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Apr 15, 2008

Dr. Bob,

Thank you very much for your earlier response! You have such a warm touch - bless your heart! I am still however finding it hard to put my mind to rest. The reason being that I read that there have been 16 cases of AIDS reported in medical journals with the individuals testing negative for HIV using antibody tests. I am worried sick I may be one of such people. Here is the link to the article: HELP!

How is it possible....... Apr 13, 2008

My husband of 10 yrs, and the father of my 4 children tested HIV positive in July 2007 (actually has an AIDS diagnosis: CD4 count of 88 & VL of 7940 per tests on 7/26/07). Started HAART immediately and results have been as follows: 10/12/07 - CD4 149 & VL 60 1/08/08 - CD4 128 & VL <50

He says the last sexual encounter he had outside the marriage was in 2001. The children and I have tested negative. I tested at 6weeks, 3mths, 6mths after finding out his results. Questions: 1. How is it that I have not been infected this long? How is this explained? 2. Is it possible that I am HIV positive too and that my VL is undetectable and that's why I get a negative result? 3. In 2004, I developed some purple pearly bumps (itchy pimple like) on my chest which I understand may be a symptom of HIV infection - how do I tie in all this with the fact that I am still negative?

Please help - I am scared to death.

Thanks for all you do for this forum.

Worried MOM

Response from Dr. Frascino

Hello Worried Mom,

I'm sorry to hear about your husband's recent AIDS diagnosis. I'm glad he is now on HAART and that his viral load has now been suppressed to undetectable levels. Hopefully his CD4 count will now begin to climb.

Regarding your specific questions:

1. Luckily not every HIV exposure leads to HIV transmission. In fact most HIV exposures do not result in HIV transmission! There are many factors involved in whether the virus is transmitted or not. These include both viral factors, such as viral strain and viral load, as well as host factors, such as genetics, immune integrity, local trauma, concurrent infections, etc. Certainly it is possible that a single HIV exposure could lead to HIV acquisition, but there are also many cases like yours where repeated exposures did not result in viral transmission.

2. No. Your repeatedly negative HIV tests out to six months are definitive and conclusive. You are HIV negative. HIV screening tests have nothing to do with HIV plasma viral load. Screening tests check for anti-HIV antibodies, which are circulating proteins made by the immune system in response to an HIV infection. Even if an HIV-infected person had an HIV plasma viral load that was undetectable (like your husband's), he/she would still test HIV positive on HIV-antibody tests.

3. That's an easy question! The answer is the "purple pearly bumps" have absolutely nothing to do with HIV!

Stop being scared. You dodged the HIV bullet! You should be WOO-HOOing, not worrying! I would suggest you and your husband read through the information in the archives of this forum pertaining to magnetic couples (one poz, one neg) and also the sections on HIV transmission and prevention.

Good luck to you both!

Dr. Bob

Response from Dr. Frascino


Yes, and there have been more than 16 cases of people struck dead by lightening bolts too. So if you're not worrying more about errant lightening bolts than HIV, you are worrying excessively and irrationally about extremely rare HIV situations (which had extenuating circumstances)! If you cannot "put your mind to rest," despite overwhelming and irrefutable evidence that you are HIV negative, you need to seek psychological counseling to help you accept the wonderful news you are indeed HIV negative. HIV is not your problem; fear is. I'll repost something from the archives that discusses real risk versus unrealistc fears.

Dr. Bob

So How Many Got Infected Via Insertive Oral Apr 5, 2007

Dr Bob,

Like reading the bible, I come to your forum every morning for the past months and have read most of your archives until I feel tired.

You are a saviour, you have helped thousands of people (those who are positive thinking)but many are still worried to hell (the negative thinking ones), and sadly I am one of them.

However, I found one simple question and answer which slightly lifted my mood and I reproduced it here below.

"Mutual masturbation... Nov 6, 2006

Docctor Bob:

In all your years working in your office helping HIV people, have you ever heard of HIV resulting from mutual masturbation?

Just curious... keep up the awesome work.

Response from Dr. Frascino


The short answer is no. The long answer is nope. "

But why am I still so worried as Mutual Masterbation is all I practise?

The reason is once I was in inspecting my Mr Happy, turning over the fore skin, when the guy next to me suddenly dived and put it in his mouth. It lasted a few seconds but because I have exposed my mucous membrane, I am worried sick and like everyone else, every change in my body is a symtom. I just cannot bring myself to go for a test because I fear it will surely be positive. I rather live with a hope that I am not infected.

In your replies, you always say insertive oral is "VERY LOW OR NEGLIGEBLE risk", "ALMOST or Virtually non- existent".

So here is my question which I hope will help me and others.

In all your years working in your office helping HIV people, have you ever heard of (documented) HIV resulting from Insertive Oral?

I am afraid you would not be able to give the same answer as there is a Documented 0.5 per 10,000.

Lastly, I wish to reiterate that you have done a wonderful job. I only wish you are as omnipotent as God being able to answer every question you received, but I know that is impossible.

Sometimes, you may receive nasty letters but I guess they are from desparate people who did not get their answer. They like me, are like frightened lambs in a pen waiting to be slaughtered.

Please dont be affected by these letters, and carry on your noble work.


Response from Dr. Frascino

"Frightened lambs in a pen waiting to be slaughtered????" Don't you think that's maybe the tiniest bit overdramatic as it relates to the risk of a two-second blowjob?

Let's try to put some perspective on this situation. First, the 0.5-per-10,000 statistic is only a statistical estimate of potential risk and it relates to insertive oral sex with a partner confirmed to be HIV positive. It is not a "documented risk." Often, our worries are way out of proportion to actual risk. For instance, most people worry more about being murdered than committing suicide, yet twice as many Americans commit suicide each year as are murdered! Similarly, folks worry more about being struck dead by lightening bolts than falling out of bed, yet 10 times as many Americans die from falling out of bed as from lightning strikes. Your risk of contracting HIV from two seconds of oral insertive sex with a partner of unknown HIV status is, in reality, far, far, far less than being hit by lightening. So if we put all this together, if you are not absolutely positively petrified of falling to your death from your Sealy Posturepedic each and every time you crawl into bed, then your fears of HIV from this incident are way overblown (so to speak) and completely irrational!

Have I ever heard of HIV resulting form insertive oral sex? Sure, I've heard about it. But can I document it? No. What we do have is 26 years of epidemiological experience to support the fact that oral insertive sex carries a minimal to negligible risk. (See post from the archives below.)

Your fears of HIV testing are unwarranted and reveal a considerable degree of anxiety. I suggest you seek the help of a counselor to help you confront your unwarranted fears and treat your underlying anxiety. Your statements that you would rather live with a hope that (you) are not infected," while simultaneously feeling "like a frightened lamb in a pen waiting to be slaughtered" don't really add up to a rational way to approach the rest of your life.

My advice is that you get tested and stop all this nonsense before you fall out of bed and break your neck or get zapped by a lightening bolt, OK?

Your WOO-HOO is waiting for you.

Dr. Bob

Hello Doctor Bob, Can you PLEASE help a fellow Italian out? My boyfriend dumped me, I will try to make a donation soon. Apr 3, 2007

Dear Doctor Bob,

I am sitting hear with tears streaming down my face. I am very scared that I may be infected. I was in a great relationship, well one I thought was great. He dumped me 6 months ago for a 20 year old twink. I have always been careful sexually, ALWAYS condoms for anal sex even in this LTR. Well, being down, I have had a few sexual partners in the past months, mainly out of being sad and lonely. I have performed oral sex on a number of guys (7) not with ejaculation and have had anal sex always protected, with all of them. I also rimmed them. I am so exhausted, have stopped working out, feel like I am in a total brain fog, can barely function at work, have had lymph nodes on my neck that are the size of a pea (just one) and on and on. I am scared doctor. As I have found out two of the guys I had sex with (on more than one occasion) are HIV positive. My questions are:

1. Since I have always had protected anal sex, as a top, should I be ok here? I put the condom on before going in, used a Trogan, and pulled out and every time checked the condom with water to see if it broke. My only concern is if I took the condom off the right way.

2. I know oral sex is minimal risk, but what if these guys that were positive had a high viral load? That would increase a minimal risk woudn't it? I don't allow guys to cum in my mouth, but I DID taste precum. Is my risk still minimal?

3. Rimming is supposed to be very low risk, but how low is low?

4. Do you think my chance are good that I am negative?

I have read so many stories online about guys getting HIV from oral sex, or that have always played safe and now they have the virus and don't know how. This scares me.

I am going to get the courage to get tested, but I would like to see a doctor first for this anxiety and depression treated. So I can cope better. I think about HIV 24 hours a day, I wake up feeling like I never slept. My body know the story.

I will try and make a donation when I get my taxes back - hopefully by then I will be smiling more and the old great person I was.

Anything you can give me: inspiration, calming words, or your amazing advice would so appreciated.

Sadly, and still in tears.

Josh in Southern Calif.

Response from Dr. Frascino

Hi Josh in Southern Calif.,

An Italian named Josh??? Hmmm . . . exactly which part of Italy do you hail from, Josh? Or perhaps Josh is just short for Josheroni???

Sorry to hear you got dumped and are now down in the dumps (so to speak). I'm fairly certain you'll soon be rebounding and realizing that who you thought was Mr. Right really wasn't. Chances are ultimately he'll be singing "The One that Got Away Blues" when his infatuation with the twink fades. Remember Twinkies, Hostess or otherwise, may taste good initially, but in reality they're just junk food and not very satisfying for a regular or healthy diet! Right?!?!

So on to your questions:

1. The key here is "protected." If the latex condom was used properly and did not fail, your HIV risk would be essentially nonexistent. Taking condoms off is not a problem!

2. Yes, this risk remains minimal at best.

3. Twenty-six years into the epidemic there are still no documented cases of HIV transmission from rimming or getting rimmed. That's how low!

4. Yes, I'd rate your chances as excellent!

5. "Online stories" are just that "online stories!" I've read "online stories" that claim condoms have holes in them that allow HIV to swim right through and that George "Dubya" is an excellent president with a brilliant mind. Obviously those things aren't true either. There was a recent study of 198 gay or bisexual men in San Francisco who said they only had oral sex for a year. Thirty-nine of those performed oral sex on HIV-positive partners. Thirty-five of those did not use a condom and 16 reported swallowing. No one became HIV positive during the study. Because the number of participants in the study is relatively small, we cannot say absolutely that oral sex carries zero risk, but the study certainly supports our current understanding that the risk is extremely small at best.

So Josheroni, it's time to dry those tears, realize your HIV risk is essentially negligible and get tested. Your negative result will help chase those blues away with a resounding WOO-HOO! You also need to get back to the gym to clear that brain fog and improve your sleep cycle.

Yes, see your doctor and/or a counselor to help with your anxiety and depression if needed. But most importantly, dry those crocodile tears and fix that frowny-face. It's time for the Italian Stallion to reemerge!

Good luck!

Dr. Bob

Use condoms/Get tested
CD4 %

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