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A story and a question from Saudi Arabia
Apr 13, 2006

Dear doctor,

This is to all my American friends. You have no idea how lucky u guys r in HIV related facilities and to have people like Dr. Bob. It is a true blessing which I dont have where I live. I am a regular reader of Dr Bob, your words kept me happy for a long time, Thank you very much sir for making me smile when I am down to the bottom with your words.

Doctor, I know you get millions of e-mails daily with the same kind questions, so I will try to keep my problem as short as possible not to waste your time.

I am working in Saudi Arabia for the past 10 years in a hospital. On May 2004 I had sex with a prostitute without protection, penil vaginal for about five minutes ( yes we do have prostitutes in Saudi, not a surprise at all). Yes agree it is total stupid move. Started getting all the symptoms in the book . had a friend in our lab so went and did a ELISA after 3 weeks discretely, because you have no idea the stigma attached to HIV in Saudi Arabia. As expected result was negative, too early.

After 3 months of possible exposure, had severe ACUTE FOLLICULAR CONJUNCTIVITIS for almost 2 months. Past two years my ongoing systems are lymph node swelling and chronic fatigue. I went crazy, then thought can I do some thing about it, nope I cant. so just live with it, even after that I had symptoms (in case if the mind is causing symptoms, I would not have lymph node swelling constantly rite).

My real problem starts here. Why I did not do a test after 3 months because my friend in lab left the job. Why I did not do the test outside, well in Saudi Arabia if you want to do a HIV test you should submit your work permit to the clinic. Every thing works around work permits here, even traffic violations. In case if the result is positive clinic will immediately notify that to Ministry of Health, positive patient will be treated like a prisoner here and deported to his country ASAP. Deportation is not a big issue, after the outcome it is a nightmare with Saudi authorities, will be interrogated like a 9/11 guy. My uncle is also working here, so in case if I am positive my whole family will know immediately and I dont want them to suffer because of my stupidity. Worked in this place for 10 yrs so dont wanna leave like a prisoner.

Some time I think, to hell with it let me do the test, last nite had the same thought and went to a clinic, first thing they asked Can I have a photo copy of ur work permit pls. had no guts to do it, came back.

I am planning to resign and leave this place peacefully Doctor. But mind is playing tricks, what if I am negative I am loosing a good job, what if I am positive I will be treated like a killer here. Big dilemma, just need your reply should I go and test submitting my work permit?

Thanks in advance

A worried Ocean, not a well

Response from Dr. Frascino

Hello Worried Ocean,

Thanks for your kind comments.

Regarding your HIV risk, the estimated per-episode risk for acquiring HIV from insertive unprotected penile-vaginal sex with a partner confirmed to be HIV positive is 5 per 10,000 exposures. Your estimated risk would be even less, as we do not know the HIV status of your Saudi-Naughty. So, just from that alone, you can see your chances of being HIV positive are miniscule.

Next, your negative three-week ELISA is encouraging, but not definitive. Your symptoms are not consistent with HIV ARS. The vast majority of swollen lymph nodes have absolutely nothing to do with HIV!

So what should you do with Saudi Arabia's draconian and discriminatory HIV policy? How about a quick trip out of the country for a vacation and quick HIV test? I've known others in your situation who have done that. Alternatively, since the odds are astronomically in your favor, you could just take your chances and get tested there. No matter what you decide, how about staring a local movement to confront and hopefully do away with Saudi Arabia's HIV policies? Change always begins with one brave person.

I'm sending you my very best good-luck/good-health karma!

Dr. Bob



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