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ok just read this last one
May 3, 2003

first of all i apologize for the insulting email i just sent you. you got me very upset when you acted naive to the many accounts of anal warts in so-called "no risk identified" men with hiv. that's an old story.

but i want you to honestly tell me that hiv has entered the heterosexual community. i dont mean heterosexual women, i mean the heterosexual community. that means that men are now passing hiv to women and women back to men. is that what you claim?

secondly, if you feel this is the case, then why when i went to dr. eric rosenberg of mass general hospital, because i felt i had acute retroviral syndrome, his assistant (who obviously follows rosenberg's protocol in these situations) asked me numerous questions before he was willing to administer a free rna pcr test to me as part of a study of early infection. in order to not waste money on people whom they decide aren't likely to have been infected, they try to gage whether or not its possible the person could have been infected. i passed every bit of criteria for getting the test, every symptom in the book, except that i "told them" my risk was insertive vaginal sex with a prostitute who was having her period at the time (i was still in the denial phase of my bisexuality). they refused to give me the test, and no, they didnt admit it was based on that. they claimed it was based on the fact that i didn't remember having an elevated fever. and they gave me this ridiculous excuse only after i told them my risk was heterosexual. i had swollen glands, rashy skin, thrush!, diarrhea, loss of appetite, night sweats, lost 10 lbs in 2 weeks for no apparent reason, tested negative for mono - i mean, i was the ARS poster boy. but when they heard the heterosexual thing, the no risk identified thing, the no needles, no sex with men, no blood transfusion, no trips to sub saharan africa.... they resorted to the "anxiety" theory. now if you don't believe me about this, just give dr. rosenberg a call and have him put his assistant on the phone with you and discuss this. while you're at it, ask dr. rosenberg himself if he thinks heterosexual men in this country should be worried about contracting hiv from women.

again, im sorry for the rageful email i wrote just a moment ago... of all people, i couldn't bare to think that you dr. bob, a person i whole heartedly respect, would deny that men who claim no gay sex frequently manifest anal warts - i have heard about this from just about every infectious disease specialist i ever spoke to, and i've spoken to many.

ok, that's all for now. stay well.

Response from Dr. Frascino

Hello again,

Apology accepted! After reading that last message (not posted), I was about to suggest you get help from an anger management specialist. I think I can clear things up for you . . . . at least Ill try.

Just like you, there are many, many men who are "in the denial phase" of their sexuality. Im sure you can understand why a married guy or supposedly abstinent clergyman who comes down with HIV might be reluctant to tell the truth. Sure, some of these unfortunate guys may have anal warts. So what? Im certainly not denying or refuting that. I just feel sorry that normal sexual behavior has been stigmatized to the point that people have to alter the truth when they visit their doctor (or in your case, try to enroll in a study). OK, now we both agree, right?

On to the next point. Yes, absolutely and without question, HIV has entered the heterosexual community that includes both men and women. Its much more efficient for an HIV+ male insertive partner to infect an HIV-negative receptive partner (male or female). Thats just basic science and common sense. Infected spunk (relatively large volume) up the butt or in the vagina is statistically going to transmit more infections to an HIV negative receptive partner than the reverse --infected mucosal fluids (relatively smaller volume) from the receptive partners vagina or rectal canal. finding their way into the urethra of an HIV negative man. Makes sense, right? OK, we agree again. Now, even though it is more common and more efficient for transmission to go in that direction, it is absolutely certain and conclusively documented it goes the other way as well. Thats correct: Infected female to non-infected male. There is no mystery to this at all. You can watch it happen under the microscope in tissue cell cultures. Large-scale epidemiological studies from around the world have documented this for over 20 years! If you look at the AIDS pandemic worldwide, its primarily a heterosexual epidemic. That is not only what I claim, but also it is hard scientific fact.

Now, much of your confusion seems to stem from your experience in Dr. Rosenbergs office. Remember, you were going in to get a "free RNA PCR" test as part of a study of early infection. All clinical trials have entry criteria and exclusion criteria. If they didnt, why wouldnt everyone just pop into Dr. Rosenbergs office for this very expensive "free" test? You clam it have "every symptom in the book." Already thats a red flag. You then were not honest about your exposure. Can you begin to see a problem here? These studies and the questions they ask potential participants are designed to rule out folks who feel they are "the ARS poster boy," but may not meet strict criteria for enrolling in the study. Yes, indeed, even not having (or not re-calling having a fever) could exclude you from a study. It really has nothing to do with gay, straight, warts, no warts, or anything like that. I have no reason to discuss specifics with Dr. Rosenbergs assistant, because what you are telling me makes perfect sense. I also know Dr. Rosenberg, and can assure you he understands the basic facts of HIV transmission, including "heterosexual" male-to-female and female-to-male cases.

What you heard form "every infectious disease specialist" is true and makes sense. Guys can be embarrassed about gay sexual experiences and a variety of physical findings might indicate they have indeed had gay sex. I certainly did not mean to imply this doesnt happen. Of course it does; however, that does not preclude other scientific facts, like heterosexual female-to-male transmission of HIV. OK? Are we friends again? I hope so.

Ill stay well, if you promise to, as well, OK?

Dr. Bob



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