Recent Medellín Trip

[midwestdad]

I just got back from a week in Medellin and thought I'd share some tip/pointers/observations:

• The holiday lights are absolutely beautiful!  I went on a date with a local paisa and he took me around to the various displays at night.  The displays by the river were great and made for some great vacation photos.
• I spent almost three hours in the immigration line on arrival at the airport.  It was hot and people were exhausted and frustrated.  Make sure to have some water and something to entertain yourself.  I read that a recent strike by the immigration workers' union had recently settled.  Hopefully that should improve the long lines.
• I started using a clear face pic on WhatsApp and noticed I got much better responses from guys and was offered better prices.  I'm an average looking gringo.  The guys are just more eager to respond when they can see right away who is contacting them.
• This was my first time seeing ciclovia in Medellin.  On Sunday mornings, many major streets shut down fully or partially to make room for a community run/walk/cycle.  Avenida El Poblado is one of them.  From about 8am - 1pm it was closed one-way to make room for the ciclovia.  Had I known I would have brought running gear.  It's a great way to experience a local tradition and see some very attractive shirtless men in public.
• Web cam boys - don't waste your time.  I planned a meeting with one and even brought him his favorite gourmet chocolates from the states.  He kept cancelling on me and we never met.  I gave the chocolates to an adorable Venezuelan guy who appeared to really appreciate the gift.
• The PREP situation is not very consistent.  I'm on the PREP 2-1-1 protocol, so I always have extra pills on me.  Depending on what we are doing, I offer it to guys and offer to wait the required two hours.  Some guys take me up on the offer, and others didn't.  I think some were wary of taking medications from a container in a foreign language, which makes sense.
• If you are Ubering a guy to you, ask if they will do Uber Moto.  It's Uber but on a motorcycle.  It's much faster than a standard Uber car, and much cheaper.
• I was there for a week and had zero safety concerns or issues.  I did go to many places, like Plaza Botero, with a local guy, and that really helped.  The guys know their city and what to watch out for.

Happy travels!

[Riobard]

While it’s understandable that your offer of event-driven PrEP may be driven by the reality of uncertainty of your own HIV status between routine testing iterations, there is little basis for the recipient to initiate it without similarly having tested prior to uptake. He would also need the -1-1 follow-up protocol doses, no?, if doing it correctly. You probably grasp that part in your offer.

One possible complication is that any testing he pursues shortly after, horse after the cart, may be subverted in that if he happens to be, god forbid, HIV positive but previously undiagnosed the detection of viral antigens or antibody responses may be delayed or reduced due to having antiretroviral drug in his system. This type of trade-off accounts for the clinical imperative of testing first in all cases.

[asdsrfr]

I assume you stayed in an AirBnb right? Did you clarify the guest policy before or just search one out that didn't have a doorman?

[midwestdad]

18 minutes ago, Riobard said:

While it’s understandable that your offer of event-driven PrEP may be driven by the reality of uncertainty of your own HIV status between routine testing iterations, there is little basis for the recipient to initiate it without similarly having tested prior to uptake. He would also need the -1-1 follow-up protocol doses, no?, if doing it correctly. You probably grasp that part in your offer.

One possible complication is that any testing he pursues shortly after, horse after the cart, may be subverted in that if he happens to be, god forbid, HIV positive but previously undiagnosed the detection of viral antigens or antibody responses may be delayed or reduced due to having antiretroviral drug in his system. This type of trade-off accounts for the clinical imperative of testing first in all cases.

Yes, you are correct.  When meeting I do offer the four Truvada pills, so my partner is able to complete the full 2-1-1 protocol, just like me.  I am negative and tested on a monthly basis.

[midwestdad]

10 minutes ago, asdsrfr said:

I assume you stayed in an AirBnb right? Did you clarify the guest policy before or just search one out that didn't have a doorman?

Yes, I was in an Airbnb.  I contacted the host ahead of time and asked about the guest policy.  I specifically stated, "I am traveling solo and would like to have friends come visit."  She told me that guests were allowed as long as they had proper identification.  I had no issues with the security desk staff.

[Riobard]

Here’s the very organized and detailed PrEP manifesto. Apparently prescribing and dispensing is covered under the public health system. Locals’ awareness is key.
https://prep-colombia.org/wp-content/uploads/2023/07/Lineamiento-PrEP_FINAL_Junio2023.pdf

[Birmingham boy]

Glad you had a great time, I envy you😅 Soz for a stupid q, but what was the point of giving them prep if you're on prep and they can't get it from you? Also, I was planning on getting doxy prep from local pharmacy, would you say it's generally safe to order medicine from Rappi or is it likely to be fake? 🤔

 

[floridarob]

3 hours immigration line, my goodness.... Bogota a couple of years ago was 2.5 hrs and that's the worst I ever endured anywhere.

What time did you arrive and hit that line, my 3 times this year were all afternoon arrivals and no wait....

[midwestdad]

2 hours ago, floridarob said:

3 hours immigration line, my goodness.... Bogota a couple of years ago was 2.5 hrs and that's the worst I ever endured anywhere.

What time did you arrive and hit that line, my 3 times this year were all afternoon arrivals and no wait....

I arrived just after 9:00 p.m. and got through at midnight. When we arrived, the line was about 1/2 full.  Three flights arrived after us, so when I got through at midnight, the line was all the way to the back of the room. 

[midwestdad]

2 hours ago, Birmingham boy said:

Glad you had a great time, I envy you😅 Soz for a stupid q, but what was the point of giving them prep if you're on prep and they can't get it from you? Also, I was planning on getting doxy prep from local pharmacy, would you say it's generally safe to order medicine from Rappi or is it likely to be fake? 🤔

 

Good question.  Neither daily nor on-demand PREP is 100% effective.  So I take it, and offer to sexual partners, as a method to reduce the overall risk.

I don't know enough about the local economy to answer your question about buying doxy through Rappi.  I typically just stock up in the states before I go on a trip because it's cheap and easy to get here.  Maybe @macdaddi has some more insight! 

[macdaddi]

The medications that are offered through Rappi are supplied by local pharmacies i.e. it is the same product you would purchase in a pharmacy.  I have fulfilled several prescriptions this way.  However, be aware that some drugs are not allowed to be delivered through Rappi without a prescription on file,  so your particular brand-drug class may not be available. A quick search on the Rappi app turned up nothing.

You may required to purchase in person from a licensed pharmacist (and therefore know the correct drug name in Spanish).  I do not know if this is the case in Colombia for PReP, however a quick WhatsApp conversation with a men's health clinic in any major city would answer that question. Another option is to book an appointment with a local doctor who can facilitate delivery from the pharmacy.  There are several medical service providers offering house calls in Medellín that will do this for you.  The extra $20USD to organize this is massive value-add IMHO.

Regarding drug quality, almost all Colombians will swear that the quality of foreign manufactured prescription medications is superior to locally available products, but I have zero data to back that claim up. Caveat emptor applies here, I am afraid.

[speedoo1]

It is easy to buy doxiciclina (Doxycycline) in pharmacies in Colombia. No prescription needed. Don’t ask for Doxypep; most likely they will not know what you are talking about. 
 

If you are on the daily PrEP protocol you really don’t need to suggest the local guy to take the 2-1-1 PrEP as well. The chance of you winning the lottery is higher than you getting HIV when on PrEP (taken daily of course). Besides, most Colombian chicos will fuck raw, PrEP offered or not. 

[Riobard]

I doubt that either the OP or the 1 in 60 research subjects assigned to Truvada and acquiring HIV infection over their first year of enrolment in a more recent trial buy into the lottery odds analogy. 

[Birmingham boy]

1 hour ago, Riobard said:

I doubt that either the OP or the 1 in 60 research

I've heard that majority of those cases of HIV under prep were attributed to those taking the pills inconsistently or breaking the schedule 🤷🏻‍♂️ I guess there would be some cases where ppl aren't responsive to prep as they should but those cases must be rare. I guess it would be a nice precaution to get both prep and condom if you feel like the person in front of you could be at risk..

[Riobard]

1 hour ago, Birmingham boy said:

I've heard that majority of those cases of HIV under prep were attributed to those taking the pills inconsistently or breaking the schedule 🤷🏻‍♂️ I guess there would be some cases where ppl aren't responsive to prep as they should but those cases must be rare. I guess it would be a nice precaution to get both prep and condom if you feel like the person in front of you could be at risk..

The point is that the gold standard of analysis is intent-to-prophylaxis and research subjects are usually as a whole more adherent to ideal drug uptake for prevention than in the real world as they are altruistically committed to scientific contribution. The real world assessed estimates of PrEP results are dreadful.

Nobody in spite of demonstrated perfect adherence is justifiably dissuaded from regular testing and considerations of transmission risk. “If only they had done it right” as a factor in breakthrough infection is no rational argument for the cavalier assertion that prevention is virtually guaranteed and that the HIV-negative partner of a PrEP consumer need not make all efforts to access the same prophylaxis advantages.

The fact is that the relative contributions, to a research trial’s HIV seroconversion rate, of adherence, the much higher known risk of receptive anal intercourse position orientation, encounter risk frequency, co-STI infection, and reverse transcriptase inhibitor resistance are unknown. The high rates of breakthrough infection in structured research over short durations are sobering.