen population as a whole is mostly susceptible to some drug. Occasionally there are mutations that grant partial resistance.
If there is no dose of the drug, the presence or absence of the mutant allele over the wild type has no bearing on fitness.
If there is a very high dose of the drug, the partial resistance is insufficient to protect the carriers of the mutation, so they die just like the wild type. Again, no change in fitness.
If there is a moderate dose of the drug, it's enough to kill most of those without the resistant allele, but there is substantial survivorship among those with the resistant allele. Thus there is a large difference in fitness based on the presence of the mutation, leading to the mutation becoming more prevalent going forward.
I spent four years of my life at one of the best schools in the world studying evolutionary biology et cetera, dirtclustit. Think you know better than me? Explain how I'm wrong; put up or shut up. If you don't understand what I'm saying, the problem may be on your end.

venomlash on November 15, 2014 at 1:49 PM

Although pregnancy can be life threatening and you could be stuck with a kid to raise for eternity, it is not a death sentence like HIV was in the 80s and still is if you don't have access to healthcare. Plus, as pretty much everyone else pointed out, the pill doesn't protect against STDs, including HIV.

idaho on November 15, 2014 at 4:58 PM

So what if PREP enables people to have more sex, with more partners, with fewer condoms? There is nothing evil about sex and pleasure. It doesn't need to be justified. Anything that rids sex of negative consequences should be embraced as an unadulterated, unambiguous GOOD THING.

Always east coaster on November 15, 2014 at 8:19 PM

The difference between PREP and birth control? We have more data on the effectiveness of birth control because it's been around so much longer. The science on PREP seems sound, but it's requires humans to be effective medicine takers, and that's the same problem with the failure rate on hormonal birth control pills. When there's an IUD equivalent for PREP (set it, and forget it), I think they'll be pretty close.

AdamWashington on November 16, 2014 at 5:02 AM

53

There is nothing 'evil' about sex and pleasure.

However promiscuous sexual behavior is unhealthy and dangerous. So-called 'safe' sexual practices lessen the danger marginally but do not change the basic fact.

You girls claim to worship SCIENCE! but you are quite adept at totally ignoring sexual public health science that does not fit into your degenerate depraved lifestyles.

To the extent that PREP encourages promiscuous sex and lessens diligence in the use of physical barriers it is a public health negative.

Your ignorance (or indifference) is lethal.

on November 16, 2014 at 5:16 PM

@55: Reality check, fool. IRRESPONSIBLE promiscuity is inherently bad for you. RESPONSIBLE promiscuity isn't. If you vet your partners and require that they produce a clean bill of health before bumping the uglies, there's not actually any risk of STD transmission. If medical tests verify that fifty people are all STD-free, you could sleep with all of them in succession and have no risk of catching anything. Not to say that people should let functional immunity to HIV infection make them complacent in their sexual health practices, but you're wrong in what you say.
It's awful close to Thanksgiving to be such a jive turkey.

venomlash on November 16, 2014 at 6:16 PM

56

oh....

RESPONSIBLE promiscuity........

the kind practiced by pink unicorns, right?

cause whatever the gays are doing gives 75% of them STDs.

and those numbers are going up.

btw....what colour is the sky in the fantasy world you live in?

Your ignorance and indifference is LETHAL.

on November 17, 2014 at 3:51 AM

@57: So you moved the goalposts and made up some numbers out of thin air. You want a cookie?

venomlash on November 17, 2014 at 8:01 AM

58

PROVE US WRONG

what is YOUR number for gay STD rates?

on November 17, 2014 at 8:45 AM

@47 "Pregnancy's ability to spread is fairly contained."

However, it is worth noting that if you've contracted pregnancy, any kids you may have will likely be asymptomatic carriers most of their lives.

on November 17, 2014 at 9:34 AM

@59: The burden of proof is on the person making the claim. I'm not going to do your homework for you, sonny boy.

venomlash on November 17, 2014 at 11:48 AM

"So what if PREP enables people to have more sex, with more partners, with fewer condoms? There is nothing evil about sex and pleasure. It doesn't need to be justified. Anything that rids sex of negative consequences should be embraced as an unadulterated, unambiguous GOOD THING.”

Which is why I don’t give a shit when you contract a nasty STD.

So enjoy your bath house culture but just do me a big favor, don't blame Ronald Reagan when you contract some horrible disease

on November 17, 2014 at 6:33 PM

“require that they produce a clean bill of health before bumping the uglies”

Oh yeah, lots of that going on in the bathhouse after a few meth hits. “Look, here’s my paperwork”

So party on fellas. This time you can’t blame Reagan when you contract something horrible though.

on November 17, 2014 at 6:36 PM

What Are the Parallels Between Birth Control and PrEP?

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