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"reposted per your request, Dr. Bob,"
Jul 22, 2006

Dear Dr. Bob, I couldnt help but repost my question since u sympathized with me and told me that u will answer me even if it is a repeated question. I sent u as a foreigner who lives in the state who has fears about being HIV positive. I will try to make this is as short as possible(but probably will end up being detailed)sorry!!. 7 weeks ago I had 3-4 encounters with a friend of mine from my old job. The encounters included prolonged french kissing(deep kissing), touching, hugging,genital grinding with the clothes on and mutual masterbation which took place twice. I was careful not to touch myself with the hand I used to finger her and I washed my hands right away, I am also circumsized. since I am a married man for 4 years now I realized I was wrong and foolish (despite the fact that my wife is making my life hard with her bad temper and possessive personality) and that these encounters werenot mainly meant to be sexual but rather romantic , which is sthg i am missing in my marriage. I decided to stop and told my firend I cant do this anymore and I cant have sex with her. (I was a virgin till I got married). Now everything looks fine to u and u r asking urself what is this guys problem wasting my time now!! I wouldnt have worried about it, but about 2 weeks after these encounters I developed symptoms that I almost never had before. It started with diarrhea and severe upset stomach and abdominal cramps, I took OTC malox and kinda went away in a day or 2, then got so constipated,then the color of my stools was always the color of what i ate, one time black, i thought either an ulcer or from the bithmus in the malox, the next day red and brown (only drank gatorade that day) and one time kinda green (only ate salad)!, few days I started feeling tihtness in the front and side of my neck, and difficulty swallowing, felt sthg like heavy in my neck, didnt know if it was lymph nodes or muscles, it didnt feel like a normal sore throat, but anytime i swallow, i feel like there is sthg stuck there, I totally freaked out and I knew I got infected. ?I had no fever, only hot flashes,one time my temp was 99.1 though. frequent urination and very dry mouth with white tongue. I went to see a family doctor, didnt tell her about my encounters, she told me my thraot looks fine (does a sore throat have to look red on examination?), my neck lymph nodes are not swollen, and said it might be d/t a virus and gave me a 250mg z pack. after 2 days i started taking it,the thraot was still bothering me, i lost my appetite from the fear, my stomach was still killing me,also tenderness on my stomach and constipation. i had belching, and one night my pulse was so weak and i couldnt breath i thought i was gonna die. 2 consecutive nights i kinda sweated, not to the point that i had to change, but i was covered and it was kinda hot, also felt like tingling in my chest area, dont know if this was chills or what. in 2 weeks the difficulty swallowing went away, neck muscles are not as tight, abdomen got better, now only some tenderness on my uper abdominal muscles bilaterally. there was also one incident of watery darhea twice when i was on the z pack, and i remember my stomach was empty and i woke up and drank liquid antiacid, when i stopped taking it the diarhea stopped. After that i woke up one day and i felt my axiila was kind of heavy, and there was strange pain/burning sensation in my armpits, my pectoral area also around the nipples, there was no lumps though, that has been there for almost a month now, kinda got better but still there, it hurts when i poke under my axilla (about 3 fingers down from my nipple right on the ribs) and a little bit lateral to the nipples. later i felt discomfort in my right groin, no swelling still, in a few days after that (5 weeks since symptoms started) i had a swollen lymph node behind my left ear, the first day it swoll it kinda felt like my face was puffy and hot, the next day didnt feel as bad, still kind of tender to touch but kinda got smaller, it is still there though. now, 6 weeks since sympotms started i still have that lymph node swollen and tender behind my left ear, my armpits still feel painful and tender to touch mainly in the area i specified above, also on the sides of the ribs, also tenderness in my groin and feeling discomfort even when lying in bed , also tendrensss on my lat muscles and my ribs from the side, still no swelling there (in the gorin i mean).i lost 10 pounds during that time i wasnot eating at all for 2 weeks. I know now u already hate me with my long and boring list of symptoms, but i am done with sympotms now. I went to see a doctor at a public clinic since i dont have insurance,i told the nurse everything and the doctor as well, he said i was at no hiv risk and didnt need testing, i asked him what about the buring pain in my axilla, the lymph node behind my ear and the groin pain , he checked me and looked at my genitals and pressed on my inguinal area and looked in my mouth and poked my stomach, then he said he doesnt know, and he will run a CBC, CMP and syphilis just to get an idea. what worries me doctor is that that girl used to be an iv drug user bur quit 8 years ago, she had hep c from that (which she was honest about). she told me she tested -ve for hiv 1 and a half year ago, and she has only been with her partner (she is bisexual) since then, she recently broke up with her partner after a 6 year relation,and i was the first one she had an encounter with. she went to get tested and around the time she was suppose to get her STD/hiv results, she stopped talkin to me and sent me a msg saying she doesnt wanan be friends with me, and when i asked her on a msg if this is due to sthg she heard about her results, she said that it was merely a personal decision and she told me" go get ur own tests please", now i freaked out that she knew how anxious i was that she gave me sthg and how scared i am, i dont know if she took it personal and that i over reacted when i told her to get tested and tell me her results before i go get tested coz i was so scared. I also have periodontal disease, meaning i have pockets around my teeth, no bleeding, sores or inflammation though, could this be a way to get hiv, she brushed her teeth once before we kissed ! , can some secretions from her that ended up on my scrubs pants went through my thin pants and my underwear and got me infected? What could these symptoms be? i also have muscle aches, and feeling like a tingling in my upper back, i also kept getting pimples (one at a time) in different parts of my body that go away with hydrocortizone. Doctor i am so sorry that i am so boring and my question is long, please try to understand my situation, i have no one here to talk to exceot u. :-( , as for the country i was talking about, plz read this http://news.bbc.co.uk/2/hi/middle_east/3240938.stm , they cover up alot for political reasons, but i lived for 15 years beside one of those (fever hospitals) as they call it and i know what they used to do. . and when u read the article u will get an idea of the no medication, no support , no understanding thing. I hope u give me some assurance, i will get tested in the 13 week mark , plz assess my risks and let me know if i might be sick. I am sorry doctor bob that i am such a scared and boring person with the longest question posted ever, but I guess your kindness and big heart will understand why i am like that. I love u doc, take care and God bless u...

Response from Dr. Frascino

Hello,

Welcome back to the forum. I'll be brief, because you do not have HIV.

1. Your HIV risks are nonexistent: kissing, touching, hugging, genital grinding with your clothes on and mutual masturbation are not considered risks for HIV.

2. Your symptoms are not suggestive of or worrisome for HIV ARS or HIV disease. They are, however, quite classic for anxiety.

3. Regarding the Egyptian response to HIV/AIDS, I will post below the BBC news item you reference in your question for all to read. By focusing worldwide attention on and outrage at these shameful policies and practices, we can more effectively advocate for change!

4. I agree, despite the fact you have no HIV risk and are unquestionably HIV negative, a 13-week test may well be the most efficient and effective way for you to overcome your irrational fears. Ultimately, you will need to address other problems: guilt, marital problems, anxiety, etc. Leveling with your wife and getting psychological counseling may help.

One thing you don't have to worry about is HIV.

Good luck.

Dr. Bob

Egypt faces up to Aids

By Magdi Abdelhadi

BBC Arab affairs analyst

Egypt could be making its own anti-HIV drugs within a year to fight the country's small but potentially explosive HIV and Aids problem.

Aids posters in Egypt - critics say they are too vague In an exclusive interview with the BBC, Health Minister Dr Mohammad Awad Tag El-Din said the country is negotiating with international pharmaceutical companies to produce cheap antiretroviral drugs locally. At present, Aids patients in Egypt have to buy the medicines on the black market at exorbitant prices. Dr Tag El-Din also said the new health insurance system which parliament is currently considering would cover treatment for HIV and Aids patients in Egypt. An Egyptian Aids patient can pay up to $1,000 a month to buy antiretroviral drugs, a price that very few can afford.

ANTIRETROVIRAL DRUGS

Foreign drugs are generally too expensive for the average Egyptian - and Aids medicine even more so, because it is smuggled into the country.

This is because the government has not authorised legal imports. But this is about to change, as Dr Tag El-Din, himself a medical doctor, told me when I met him at his office in Cairo. He said the medicine could be manufactured in Egypt within one year. But he gave no further details. These antiretroviral drugs are vital in increasing life expectancy for Aids patients. Those who cannot afford to buy such medicines in Egypt face inevitable death.

Isolation

But lack of affordable medicine is not the only problem facing an Aids patient in Egypt.

Widespread stigma and isolation face anyone diagnosed with HIV. A patient I met at one of the few private clinics that treat Aids patients in Cairo agreed to talk to me only on condition that I did not disclose his identity.

His doctor spoke to me of the appalling state of knowledge about HIV in the country - even among physicians.

His patient was misdiagnosed several times before he was finally advised to have an HIV test.

Stigma

Mamdouh (a fictitious name) told me that, in order to avoid revealing his identity, he had to get his father to put his name to the blood test.

Mamdouh says the worst thing facing people like him is that they have no one to talk to about their ordeal. He says he knows he is not the only person with HIV in Egypt, but it does feel as if he is.

The concept of safe sex is alien to this culture, where sex per definition is safe, because it is between a husband and wife.

The stigma attached to the disease is also hampering an open and candid discussion of the threat and how best to protect oneself. International experts estimate that the number of HIV and Aids patients in Egypt is around 8,000. In a country of 70 million people, this is a very small figure compared with sub-Saharan Africa.

The challenge facing Egypt is to keep that figure low. In order to do that, it will have to fight prejudice and increase awareness.

Safe sex

The problem is that cultural attitudes constitute a major obstacle to that. A young doctor told me that Aids in Egypt is known as "the foreigners' disease".

Dr Tag El-Din: Egypt may soon make its own anti-HIV drugs The implication is that Egyptians do not have sex outside marriage, hence Egypt is immune.

But nothing could be further from the truth.

Egypt by all accounts has a vibrant sex industry and a sexually active gay community - two of the most vulnerable groups. Religious leaders in Egypt - Muslim as well as Christian - say the best way to protect oneself is to avoid sex outside marriage. This may very well be true, but only up to a point. As reality clearly shows, moral indignation alone does not stop the spread of the infection.

Dilemma

A senior Muslim cleric, Sheikh Ibrahim Abu-Steita, who advises social workers trained by the Catholic charity Caritas on how to help Aids patients, insisted he would not recommend the use of condoms.

If a young man cannot resist the temptation of illicit sex he should masturbate instead, Sheikh Abu-Steita told me. The concept of safe sex is alien to this culture, where sex by definition is considered safe, because it is between a husband and wife.

Condoms are used - to the extent that they're used at all - as contraception.

The Egyptian government faces an enormous dilemma. Promoting safe sex, for example, could be interpreted as encouraging promiscuity in this deeply religious society. But international experts have warned that, unless there's a change of attitude, there's a real possibility of an epidemic in Egypt.



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