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CDC says stats dangerous

Aug 27, 2003

First of all, let me say that the experts here are real heros for helping out on a very important and distressing issue. I admire the efforts and good wills, but perhaps the experts here need to think about the advices being presented here with more care.

Dr. Frascino has always been supportive and done a wonderful job helping those "worried well" people. But I can't help but noticing that Dr. Frascino's comments tend to make HIV infection a extremely rare occurance. In one post where the poster had unprotected intercourse with a person of unknown status, Dr. Frascino replied that he is confident that the odds is in the poster's favor and the test result would turn up negative. Also in numerous replies, Dr. Frascino and other experts here have quoted stats claiming that a single act of unprotected intercourse with a known HIV positive person carries only 0.1 - 0.3 risk. These are extremely small numbers. The fact is that there are 40,000 new HIV cases in US alone, and the number is on the rise. If this estimated risk level is realistic, the number of unprotected, dangerous intercourse in US must be dangeriously and alarmingly high. If you work out the number of unprotected intercourse needed to produce 40,000 new cases each year according to the 0.3 risk level, one might conclude that all that Americans are doing each day is unprotected intercourse. Another possible factor is the realiability of condoms in preventing HIV transmission. Perhaps condoms aren't as safe as the 99.99 risk level presented here, and that's why the new cases each year is this high. It is widely accepted that condoms are highly effective, except among those, as Dr. Frascino would call, right-wing fanatics. I agree with the great Doc that a lot of misinformation about condom effectiveness is motivated by conservative agenda, and such view can't be constructive in preventing the spread of HIV. However, I also found the perhaps overly optimistic view of Dr. Frascino dangerous.

In a recent phone call to CDC AIDS hotline, I asked the representative about the 0.3 per act number. The lady over the phone immidiately told me that number is way too low to reflect the truth. She said there are numerous accounts of transmission resulted from one single act of unprotected intercourse. She told me that CDC considers such number misleading and extremely dangerous. To be fair, I need to also point out that she told me that CDC considers correct and consist condom usage extremely safe, and the number of 99.99 protection is realistic.

Dr. Frascino has done a great job reducing anxiety for those "worried well." I have all my respect for him. However, sometimes I can't help but feeling that his personal belief might have contributed to the overly optimisic advices given here and in the case of 0.3 risk esitmate, dangerous. For those worried well, if they find the 0.3 number way too low, they might start doubting the accuracy of all info presented here, including how safe protected sex really is. Such doubt might have them worried well again. For those who take that 0.3 number seriously, some might start having unprotected sex because of the belief that the odds is in their favor. Even though Dr. Frascino has made it clear that he does not recommend anyone betting against the odds, I think some would wrongly take such small number as an indication of safety. This is not an attempt to attack Dr. Frascino's credibiity as an expert, but I think a response is needed to further clarify the issue of safer sex and HIV prevention. Only an objective and accurate number can empower the readers with the knowledge needed to stay safe and well, and help stop the spread of the deadly virus. Thank you very much for your time and effort.

Response from Dr. Frascino


Thanks for your comments. I'm not sure whom you spoke to at the CDC, but the 0.1 0.2 percent risk of HIV transmission per episode of unprotected receptive vaginal exposure is a CDC- published statistic. Perhaps that's why you see me and "other experts" quoting it. It is the most "objective and accurate" estimate of risk that we have. Perhaps the confusion doesn't stem from my being "overly optimistic, but rather from your lack of understanding of statistics. Let me try to clarify things for you. Let's take an easy statistic like 1 percent. Does that mean the odds are 1 in 100, so that someone can have risky behavior 99 times before having to worry? Of course not. With 1 percent risk, certainly someone could pull the winning (or losing) ticket on the first try. And so could the next person after him. That's probably the concept the CDC hotline was trying to get across to you. HIV has been extensively studied for over 20 years. Yes, there are 40,000 new cases diagnosed each year, but that number reflects many factors that you have not taken into consideration. For instance, a positive test doesn't mean that person just became infected. HIV can also be transmitted by contaminated needles in the IV drug-using population.

Please note the experts here do indeed "think about the advice" we give. Perhaps that's why they call us experts.

One last thing: Condoms do indeed protect against HIV when used properly. I agree the right wing "virturecrat's" misinformation is dangerous and harmful. Perhaps you could write them a letter? The information presented here is scientifically sound. Theirs is anything but.

Hope that clarifies things for you.

Dr. Bob

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