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"Pay it Forward !!!!"
Jan 31, 2005

Doc, Thank you for being a true hero! There aren't many out there. You have certainly left a positive imprint on this world (no pun intended). Sorry to be so sugary but I sincerely mean it. Now to my question- The CDC posted new guidlines for pep on 1/20/05 as you know. I have read those guidlines and there is a chart which lists the risk per exposure for various types of expos. It assumes contact with an hiv infected person and lists insertive oral as 0.5/10,000 or 1 in 20,000 if my math is correct. I know, from reading your site, that this type of activity carries only a theroretical chance of transmission and that there are no known cases documented. If this is true then how can the risk be calculated as 0.5/10,000??? Is there a cases(s) that we should know about?? I tried to research the footnoted document to find out how they arrived at this figure but could not. I find this a very astounding finding considering that there are zillions of oral contacts especially with sex workers where oral is "really" the "only" exposure. Would precum "moving" out of the penis help keep any fluid like blood stained saliva from entering the urethra?/ could this be a reason that in the absence of open sores even insertive vaginal seems to be an inefficient way to acquire hiv? That you in advance for considering my post I have sent my donation as it is more than deserved. SUGGESTION TO ALL who read this post KINDLY DONATE 1/10 of all the money you spend on sex to the foundation and PAY IT FORWARD>

Doc, You don't have to post - just wanted you to know I went on the foundation web sit and donated $59.99 by credit card on 1/29/05- the price I paid for my home access test today (exposure - insertive oral sex worker- i have symptoms- let's pray "they're inconsistant with hiv"). I suggest Everyone donates a percentage of what they pay for the gazillion tests or what they pay for sex to your wonderful foundation. Let's call it tithing. May I please get your good Karma? Be well- you're in my prayers!!!!!

Response from Dr. Frascino

Hi "Pay It Forward,"

Thank you for your kind comments.

Regarding the "risk per exposure" statistics, please realize these are estimates only. Consequently, an estimated HIV infection risk of 1 in 20,000 would be extremely low, right? And that's exactly what many of us have been saying for several years. The statistical estimates were based on large-scale epidemiological studies. As I have pointed out before, conclusively documenting that someone was definitely and exclusively infected by insertive oral sex and had absolutely no other potential risk behaviors is very difficult to do. You also point out there are "zillions" of oral sex encounters (and that's just during one Saturday night in San Francisco); consequently, if oral sex were an efficient means of HIV transmission, we would expect HIV infection rates to be much higher than they currently are. Explaining the detailed biological facts and statistical science behind the risk estimates is beyond the scope of this forum. Therefore, suffice it to say that extremely rare things happen extremely rarely, and that's why we call them extremely rare things. OK?

Thank you for your donation and suggestion to others! If even a fraction of the money wasted on unnecessary HIV tests was actually used to combat the pandemic, we could indeed save lives, give hope and, in essence, work miracles.

Yes, I'll be delighted to send you my very best cosmic karma that your test will be negative. Certainly the statistical odds are all in your favor.

Good luck.

Dr. Bob



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