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I know, but I don't want to know
Apr 22, 2007

Dear Dr.Bob,

This is the first and only time I am writing to you. Honestly, I don't really have a question but I just wanted to share my feelings with someone as knowledgeable and compassionate like you.

My Background: 34-year old married male. Unfortunately, I am UNCIRCUMCISED. My wife is in the last month of her pregnancy and scheduled to deliver in a month. She is HIV-negative as per her Pre Natal test.

My Roots: I am in the USA on a visa and my original country is by far the worst place to be in for an HIV infected individual. There is absolutely no HIV care available and HIvers are usually pelted with stones and ostracized from the society. Sadly, HIV is rampant there and there is absolutely no hope for the situation to improve. A recent growing trend for HIV-positive people in my country is to become suicide-bombers.

My Risks: I am ashamed to admit that during my wife's pregnancy, I have cheated on her. I chatted online and met a lady who gave me a blowjob unprotected. Thats all. Couldn't see any blood stains on my white underwear later on. Unfortunately, during the event, it was dark and I have no way of knowing if she was bleeding in her mouth. I never had any penetrative intercourse nor did I perform any oral on her. I later found out that this woman's husband is an on-probation druggy who needs to get HIV-tested regularly as part of the probation conditions.

My Symptoms: This incident happened in early December 2006. Since then, I have had two of the most specific HIV related symptoms and I still have them. They both began in late December 2006.

a) A non-itchy patch on my chest that eerily resembles Seborrheic Dermatitis. b) A lump behind my left ear that eerily feels like and resembles a swollen lymph node.

I have been to my Family Physican(s) practice 3 times regarding these symptoms and each time I got a different diagnosis from 3 different doctors: "sebaceous cyst"/ "protruding bone"/ "internal sac of a ruptured sebaceous cyst" for the ear lump. I have only shown my chest patch to one doctor and he said its eczema (atopic dermatitis not seborrheic). But from my research I know that atopic dermatitis itches but mine does not whatsoever. So I am not sure if my doctors' diagnoses are correct. I am also not sure what kind of doctor should I approach for a correct evaluation.

My Concerns: I know the general consensus is to get tested but given my non-immigrant status, I am concerned that if positive, I will immediately be deported from USA to my country where I have no intention of going back to. (I literally escaped from there in 2000). Going back there is worse than death. I would rather commit suicide than going back there. I also can't break such drastic news (if positive) to my dear wife. She will be devastated. I really wanted to enjoy the birth of our child but here I am writing to a HIV specialist on the internet. I wake up each morning, feeling the backside of my ears and checking my chest patch. I keep checking those areas 24/7.

My Future: Alas, I can't really escape HIV testing. As part of the US immigration process, I have to take an HIV test but I don't think that process will begin within the next 4-5 years. So in all fairness, I have 4-5 years to live and I want to live my life to the fullest in this time frame doing all that I can for my little family.

In summary, I know I sounded selfish, insensitive and rude. Here I am willing to escape from my problems literally leaving my wife and child alone (If I have to die). But this is all that goes on in my mind 24/7 and so I thought I will write to you. I had been to a mental health counsellor but that experience was terrible. He kept looking at his watch after 15 minutes or so and did not offer any worthwile suggestion or advice.

Maybe you can help.

regards

Response from Dr. Frascino

Hello,

HIVers in your country are "usually pelted with stones and ostracized from society." That's shocking enough, of course, but then you proceed on with more horrific details: "sadly HIV is rampant there and there is absolutely no hope for the situation to improve. A recent growing trend for HIV-positive people in my country is to become suicide bombers"!!!!! YIKES! This is new information for me and I find it credible and chilling. However, I refuse to believe there is no hope. Hope, in my view, is both transferable and transformational. Hope is the opposite of suicide, that includes suicide bombers as well as your own thoughts of taking your life if you test positive.

Let's return to your situation. Your HIV risk is minimal at best. Unprotected insertive oral sex carries a negligible risk for acquiring HIV. The estimated per-act statistical risk of acquiring HIV from an unprotected blowjob with a poz partner is 0.5 per 10,000 episodes. Your statistical-risk estimate would be even less, as we don't know the HIV status of your partner.

Your symptoms are neither worrisome for nor suggestive of HIV acute retroviral syndrome (ARS)! The swollen lymph nodes associated with HIV are generalized (multiple sites), not limited to one behind the left ear. Seborrheic dermatitis and eczema are both extremely common conditions. The vast majority of folks with either condition do not have HIV.

Next, if you are concerned about your non-immigrant status and getting an HIV test, I suggest you get a Home Access HIV test. You can order these online or purchase the kit in some pharmacies. You can then run the test anonymously.

Finally, despite your initial terrible experience with the mental health counselor, there is no doubt you need psychological or psychiatric help to cope with your guilt, suicidal ideation, irrational HIV fears and other issues. Talk to your doctor or call your local AIDS service organization for a referral to a more compassionate (and competent) therapist.

Your hopelessness on many fronts should and can be turned into a plan of action of hope in the truest sense of the word. Get tested. Get informed. Get involved. Become part of the solution to the global pandemic.

Good luck.

Dr. Bob



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