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Asian HIV, c'mom Doc, please answer this time!

Nov 13, 2005

Hi Dr. Bob. I am 30 year old Canadian male on an expat assignment in Malaysia. Your site, and your personal responses are the only thing right now that make me feel like I have a fighting chance NOT to have contracted HIV. Here's my scenario, same as many others, unprotected insertive vaginal intercourse and performed cunnilingis with a female (could have been 'sex-changed' male) Thai sex-worker/prostitute in Singapore. I know you've heard it before, got way too drunk and played a game of Russian roulette that has SCARED me to DEATH. This really sucks and the stress and mental fatigue are not worth it! Unfortunatley, it is usually after someone has really messed up that they search hard for your site and read the informative responses. I have learned so much since my episode, and will try to share what I have learned with others PRIOR to them taking risks. Onto my questions. I have read that the chances of transmitting HIV as described in my incident, assuming the female was HIV pos+, are approximately 5 per 10,000 exposures. 1.Are these numbers based on HIV B status which is most common in the US? I have also heard that HIV in Asia is primarily HIV E status. 2. Is this form of HIV MUCH more easily transmitted by heterosexual encounters, specifically female to male vaginal insertive? Do you have any statistics on this form of HIV? Please answer me Dr. Bob! I NEED some help! Also, prior to this exposure, I have NO history of any STD, and 2 days after the episode I checked negative on all STD's. I am circumsized, and will donate $500 USD to your research if you answer me (and I test negative after 12 weeks) ;). Please Doc, what are my odds?! Do you think I'm ok?! Im freakin dying over here!!!

Response from Dr. Frascino


Ah yes, the Canadian Ex-Pat on assignment in Malaysia who got way too drunk and played a game of Russian roulette unprotected insertive vaginal sex and cunnilingus with a female who could have been a sex-changed male Thai sex-worker/prostitute in Singapore. It's a story we hear frequently here on the sex channel, so we'll skip the details and proceed to your questions:

1. The studies that produced the estimated risk statistics for HIV acquisition did not focus on differences between subtypes.

2. Regarding subtype E, there does appear to be some differences regarding transmissibility. I have seen some laboratory data suggesting subtype E is more tropic (attracted to) Langerhan's cells (cells that can take up HIV) found in the foreskin of men and in the cervix of women. This may explain the more rapid heterosexual transmission of the E clade viruses. There was also a cross-sectional study from Thailand a few years ago that looked at viral subtypes between men infected with subtype B versus subtype E and their sex partners. The study suggested more of the subtype E-infected men transmitted the virus to their partners than those of the men infected with subtype B.

The bottom line is that you placed yourself at risk and need to be tested at the three-month mark. The odds are still very much in your favor. Try not to freak out. You can't undo what happened yesterday. You need to focus on the reality of today and the promise of tomorrow.

Thank you for your generous donation. Your gift will provide potent life-sustaining and life-enhancing medications to those in desperate need. In addition, it will provide medications to HIV-positive pregnant women to drastically reduce the chances of mother-to-infant transmission. And finally, part of your gift will help our HIV education and awareness programs. You are helping to bridge the gap between hopelessness and hope with your generosity and compassion. On behalf of those whose lives your gift will touch, please accept my heartfelt thanks. By the way, helping others is also a gray way to rack up excellent cosmic karma with the higher powers.

I'm sending my best good-luck karma to you that your three-month test is negative.

Good luck.

Dr. Bob

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