Friday, August 28, 2015

Webcast Transcript: All You Need to Know About the Use of Truvada to Prevent HIV Infection (Pre-Exposure Prophylaxis- PrEP)







TRANSCRIPT FROM GOOGLE HANGOUT ON HIV PRE-EXPOSURE PROPHYLAXIS (PrEP) WITH DAMON JACOBS AND NELSON VERGEL

Scott:           Hello everybody. Scott Sillary here with Viral Marketing. I'm here with Nelson Vergel and Damon Jacobs. Welcome to the Power Hangout. It's going to be fantastic. Nelson, tell us a little bit about what we're going to be going through today.
Nelson:           Yeah. I'm very excited. This is a First Power Hangout. We're going to have a series of hangouts or webcasts really every month on different topics on HIV and health. Today is our first one and we have a celebrity with us, Damon Jacobs.
                        Damon is actually a licensed marriage and family therapist in New York City and he's also become the national lead and educator on pre-exposure prophylaxis or the appeal to prevent HIV. He goes around the country, speaks in conferences. He was just done with an international conference in Vancouver. Very well-known, he's got a big Facebook group, PrEP Facts. We'll talk about it later. I'm very, very excited.
                        Also, he's an author of two books, Rational Relating and Absolutely Should-Less. Tell us a little bit about your work, Damon, and your books, and then we'll go for all the questions that we have. We have a lot of questions here. By the way, I think Scott can let us know how the audience can ask questions, too.
Damon:           Hi, Nelson. Thank you so much. I am a licensed marriage and family therapist in the state of New York as well as California, where I was originally licensed. In my experience working in the mental health profession, it seems incongruent to be a healer, to promote mental and wellness, and we're not looking at the systematic issues that often promote or exacerbate grief and trauma, and suffering.
                        Because of that, early in my career, I became both a therapist and an educator/activist, and started talking about HIV prevention in very explicit, blunt ways even back in the 90s when condoms were the main message.
                        Now, I am both a PrEP educator and a consumer for the past four years. I use PrEp daily. As you said, I speak about this all over the world, and with a Facebook group where people can ask questions and learn more about this. That Facebook group is called PrEP Facts Rethinking HIV Prevention and Sex.
                        I really am so glad to be here with you. I want to thank you for I inviting me, and invite any questions from anyone who's listening or hearing this.
                        PrEP is a really sensitive issue and it brings up a lot of reactions in people, and I completely understand a lot of those reactions, so I want to really create a space here where people can ask anything. They don't have to worry about being politically correct, they don't have to worry about hurting my feelings, they don't have to worry about being offensive. I really want to invite that dialogue and ask people to ask anything they want to ask.
Nelson:           Great, Damon. Don't forget, I want to hear a little bit about your books, too. Tell us [crosstalk 00:03:07]-
Damon:           My books or my two children, so to speak, are called Absolutely Should-Less and Rational Relating. Absolutely Should-Less talks about living in a world without the word "should," without rigid and inflexible expectations that we carry about ourselves, about others, about the world. All the "shoulds" that we carry that result in depression, in anger and resentment, and sometimes, drug abuse, and in extreme situations, violence and suicide.
                        The other book is called Rational Relating. It is a very practical easy guide for any two people in a relationship or even more than two people who might be in a relationship who want to create negotiations and agreements, and arrangements to make the relationship full of serenity with joy and with pleasure, and with marriage equality passing, I find that everybody wants to talk about marriage equality. Nobody actually wants to talk about relationships. This is the ideal book for people that are either already in formal relationship or going towards a formal relationship.
                        The common thing here between my books and PrEP is this idea that life is so much better if we're proactive, if we have the tools and the resources, and the mindfulness to think ahead about the situations that might get in the way of experiencing joy and pleasure, and take action ahead of time.
Nelson:           Great. Where can people get it, get the book?
Damon:           They can get it at my website, [inaudible 00:04:24] damonljacobs.com. They're on Amazon. They're on barnesandnoble.com. I think one of them is on iTunes. Pretty much anywhere where books are sold online, you can get them or just get them at damonljacobs.com.
Nelson:           Good, thank you. Thanks so much. Let's get into it now. For those that don't know anything, tell us what PrEP is and a little background on how it came about.
Damon:           PrEP is an acronym, as you said, that stands for pre-exposure prophylaxis. It is a medication that an HIV negative person can use in order to stay HIV-negative in case they are exposed to HIV in the future. It is a daily pill. The main research took place between 2007 and 2009, and what was called the iPrEx trial, for those who want to look that up.
                        Since the iPrEx trial results became available in 2010, there have been several other studies that had validated the results and also seen that this daily medication can prevent HIV somewhere between 92% and 99%, or to put it in another way, there has yet to be single documented instance of an HIV-negative individual using this medication daily who has become HIV positive in any research setting in any trial, or in any real world implementation project where people have looked to see how often they take the med. Not one infection has occurred, so we know that this pill is quite efficacious when it's used in preventing HIV.
Nelson:           Why do we need PrEP if condom's work or now we have this thing called treatment as prevention which has shown the HIV-positive people that take HIV medications and bring their viral load down to undetectable do not infect others even if having unsafe sex. Why do we need PrEP even though we have those two other prevention tools?
Damon:           Let's start with the condom issue. Condoms, we know, have been very effective in preventing HIV and we've known that since 1985. Even with that information, we still have 50,000 new infections in the United States every year and that number has remained stagnant since 2003, so for the last 11 years or so, we did not have any significant decreases nor increases in HIV cases in the United States. What does that say?
                        It says hat condoms are not working as well as they could. Rather, condoms are not the problems, it's that people aren't wearing condoms. Even according to the CDC's own statistics, most gay and bisexual men in the United States were not using condoms even back in 2000.
                        It's not the condoms are bad and it's not that they're wrong, and for a lot of people they are using condoms and PrEP, but the fact that we still have 50,000 new infections in this country and that it is significantly on the rise amongst gay and bisexual men between the ages of 13 and 24 points to the fact that we need another tool. We need another strategy, another way to prevent HIV, and that's where PrEP comes in.
                        Your second question about treatment as prevention, as you mentioned, this is fairly new, but it is very, very true that a person living with HIV with an undetectable viral load, it seems to be, according to all the research we are seeing that we just saw on Vancouver this last week, is incapable of transmitting HIV, meaning, an HIV-positive person, no viral loads, suppressed viral load, they cannot and are not transmitting HIV.
                        Where are these 50,000 new infections coming from? In the United States, it's usually from people who don't know they're HIV-positive. Most people, quite many people who are HIV-positive in the United States do not know their status and they are without any mal-intent, not because they're bad, but without knowing it, are often carrying around a detectable viral load and transmitting HIV to others. This is why we need testing to be accessible and non-stigmatizing everywhere, and this is why we need PrEP for individuals who could be at risk for HIV.
Nelson:           Talking about stigma, you just mentioned the word "stigma." There are lots of stigmas surrounding not only being gay but HIV-positive. I'm HIV-positive for 33 years and I'm gay, and I'm an immigrant, and we all have labels, but anyways, tell us a little bit about the stigma associated with PrEP because I see online that a lot of people are judging those who are taking PrEP. They are calling them Truvada horse. They're calling them whatever, just stigmatizing the whole thing. Tell us a little bit about what their psychology since you are an expert in the field of all that's shaming that we're having now.
Damon:           I think the shaming your seeing and the Truvada whore label that has been used against me and against anyone who is open about their use of Truvada as PrEP is a reaction to fear, and let's face it, all the safer safe campaigns the last 30 years have been laded with fear. They have told people to be afraid, afraid of sex, afraid of pleasure, afraid of intimacy, afraid of connection, be afraid of sex without condoms, to be afraid of so many things.
                        When we get a prevention strategy that is medically proven to prevent HIV that is an alternative to what we've understood, it threatens people's sense of safety in a way. People have a difficult time with change even when it's good change because it means that we have to think differently, and a lot of folks are uncomfortable thinking differently.
                        I know that as an educator and as a mental health professional, this takes time, and definitely in the last three years, there has been a change in terms of people's ability to acclimate to this idea of this paradigm shift around HIV prevention, and around the possibility of someone staying HIV-negative when they're not using condoms. Not that you can't use condoms, but a lot of us are not, but where people then point fingers and label others is when they are uncomfortable with change.
                        For many, many people, many, many first wave survivors of the HIV epidemic in the 1980s, it makes a lot of sense that there would be a lot of trauma and fear associate with the idea gained by sexual man having pleasurable sex and exchanging bodily fluids without condoms.
                        There is a visceral and real reaction that a lot of people have because they live through the worst of times and they are still experiencing the results of that. It makes a lot of sense that PrEP will sometimes push some buttons of issues that have come up before. We work with that, we deal with that, but what I always say is that nobody's fear or labeling, or stigmatizing negates the science.
Nelson:           I saw the lecture you gave last week in Vancouver. I saw it online. We're talking yesterday about pleasure and love, and how nobody brings that up in different conferences. Everybody wants to talk about the data, the infection rates, efficacy of Truvada or PrEP. That was very interesting for me to hear. Can you tell us a little bit about the content of that lecture you gave last week?
Damon:           Sure. At any conference I go to, it's about research, it's about medicine, data, science, and expanding that a little bit, when I think about every safer sex campaign that I have seen for 30 years, it's always about how to avoid something you don't want. It's always about disease aversion and sometimes, using fear to get people to try to use condoms which they're not using anyway.
                        What gets lost in these conversations is why people still are having sex even at the risk of becoming HIV-positive now. Why did people 20 years ago still have sex without condoms even when the consequences could potentially be death? Because people have sex for pleasure. People have sex to feel good. People have sex to connect, to have intimacy, to have a sensational experience.
                        Unfortunately, I think these gay and bisexual men, even the well-intentioned doctors and researchers, and educators sometimes forget that when you're sitting across the room from somebody who's at risk for HIV, you want to find out for them what it means to have a pleasurable active sex life, what it means for them to have value and meaning in terms of their sexual expression. You want to be in their world, not try to get them to be in your world if you're talking about effective strategies for minimizing risk of HIV.
                        I talk about pleasure and I talk about love openly at these conferences because these are words that are rarely ever spoken in medical circles, in scientific circles, in safer sex circles. We somehow forget a gay, bisexual man, as most men and women in this world, want to have sex because it feels good.
Nelson:           I see. That's exactly what I want to do.
Damon:           Who knew?
Nelson:           I know, but it's basic and kind of a basic concept. I know what it talks about, so it's very refreshing for you to say that, but anyway-
Damon:           Just to think why we've ignored that for so long.
Nelson:           Yeah, 30 years of fear-based campaigns can do somebody some damage, but anyways, there are barriers. There are many barriers when, let's say somebody, whoever is this I need to this webcast, and by the way, people are going to be able to ask questions later. Scott is going to explain how.
                        We're going to get into details on how to navigate the whole process of getting PrEP and if you have insurance or if you don't have insurance. We're going to talk about that at the end, but tell us a little bit about the different barriers, the different difficulties people are having trying to access and get PrEP or even trying to talk to their doctors about it.
Damon:           Let's start by first [inaudible 00:14:36] that with that the fact the United States is the only country whose government has approved using PrEP, so, it's our FDA-approved use of prep three years ago in 2012. There's no other country in the world right now whose government has approved the use of PrEP [crosstalk 00:14:52]. Right, I know. I was amazed.
                        The United States was so far ahead of the curve on this issue. I was very impressed by that and still very impressed by that, but the downside is that PrEP is still not accessible anywhere else in the world easily. People still get them through international pharmacies and there's ways to do it.
                        If they come to my group, PrEP Facts Rethinking HIV Prevention and Sex, on Facebook, they'll learn about a lot of ways people are accessing PrEP outside the US, but in the US, that is the only country where our Medicaid is paying for it, where our private insurance is paying for it, where the Affordable Care Act is paying for it.
                        Within the US, access is still bit an issue partly because even though it is covered by insurance, there are some insurances that have put up barriers, who have put up hoops that have made it harder for people to access PrEP. It added paperwork where they've kind of passive-aggressively discouraged people from using it.
                        If I were to call an insurance company right now and say, "Hey, well my insurance cover PrEP," chances are, I'm going to get someone who answers the phone who's never heard of this and going to say no. This is why people want to find out. They have to call their insurance and they have to ask, "Is Truvada on the formulary? Not "Do you cover PrEP," but "Is Truvada on my formulary?"
                        Simply things like that can make a big difference in terms of accessing PrEP and dealing with insurance companies, and again, more tips like that are available at my page.
                        The other big barrier to access has been the medical profession. Doctors, mostly doctors in the United States who are sometimes, I'm going to give them the benefit of the doubt, well intentions, doctors who care, seem to have this idea. They have a misguided concept of cause and effect. They say if I give my patient PrEP, here she will feel like they can go ahead and have sex without condoms. What's the problem with that logic?
                        Most men, especially gay and bisexual men, gave up condoms a long time ago on a consistent basis. Not everybody, but most. For a doctor to believe that here she has the power to suddenly get people to use condoms in 2015 when people weren't even using condoms in 1995, how much sense does that make? How rational is that?
                        PrEP is appropriate because people already stopped using condoms, not the other way around, and until the medical community gets on board with that, we're going to see this power struggle and that sort of problematic dynamic, power dynamic that's coming through with doctors thinking that they can infantilize and be mommy and daddy for their patient who is probably just going to nod and smile, and then go the other way.
                        We need a medical system that's more in tuned with the needs of the pleasure of gay and bisexual men, and not judging them, not saying what you should do, but say "Here's the reality. What are you doing and can I help you to stay HIV-negative? Can you use condoms more often? Would you use PrEP? Could you use both? Let's talk about that." Insurance and the medical community had been the largest barriers in the United States.
                        Earlier you mentioned the stigma, there is still stigma in a lot of communities. People joking with their friends even though, again, most gay and bisexual men are not using condoms 100% of the time, but a lot of gay people would tease their friends or make fun of people who don't use condoms, or worst, stigmatize people who are HIV-positive. They say that being HIV-positive some sort of character flaw. What does that do in terms of helping people feel empowered about their sexual decisions? Not very much.
Nelson:           That's great. You mentioned gay and bisexual men, but straight people can take this, too, right?
Damon:           Absolutely. This is approved for anybody in the United States. It is approved by the FDA and endorsed by the Center for Disease Control for anybody who is at risk for HIV. That could be a man, that could be a woman. There are lots of women in the United States taking PrEP. There are at least two women in my group on Facebook that had used PrEP to conceive a child with an HIV-positive partner. Let's talk about that for a second.
                        It used to be, if you were an HIV-positive man married to an HIV-negative woman and you wanted to conceive a child, you had to go through an extensive and invasive process that was very, very expensive and not necessarily even efficacious in order to try to father a child. It was like the sperm washing thing.
Nelson:           Sperm washing, yeah.
Damon:           It didn't always work and it was very expensive. Now, with TASP, with treatment as prevention and with PrEP, male and female couples are conceiving children naturally without all that expensive stuff, without all that sperm washing stuff. We have two women in my group that are very outspoken about their use of PrEP in order to conceive a child with an HIV-positive husband. It is for men, it is for women, it is for anyone who wants to be in control of their HIV status if they're already HIV-negative.
Nelson:           It gives power to their receptive partner doesn't it? It really does.
Damon:           Let's talk about that because for me, I've been active sexually since 1989 primarily as a bottom partner [crosstalk 00:20:06]. I can say that here. Nobody's [inaudible 00:20:10] here, okay [crosstalk 00:20:11]? No, we never saw that coming.
Nelson:           You may get a lot of emails, so [inaudible 00:20:16] on you, but-
Scott:               I want to guess top, but-
Damon:           Okay, sure [inaudible 00:20:23]. Think about the mechanics of that for a second. Back before, we had treatment medications. Back before, HIV was treatable. If I was to have sex with anybody, as a bottom partner, I was kind of getting my life [inaudible 00:20:39] somebody else because I didn't know if that person was truly HIV positive or negative.
                        If I am getting penetrated and I'm having sex with somebody who is a top, and I am dependent on that person using a condom for me not to become positive, so I have to make sure that he is making sure it doesn't fall off, it doesn't fall in, it doesn't break, it doesn't somehow magically disappear as condoms sometimes do in the heat of the moment, that means that I've always given the power of my health status to another person.
                        With PrEP, I'm not in that position anymore. I take a pill every single day, and so, whether I have receptive anal sex with a condom or not, whether I'm with a partner who is positive or not, whether he is detectable or undetectable, I don't get HIV. I will not get HIV according to what I have experienced in the last four years and according to everything that research has been telling us.
Nelson:           But you could get sexually transmitted diseases, right?
Damon:           Yeah. Nelson, have you ever used a condom for oral sex? How many people listening hearing this and looking at this-
Nelson:           It's like taking a shower with your clothes on. I'm sorry.
Damon:           It's like [inaudible 00:21:50], most people do not use condoms for oral sex. I don't want to say nobody does because some people do, but most people don't. STDs and STIs are just as transmittable through oral sex and condoms do not protect from certain STIs depending on what you're doing and depending on what it is.
                        If somebody is having a herpes outbreak or at the verge of a herpes outbreak, that's skin to skin contact, and that the condom is not going to protect you. If someone is having a syphilis outbreak and doesn't know it, they could be contagious and you're not going to know it. You could use a condom and you could get syphilis easily that way.
                        Condoms do reduce the risk of getting an STI, but they don't eliminate the risk of getting an STI. What just came out of Vancouver this week and this was fascinating to me is that there were about a dozen demonstration projects given. Again, demonstration project is looking at how PrEP works in the real world in clinics all over the world, San Francisco, Miami, DC, but also in Canada, in Brazil and Africa, looking to see how PrEP works.
                        None of these demonstration projects have seen an increase, a significant increase in STI infections. Now, they're not raising decreases either. They're saying STI infections are pretty much staying the same throughout the course of these studies.
                        What's really interesting to note is that use of PrEP in the real world does not, so far, result in some major catastrophe explosion of uncontrollable STI exploding around this every single place. That hasn't happened.
                        Yes, it doesn't stop STIs, it only stops HIV, but I do want to say one more thing about that. When I use PrEP in accordance with the CDC guideline, that means I've seen my doctor four times a year, and in those visits, he was making sure that I do not have any STIs.
                        He is doing an oral swab, he's taking urine and he's doing an anal swab. I have to say that because it's so important for people. Anybody who's getting receptive anal sex, you tell your doctor you need an anal swab, too, because if you have, let's say, rectal gonorrhea and you're peeing in a cup, and your doctor's trying to find out if you have an STI, it's not going to show up. If it's in your butt, it's not going to show up in the urine, so you need to ask for an anal swab.
                        Now, I'm getting that done four times a year to make sure that I don't have an STI or if I did have an STI, that I'm not giving it other people. Compare that to somebody who is not on PrEP. Compare that to somebody who is not connected to health care who might be carrying around an STI without knowing it, who might be giving it to lots of people without knowing it. I always say that PrEP does not stop the transmission of STIs, but it does stop the spread of STIs because of those quarterly visits.
Nelson:           It's a program, it's not a treatment. PrEP is a program, right?
Damon:           It's a regimen. It is a strategy.
Nelson:           You have to go [crosstalk 00:24:39]-
Damon:           That you go three to four times a year depending on your relationship with your doctor. Part of that too is that my doctor is making sure that I don't experience any kidney changes. About one in 200 people who have used Truvada as PrEP have seen some changes in kidney functioning when they have used it responsively, and so far, in every single case where that's happened, when the person stops taking Truvada, their kidney functioning went back to normal, so there has been irreversible side effects from using Truvada as PrEP, but my doctor is drawing my blood four times a year to make sure there's no changes. No side effects that I'm not aware of, no kidney changes.
Nelson:           Just like you say, I lot of guys were not even hooked into the medical care system and were having unsafe sex. Now, if they take Truvada, they're going to have to go see the doctor [inaudible 00:25:28] I don't think you get a refill if you miss few of the visits, right?
Damon:           Right, you have to see your doctor in order to get a refill usually every 90 days.
Nelson:           Every 90 days, so [crosstalk 00:25:37]-
Damon:           I have a friend who, in New York City, was interested in using PrEP and went to a wonderful clinic here in New York city called APICHA, Asian and Pacific Islander Community Health Access, for anybody in New York city. He went to see the doctor and the doctor screened him for HIV and for any sexually transmitted infections, STIs, and his doctor said, "Oh, you have rectal gonorrhea."
                        Now, my friend did not know that he had rectal gonorrhea. He doesn't know how long he had it. He doesn't know how many people he's given it to, but the only thing he knew was that now that he was talking about PrEP with his doctor and he was going to be cured of gonorrhea and not give it to anybody else. In that way, we call PrEP a gateway drug.
                        It's a gateway to having a better relationship with medical professionals. It is a gateway to controlling STIs in our communities and it has really been an effective way of people feeling empowered not just about sex, but about their medical health in general.
Nelson:           Who actually takes PrEP everyday? I'm sure you. I've been positive for 33 years. I've been taking pills everyday twice a day. Sometimes, [I think there's 00:26:48] four times a day for that long. Actually, I take two but as a backbone of my treatment, I take [inaudible 00:26:55] inhibitors. I take a bunch of stuff. My total cost per year is like $60,000 on pills, so I tell people it's cheaper to keep people on PrEP and save them from having to go into HIV treatments where they're really expensive.
                        People also talk about the cost of PrEP and all that, but we're actually saving money in the long run by preventing all those expensive HIV [inaudible 00:27:19]. Anyways, tell me, in these studies, who actually adheres to PrEP?
                        There was the study called the IPERGAY, a study from France and Canada, I guess, right? The French that actually studied not taking PrEP everyday, but maybe four or five times a week. Tell us a little bit about that, too, even though it's not approved in the United States as a dosing regimen.
Damon:           Right, so a couple of questions there that I want to address. In terms of what you just referred to as the IPERGAY study, that's from France. They were the first and so far the only study to look at what we call event-driven dosage. The question being is if you want protection from Truvada as an HIV-negative person, do you have to take it everyday, or could you just take it based on the events of your life?
                        Let's say today is Wednesday, I know I'm going to have sex Friday night and I'm not going to use condom, so I want to be protected. Could I begin taking it on Thursday and take it again Friday, and then have sex, and then take it twice afterwards and have protection? That was the theoretical question that was being looked at in what was called the IPERGAY study.
                        The results that were released in February of this year were a little bit mixed. What they found is that everybody in this study who followed the directions and the protocol of the study, not a single person became HIV positive. Again, another study, nobody who took the drug the way it was prescribed to them became HIV positive.
Nelson:           What was the dosing?
Damon:           Go ahead. That's the thing. People were having sex so often in the study that the average dosing in the study was four doses a week, so when they looked at how many times people actually took the drug in a month, it averaged four times a week. We already know that four times a week is very, very effective. It's more effective to take it seven days a week, but four times a week still provides really, really strong protection from HIV if you're at risk for HIV.
                        The study told us a few things, but it really still gives us a lot of questions. I think it was about 20% of the participants took it less than four times a week, but they did take it for this event-driven dosage the way I described; two doses before the event, two doses after the event, and none of those folks became HIV-positive either. Again, the only people who became HIV-positive in the study were people who did not take the meds at all. What does that mean?
                        It means we have a lot more research to do, but for now, the Center for Disease Control recommends that anyone who wants to use Truvada as PrEP take it daily or close to daily. Obviously, if you forget a dose here or there, if you only take it six days a week and you skip a dose, and you take if four days a week, five days a week, you're still going to have a lot of protection,.
                        You know what, Nelson? I grew up in the time when AIDS was a death sentence. I lost lovers and friends and colleagues to AIDS. I grew up seeing death. I am not there. I am going to take it seven days a week because HIV is something I want to prevent and I want to do everything in my power to prevent HIV, and I feel most empowered doing it seven days a week.
                        In regards to the question you asked before that, who is this just right for it? Who is actually taking it daily? A lot of people like myself who survived the difficult days of HIV and AIDS are people that are using this daily or consistently on a daily basis in order to prevent HIV. People who grew up and saw this phase right up close, who have decided I'm not going to become HIV positive, but I still want to have these pleasurable sensational sexual experiences without condoms. Can I do both? Yes, according to the science now, you can.
                        In all of the studies, in all of the research, and people can Google iPrEx or they can email me if they want to see the data behind this, the people who adhered the most to PrEP were people that were at highest risk of PrEP.
Nelson:           They knew it already.
Damon:           The people that adhered the highest were people that were at risk for HIV. The official term used in this research study, it's URAI. That stands for unprotected receptive anal intercourse. The people who used Truvada the most in all of these research studies were people that were having unprotected receptive anal intercourse.
                        Today, I just posted this on my PrEP group page a couple of hours ago, the NIH with these results of the demonstration project that was presented in Vancouver last week that again showed demonstration project in the US 557 participants in San Francisco, Miami, and Washington DC, and again, same thing, those that were at highest risk for HIV, those that recorded having anal sex as a receptive partner without condoms were more likely to take Truvada seven days a week.
                        In order to measure whether they were telling the truth or not because that could be an issue, the scientists were doing what's called dry blood spotting to measure adherence, so they know through dry blood spotting that these participants were taking it seven days a week, and the ones that were at most risk for HIV in general were taking it more often.
Nelson:           Good. For those who are afraid of side effects, we talked a little bit about their kidney dysfunction issue that happens in 1 in 100 you said.
Damon:           One in 200, about.
Nelson:           How about the nausea or [inaudible 00:33:02]. I've taken Truvada forever. I never had a side effect. My kidneys are great even though I'm taking a bunch of other pills, but there are some people that may have ... They are predisposed to either kidney dysfunction or nausea, or fatigue. Tell us a little bit about this [sort of syndrome 00:33:18]. I think that's the term you guys are using now in the prevention world. Does that go away or-
Damon:           First of all, most people don't have side effects when they take Truvada as you said. I've never had them. You've never had them. Most people don't, but a lot of people do and what that usually is, is nausea, abdominal cramping, diarrhea, gastrointestinal problems, and if someone is using Truvada everyday, in most cases, those go away within the first three weeks.
                        Doctors do, if they're doing their job, do prepare their patient to say it is possible you may experience some side effects as your body acclimates to this new medicine, and that nearly in all cases, the side effects go away after a few weeks, and you may have no side effects at all, but those are temporary side effects. The other one that doctors are looking at quarterly is the changes in kidney functioning. Again, that is like 1 in 200 according to Dr. Bob Grant who ran the iPrEx trial.
Nelson:           In their placebo-controlled studies, they did not see a difference between the placebo or in Truvada when it came to side effects. I saw the table, too, so actually, they-
Damon:           I think the nausea and the abdominal cramping, there were significant  between Truvada and placebo, but still, most people still did not have any side effects at all.
Nelson:           Do you have to take it with food? Is it more than once a day, it's once a day?
Damon:           I take it once a day and I do take it with food because for me, that's easier. My stomach will react better. Some people don't take it with food at all. The reason why Truvada was selected as the first drug to be studied for prevention is because the side effects in HIV-positive individuals are so, so rare and that it has been known that it's a medicine that you can take with our without food. You can take it in the morning. You could take it at night time. You can even miss a dose and it's still going to be very effective.
                        When the researchers were trying to see could an HIV-negative person commit to taking a drug everyday or almost everyday, they selected Truvada because it was known to have such very little disruption in somebody's daily life.
Nelson:           I'm going to add something else very few people talk about. This is my very own biased opinion. I don't even think this is part of their guidelines, but I am promoting the fact that every gay man or any sexually active straight or gay person should be vaccinated against hepatitis A and B, if they haven't gotten it, and also, especially for young men under 26 years of age, the HPV vaccine which is approved for younger man, because we do have issues with HPV especially in the gay men population.
                        I think very few doctors are talking about their vaccination required ... Not required because they're not required, but to protect sexually active people from getting hepatitis A and B. C, we don't have a prevention vaccine. We have a treatment and got a cure now, but we don't have a ... And that can be either some sexually transmitted data that scares us, but not as bad as we think in the United States, but the vaccination issue, I don't really hear people talking a lot about that. Do you have any comments?
Damon:           I would agree except I would not say ... I never tell people what they should do with their body. I have no right and I have no authority to tell people what they should do with their body, but when I'm talking to someone or educating a group of people about health and wellness, and joy and pleasure, I'm thinking about ways to maximize health and wellness, and pleasure over the long term.
                        That is when I would ask these questions that you brought up which are wonderful questions and really important. Have you been vaccinated for hepatitis A? Have you been vaccinated for hepatitis B? Have you ever talked to your doctor about the vaccine that's available for anal warts?
                        I know I'm too old to get it. I've asked my doctor. I'm over the hill. I've already been exposed according to [crosstalk 00:37:24] data, but absolutely, for younger people, it is approved in the United States, that means insurance does pay for it. My insurance would not pay for it because I'm too old. These are all prevention strategies and they are risk-reduction thoughts.
                        When we talk about PrEP, again, we're not just talking about using a drug to stay HIV-negative. We're actually talking about a shift in thinking one that's less about disease and more about health.
                        When I talked to doctors about it, this might be the first time in your career you really had an opportunity to talk about healthcare [crosstalk 00:38:03] because most of the work you do is about disease management. Most of the people who come to see you everyday are people coping with chronic or treatable diseases whether it's HIV or other diseases that people are dealing with like diabetes or hyperthyroidism, but most of your work is about treating a condition.
                        With PrEP, you have an opportunity to work with somebody on actually caring for someone's health in a proactive, responsible, and empowered way, and what a different paradigm that is.
Nelson:           One more thing, are doctors being trained? I don't know if Gilead, the maker of Truvada, is spending any money on education for doctors since they didn't really spend money in the approval process for this drug for PrEP. It's approved for HIV treatment, too. Are doctors actually being educated or do they have to find information on their own?
Damon:           There are a lot of resources for doctors. Gilead does provide training for doctors if they as for it, and it's free. Gilead has trained professionals all over the US that would go to any hospital clinic or area when doctors asked them to.
                        If they don't want to deal with Gilead which some doctors don't for various reasons, there's also trainings and a lot of information on the CDC website. The Center for Disease Control provides a lot of information and data and training, and a hotline for doctors to call if they want to talk to somebody about PrEP and how to responsibly [inaudible 00:39:30].
Nelson:           Good. Scott, why don't we go into the first graphic to explain the process of navigating through the whole process of attaining PrEP? Is that possible the first graph?
Scott:               Yeah, absolutely. Real quick before I pull it up, there was a couple of questions.
Scott:               Also, just so the viewers know, there is a Q and A up in the right corner. There are some squares. Click in there and then you can ask a question we're going to answer at the end, okay?
Damon:           Ask about Truvada Whore. Ask me anything. You will not hurt my feelings. You will not affect me.
Damon:           Do it. Rather I shame me, don't shame your friends. If you have a question, a genuine question, ask me. Don't ask the people around you who might be offended or stigmatized by you.
Scott:               All right, hold on real quick. I'm going to pull it up. Here we go. Is this the first one?
Nelson:           Yes, we need to actually expand it if we can. I don't know if we-
Scott:               Yeah, hold on. I can't-
Nelson:           It's such a busy table, but it really is a great summary. Project Inform, a non-profit obviously, if you guys don't know, in San Francisco is a National Education and Advocacy non-profit organization put together this.
                        It seems complicated, but it really is a summary of the different steps that people go through to get access to PrEP and we have a second graph that we're going to show later on who pays, whether insurance, if you have insurance, if you don't have insurance, if you are a US resident, if you don't have a green card because there are other ways to access this, and how much money you have to make if you don't have insurance.
                        It gets very confusing. We may or may not have too much time to go into details for both of them, but we will. You can go into the Project Inform website and they have the information there, too, or you can actually type on their Facebook search box on the top, PrEP Facts. Actually, just typing those two words gets you to your page. I've done it many times. We have more than 5000, 4500 hundred members or so?
Damon:           Seventy-eight hundred now. As of today, 7800 people, international.
Nelson:           Amazing. We all do. There's a bunch of us answering questions there. Actually, that probably is s ... But some people don't like showing their faces sometimes for questioning, so you can go into to the website, but anyways-
Damon:           They can direct message me on Facebook or they can go to damonljacobs.com, and my email and all my contact information is there, so anybody can ask me anything privately if they prefer.
Nelson:           Good. Scott, can we go to the-
Scott:               Yeah, there you go.
Nelson:           Damon, can you like really briefly ... We don't have to read all these out loud because it's too much. It will take us forever, but briefly, the main points of each on these steps, if you can.
Damon:           I can't really see the ... from the ... They're coming up at the little corner of my screen.
Nelson:           Yeah, just put it on the [crosstalk 00:42:49]-
Damon:           I'm not really familiar with the process though they can describe-
Nelson:           Scott, put it on the main screen. Just-
Scott:               It's on the main screen. Damon, click on my screen and then, it should come up.
Damon:           Okay, it's coming up. This definitely describes the process. First thing you want to do is empower yourself with knowledge from the insurance standpoint. Again, you don't want to ask your insurance company, "Does PrEP get covered on my plan?" You want to ask them , "Is Truvada on the formulary and what tier it is in," because then, you're going to get a better idea about what your expenses are going to be.
                        A lot of people who are HIV negative aren't used to dealing with insurance companies and medical plans, and deductibles. It can be a little daunting in the beginning. Places like Project Inform in San Francisco and APICHA here in New York do help people through that process, but not everyone has access to that, and of course, they can always come to my Facebook group if they need help, but check with your insurance plan, find a medical provider who supports your decision. That is easy to do in some areas, harder to do in others.
                        What people are doing with the PrEP Facts group I going on saying, "Hey, I'm on Oklahoma City. Who are the doctors that prescribe PrEP here?" Quite often, there's members who have already gone through this who can help with that.
                        Once you see your doctor, and here, she chooses to prescribe PrEP, then you are going to have your blood drawn. Before you get a prescription, the doctor is probably going to draw blood because they want to verify you are HIV-negative first before prescribing PrEP.
                        They are also probably going to do an STD check. They're going to do your through, your urine. If they don't do it, and if you ever bottom doing it your life, ask them for an anal swab. They're supposed to know to do it, but a lot of doctors don't, so ask them for an anal swab because you want to make sure you know what's going on up in there.
                        Then, you get the prescription, you get it filled, and you start taking it. As we said, some people have side effects when they start, some don't, but I think for a lot of people, what's not on here, is just how you begin to act and make your life to the idea that you were being responsible every single day whether you're sexually active or not, that you are being proactive responsible and empowered about the pleasure that you want to have. That's such an important part of taking PrEP as well psychologically and emotionally.
Nelson:           How about co-pays? We can go into the next one. Let's go into the next site which is probably the most important. This is not a cheap drug, by the way. I think your total cost out of pocket, retail is 1100 a month like every HIV or non-HIV drug. It's not very cheap, but thank God, the company has a patient assistance program and they are also is covered by insurance in most cases, and also there is a foundation that can help with some of the cost. Damon, can you go through this really quick? There's a lot of input to it and everybody can go to projectinform.org/prep, and you will find this, but just really briefly-
Damon:           They can come to my Facebook group and get this information as well. There are a lot of resources and this chart is wonderful because it takes you through the "it then" statements.
                        Basically, if your insurance covers it, you'll have a co-pay. Gilead will pay that co-pay up to $300 a month no matter what your financial situation is. If you have Medicaid at any 50 states, Medicaid will pay for Truvada as PrEP in all 50 states. If you have no insurance, if you have zero coverage, Gilead will still pay for your coverage through the medication assistance program if your yearly income is under the 500% of the federal poverty level which is about 58,000 a year, then Gilead will pay for it.
                        As you see on the chart, there's various ways to think about enrolling, and with open enrollment coming up towards the end of the year, if you are going to be on PrEP on the Affordable Care Act, you really want to select a plan where Truvada is going to be properly covered.
                        Where I've seen a lot of people get some trouble here with the Affordable Care Act is because they select a plan that doesn't ... It has a very, very low monthly cost, but has very, very low coverage, and they are under insured. They can't really afford Truvada a lot of times because they'd be paying this at like incredible [inaudible 00:47:26] expense in order to get it.
                        If you are on the Affordable Care Act and you are considered using Truvada, I would encourage you to consider either a bronze or a gold plan.
Nelson:           You mean silver?
Damon:           It's silver. Thank you. Silver or Gold plans because those are the two higher ones. There is assistance to the patient's assistance network. If you qualify for that, that's about 4,000 a year of assistance you can get.
                        If you're living in the state of Washington or the state of New York, there are state assistance programs. If you are under assured and you cannot afford Truvada as PrEP, the state will actually pay for it in these two states, and I'm hoping other states will follow soon.
                        There is just a whole bunch of good information here and many, many resources in order to cover Truvada as PrEP. I'm on the Affordable Care Act. I'm on a gold plan. My usual co-pay would be $70 a month. All of that is covered through Gilead.
Nelson:           Are there cities thinking about covering cost too like San Francisco is doing it, right, or not? Chicago, San Francisco, LA none?
Damon:           The state of Illinois is next. Then, they have a republican governor that got elected in November and that went bye-bye. Illinois was going to be providing state assistance for Truvada as PrEP and now they're not.
                        The county of Los Angeles recently announced a month ago that they will be providing assistance as well. I believe San Francisco already does, so you are seeing some specific counties where there is a lot of risk for HIV where the counties are stepping out to provide assistance for individuals because again, as you mentioned, Nelson, from a fiscal point of view, the cost of treatment is a lot more than the cost of prevention. These counties and states are actually doing themselves a huge favor by spending some money now preventing HIV versus treating HIV down the road.
Nelson:           I also suggest for everybody to Google their closest community clinic. Every large city has community low-cost clinics. Most of them are treating HIV, by the way, and many of them have case managers that can navigate through the patient assistance programs, because it can be overwhelming, so do that.
                        Also, as I said, show their Facebook page that we have the third graph so that people can find us. Damon, me, and 7000 other people from all over the country, they're all over the world, this is is their Facebook page, PrEP Facts.
Damon:           Yeah, that's a good clip.
Nelson:           Yes, 7800 people now, so-
Damon:           Yeah, now it's 7800 had joined all over the world to learn about this valuable information that's out there.
Nelson:           Do you have anything to add? We can answer questions now. We still have five to 5 to 10 minutes maybe.
Damon:           Yeah, let's answer some questions.
Scott:               All right, we got a question here. Providers who refuse to prescribe PrEP for patients who request it, if that patient subsequently gets infected, could he or she conceivable sue their provider for refusing to prescribe PrEP when requested? That maybe the only way to affect change?
Damon:           It's a great question. I'm not a lawyer, so I really can't speak to legal issues. As an activist, I think that would be an appropriate use of using the legal system to make a statement. I don't know if legally you could win that, but certainly, from an activist standpoint, that is often how the message has gotten through and change has occurred.
                        If you are in that position, I would encourage you to talk to our lawyer and/or Lambda Legal, and you can google Lambda Legal about that. I don't know what kind of resources they could provide, but it has not happened, but I certainly think it could, and if it does, that might be a necessary message for the medical community to start being responsible about how they're reacting or not reacting to PrEP.
Nelson:           But they can always go to the Facebook group and ask for a doctor in their cities because there are almost 8000 people, so chances are, somebody lives in their city that knows doctor there that's prescribing.
Damon:           Hopefully. Now, again, that's more and more the case, Nelson. There are still a lot of areas of the US, a lot of rural areas of the US, a lot of smaller towns, but that's not the case, and exactly the question that came up, people are going to their doctors and being told no for no medical reason, just for moral reason. Their doctors are practicing morality not medicine, and if that person becomes HIV infected and turns around and sues their doctor, I don't know what's going to happen, but I do think that will send a loud and clear message to the medical community.
                        The need to get on board with this. They need to follow FDA guidelines. They need to follow CDC guidelines, or else. The AMA says "Do no harm." As a doctor, do no harm. There are doctors doing harm by refusing PrEP to people who qualify for it under the CDC guidelines.
Nelson:           They also should say do not judge, but anyways, the next question is-
Damon:           I wish, yeah.
Nelson:           When someone is exposed to HIV while on PrEP, what happens to HIV inside the body? I understand that it does not replicate, but where does it go? Does it die? What happens to it?
Damon:           I'm not the best scientist who can explain that basically, and Nelson, you might have better insight how to explain this. If you go to whatisprep.org, they also have a video that sort of shows by taking Truvada everyday, there's like a coding around my T-cells and if I was exposed to HIV, the HIV could not replicate. It could not duplicate. It could not copy itself in my system. That is a really basic response. If you come to PrEP Facts Rethinking HIV Prevention in Sex, there's a lot of people who can explain it a lot better than I can.
Nelson:           Truvada is actually a combination of two medications. They are both nucleoside and analogs that really get involved in cutting off the life cycle inside the CD4 when HIV penetrates the CD4, and it basically cuts. They're like scissors. They cut this reverse transcriptase. It's an enzyme that the virus needs to replicate itself. Truvada is actually a combination of, we didn't say that before, of tenofovir and [inaudible 00:53:52] together, and both are nucleoside and analog.
                        What happens is that if you're exposed to HIV while taking Truvada, you're taking it everyday and you have already taken it, that's another question. How long can you have protected sex after starting Truvada? I've heard that anywhere from 5 to 7 doses. That's maybe a question that is coming up, but I don't want to go into that, but if that-
Damon:           Nelson, I can-
Nelson:           Yeah, go ahead.
Damon:           I could say that because I haven't had unprotected sex in Truvada because Truvada is protected sex.
Nelson:           There you go. We use that word for [inaudible 00:54:28]. We actually equate it to condoms, right?
Damon:           Right. Truvada is protected sex. In order to make sure you have the maximal protection for rectal sex, anal sex in 7 days, for vaginal sex, it's 20 days according to the CDC.
Scott:               Okay, another question here. There are some research showing that women have lower concentrations of tenofovir ... I don't know if I'm pronouncing that right ... In the vaginal tract. Should women be concerned that PrEP might not work as well for them as it has for MSN?
Damon:           We definitely need more science, but this is why the CDC is recommending 20 days for vaginal tissue, that it takes 20 days for the vaginal tissue to absorb Truvada, whereas in the rectal tissue, it's 7 days.
                        I know plenty of women who enjoy anal sex. They could use Truvada and have anal sex, and be protected in the anal cavity after 7 days. These are conservative estimates. As we know from the IPERGAY study we talked about earlier, it might actually be sooner than that, but as our basic understanding where we're at right now, it's still 20 days for vaginal sex, 7 days for anal sex. More research does need to be done as far as how it affects vaginal tissue.
                        I just have to add to that that transgender people, for the most part, have been left out of all of these trials. When I'm talking about men and I'm talking about women, I'm talking about [inaudible 00:55:55] gender, meaning men and women who were born with the sex that they fit into, we actually don't know how long it takes for Truvada to build up in the system for a transgender man or a transgender woman.
                        Transgender women have been included a little bit in research studies, but transgender men have not been included at all. Unfortunately, there's no hypothesis to suggest it doesn't work just as well in a transgender man or transgender woman, but we can absolutely say it does because they've been left out.
Scott:               Got it. Okay, another question here. The Vancouver consensus that was signed called on governments to remove policies and legislation in order to make PrEP accessible to all. Where there any discussions or decisions as to what specifically will be done to affect this?
Damon:           Good question. My understanding is that, of course, we're talking about so many different countries. What needs to happen first is that the pharmaceutical company needs to apply with each country's medicine regulation board and it's different in different countries, but Gilead needs to at least apply for this kind of approval in each country, and that they haven't always been up-to-date and stepped up to that the way they could have. Nelson do know more about where-
Nelson:           No, not at all. You're the expert. I really feel especially really bad for all the other countries. The Europeans are posting a lot on the group. People flew in their countries and I have no idea where we are when it comes to approval of PrEP internationally. Do you have any idea what is the next country, Canada or UK? Do you have any idea?
Damon:           I don't know of any country that's immediately close to it.
Nelson:           Maybe the French since they've done so much research?
Damon:           That would be great. I hope so. It's awful. How is it possible that we have such an effective way to end HIV and the US is the only country to step up to that? It's preposterous, but this is where were at.
Nelson:           Maybe we need more activist. I'm sure their activist there were, yeah. Okay, the next question?
Scott:               Damon, why are you so cute?
Damon:           I give my mom and dad credit for that.
Scott:               That's from Roby from Fort Lauderdale, but maybe talk about pipeline of future PrEP products.
Nelson:           Great question.
Damon:           There's avac.org and they have a list of about close to 50 demonstration projects that are taking place around the world. Again, demonstration project means does PrEP work in the real world. We know that works in research trial settings, but does it actually work in the real world? That's the step. That's what's happening in the pipeline as far as understanding Truvada as PrEP and how this is going to work.
                        As far as other meds, there are other meds that are currently being studied as pre-exposure prophylaxis. There's other drugs that are currently being studied in clinical trials. There is the HPTN-069 study called the next PrEP study that's currently underway in various parts of the United States and Puerto Rico.
                        There's also gels that have been tested. We haven't seen a lot of success with that. It's something called microbicide gels. Question, could a woman or a man use a gel in their anus or vagina and have that protect them from HIV? We haven't really seen it be effective yet, but that is being studied in clinical trials, and then the other thing that's being studied in the pipeline right now are injectable preps.
                        There are studies going on in the United States looking at the efficacy and safety of an actual injectable. Let's say I don't want to take or can't take a pill everyday, but I could go to my doctor and maybe once a month or every three months get injected with something that will keep you HIV negative. That is another option that's being studied.
                        When we talk about PrEP, when we talk about pre-exposure prophylaxis, right now, that's synonymous with Truvada, but it wont' always be that way. Eventually, PrEP is going to be like a whole toolbox of interventions for people who want to stay HIV negative.
Scott:               Awesome.
Damon:           That's where we're at.
Scott:               One more question. Does PrEP lose its effectiveness? You kind of already talked about this if someone uses it intermediately or meaning like if they take it for a while and then stop, but they're absent at the same time, and then, start taking again when their not [inaudible 01:00:38], that's just a yes to that question, right?
Damon:           It does not lose it efficacy if people start and stop. It was designed as a strategy so that people could start and stop. Much like women do with birth control pills, you take it when you're at risk for an adverse consequence in sexual pleasure. You don't have to take it when you're not at risk for HIV.
                        However, that being said, you really need to know one thing, and if you remember nothing else about this, you got to understand one thing. If you stop taking PrEP and you decide later you want to start again, you must at least get verified as HIV-negative first. I can't emphasize that enough.
                        All the crazy critics and people who are against PrEP out there, there's only on agreement I have with them, and that agreement is that it's dangerous for somebody to start and stop on their own. They can stop on their own, but if you're going to restart, you must do this in tandem with the doctor or a nurse or physician's assistant who can verify you are HIV-negative before you begin.
                        If you are HIV-positive and you do not know it and you use Truvada just by itself, there could be some adverse consequences for your ability to respond to treatment down the line, so please, start Truvada with a doctor.
                        If you choose to stop, that's always better to do that with a doctor. You may say, "Hey, right now, it's summer and I'm going to run off to Fire Island and have a lot of sex and take a lot of loads. Once September and October come around, I'm really going to be sexually active anymore, so I don't really need to be on PrEP."
                        Okay, cool. That's great, but if you are going to restart for spring break next year, you must please get your HIV-negative status verified first. If you do, we have seen no diminishment in efficacy, it is not worth any less in your system if you stop and restart, right? Just please do not restart without a doctor.
Nelson:           If you restart after HIV test, wait at least 7 days after you start again.
Damon:           Take it for 7 days. For anal sex, you're still are going to need to take it for 7 days, vaginal sex for 20 days. That's the most conservative estimate of how effective it becomes right now with what we understand, what the CDC is saying, right?
                        Of course, earlier we said PrEP stands for pre-exposure prophylaxis, but there's a different acronym that I use when I'm thinking about PrEP and when I'm teaching about prep, and I mentioned it earlier, that is proactive, responsible, empowered pleasure.
Nelson:           I like that.
Damon:           Thank you. When we think about those terms, what that means is it's inclusive for people that are HIV-negative and it's also inclusive for people that are HIV-positive in terms of making the most proactive responsible and empowered decisions about their pleasure as well which for most HIV-positive individuals right now includes treatment as prevention, which is TASP.
                        For a lot of HIV-negative people, that means using PrEP, and for some HIV-negative people, they're still using condoms only without PrEP, and if they can do that 100% of the time, that's great, but what I'm considering is a framework for all of us to really evaluate what is the most proactive, responsible, and empowered way that I can experience pleasure, and that PrEP allows us to begin to ask these questions for any man, for any woman of any background, and any HIV status.
                        That is what I really like people to consider when they are thinking about PrEP for themselves or thinking about PrEP for others, and especially if they're going to judge or stigmatize. I don't think anybody listening or re-listening to this, or watching this is judging others, but can really just think about, "Is PrEP right for me or not? What would it be for me to be proactive, responsible, and empowered about my pleasure?" Then, have conversations with that or join the Facebook group and ask questions about that.
Nelson:           Great.
Scott:               Awesome. Nelson, I think we're kind of out of time here. Anything else you want to wrap us up or-
Nelson:           Oh man, this has been great, Damon. You're like a star. I knew you're the great. I appreciate it. This is going to be available on YouTube right away, right, Scott?
Scott:               Yeah, right away and then you can take the link and post it up wherever you want all the groups. Damon, you can share it, too, whatever you guys want to do.
Damon:           Share is good.
Nelson:           I appreciate it, Damon. I appreciate this, Scott. Damon, I will talk to you later. You really have helped hopefully thousands of people. I hope this video is watched by thousands. There is no reason why it shouldn't.
                        If anybody, as I we said, has any questions, to find us on Facebook, on the PrEP Facts, or your own website, right, damonl
Damon:           Damonljacobs.com.
Nelson:           Damonljacobs.com.
Damon:           Don't forget the L.
Scott:               Real quick, Nelson, what could people expect from the next Power Hangout?
Nelson:           The next Power, I'm thinking about having one of the experts on supplements in HIV. We're going to talk a lot about more of what I do, exercise supplements and all that. I wanted to do the PrEP one first because it's a hot topic. It's a very misunderstood topic and I have a star speaker speaking instead of me, so that's great. Look forward to my next postings on the next Power Hangout. It's going to be once a month.            Thanks a lot and I appreciate your joining us and taking the time, and Damon, I will talk to you soon.
Damon:           Thank you. Thanks, everybody.
Scott:               Thank you.
Nelson:           Thank you.



Support PoWeR

Program For Wellness Restoration

Health News

Blog Archive

The Cure of HIV is Possible in Our Lifetime