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Exposure
Apr 18, 2008

Is it hard for a woman to pass the virus to her mate? I have been in a relationship with a man for about 6 months and I disclosed my status maybe in the 2nd month. Before telling him my status I made it my business to use a condom no if and or buts. After I told him he was not upset very understanding and now sometimes he forces himself on me without a condom. I know the only thing we can do at this point is to get him tested. Oh by the way I am now pregnant.

Response from Dr. Frascino

Hello,

He "forces himself" on you without a condom??? Hmm . . . sorry, but unless you are being raped, it takes two to do the unprotected horizontal mattress mambo. I do realize it's your feckless beau who is primarily interested in going commando Rambo (without protection), but you are also partially responsible, as you always have the right (obligation?) to say "no glove, no love!"

Yes, the correct thing to do is for your "Mr. In-Denial" to get HIV tested three months after your last unprotected romp. If negative, he'll also need a confirmatory test at the six-month mark to assure his negative status.

How hard is it for a woman to pass the virus to her mate? One way of looking at it is that the vast majority of men living with HIV/AIDS worldwide today (about 20,000,000) contracted the virus from heterosexual vaginal sex with an HIV-positive woman. Yes it is true it's more efficient for HIV to be transmitted from an HIV-positive man to an HIV-negative woman than vice versa, due to basic biology, but that certainly doesn't mean HIV doesn't travel in the other direction! (See below.) You can read more about this topic in the archives.

Dr. Bob

Female to Male transmission Oct 9, 2007

Hi, I have heard that it is very difficult or impossible for a male to be infected by HIV from unprotected sex with a female. What are the risks for purely heterosexual men?

Response from Dr. Frascino

Hello,

You heard it's difficult or impossible for a male to be infected by unprotected sex with an HIV-positive female?????? Hmmm . . . I'll bet that would come as quite a surprise to the over 22,000,000 men infected with HIV worldwide! Listen up! The vast, vast, vast majority of these gents contracted the virus heterosexually. Yes, that means they caught it from unprotected heterosexual sex with an HIV-positive woman!

I'm not sure where you heard the myth that it is "very difficult or impossible" for men to contract HIV from positive females, but it certainly has nothing to do with the reality of the AIDS pandemic! Unprotected sex is risky business, whether you are straight as a lawn dart of gay as a closeted GOP congressman.

Dr. Bob

Are women more easily infected by HIV than men Jan 24, 2008

Is it easier for a women to get infected sleeping with an infected male than what it is if a male sleeps with an infected female.

Response from Dr. Frascino

Hello,

Yes it is. And if you think it through, you'll probably understand why. It's simple biology. If an HIV-positive man spunks without protection into a woman's love canal, he deposits a considerable amount of baby batter right into a cavity lined with a mucous membrane. HIV can be taken up by certain cells contained in mucous membranes and transported across the membrane into the lymphatic system and bloodstream. Now think of the reverse situation: an HIV-infected woman having unprotected sex with a negative guy. The infected cervical secretions would need to find their way into the urethra (pee hole). The urethra is also lined with a mucous membrane capable of absorbing HIV. The difference in risk of infection is directly related to the quantity of infected fluids coming into contact with mucous membranes as well as other factors, such as viral strain, viral load, local trauma, etc. But all things equal, male-to-female transmission is approximately two to eight times more efficient than the reverse.

Dr. Bob

M to F transmission Nov 10, 2004

Dear Dr. Bob,

Thank you for your wonderful service. I would like to make two comments before I ask my question.

1. I appreciate your sense of humor. I believe such is theraputic and contagious as is evident by reading your forum.

2. I appreciate the cajones you display in expressing your political views and would like to add one point. Bush threatened [did he actually do it?] to withhold AIDS education funding in the SF Bay area for such education including sexual topics. I believe this is not a conservative agenda. It is hate.

Off my soap box and to the questions.

1. I am amazed at how many people still believe this is a homosexual disease. Further, many, even HIV+, believe it is impossible for a woman to trasmit the virus to a man. My ex and I used to go at it until there were clear points of entry [yes I was an idiot with an out of control libido,] regardless of what time of the month it was. So to speak. So, could you please spell out the ways in which a woman can transmit HIV to a man?

2. I understand the statistic of .1% - .2% odds of tranmission as stated here and in other forums and recognize that it is often qualified in some way. However, I believe that such statistics offer false security to heteros that are practicing unsafe sex. I have even heard medical professionals [where I receive my healthcare] refer to hetero transmission as extremely rare. To use your analogy, if a person buys a lottery ticket one week or 1000 weeks in a row, his odds of winning are the same. All that is required is the right numbers coming up or in the case of HIV transmission, the right physiological scenario [port of entry] to occur. Odds do not matter in my opinion. So, finally [whew, I am out of breath,] and respectfully I ask, is it not irresponsible to be throwing those stats around knowing that people will use it to rationalize unsafe behavior?

With respectfully and with admiration,

A fiend that learned the hard way....

Response from Dr. Frascino

Hi,

Thanks for your kind comments. Yes, the Bush Administration has cut off funding to some very effective AIDS prevention programs in the Bay Area, such as the Stop AIDS Project.

Next, are my cajones really on display??? Now I'm going to get arrested for sure.

OK, on to your questions:

1. It's really quite simple. HIV can be transmitted from human to human. After all, it's called HIV Human Immunodeficiency Virus, not GMIV Gay Male Immunodeficiency Virus. Yes, it is true that male-to-female transmission is more efficient than female-to-male transmissionapproximately 2 to 8 times more likely. This, of course, makes perfectly logical sense. If an HIV-positive dude spunks in an HIV-negative love canal, there is a large amount of infected material present that is in direct contact with mucous membranes that can absorb the virus. By comparison, if you have an HIV-positive love canal being poked and prodded by an HIV-negative unprotected one-eyed monster, the mucous membranes of the urethra (pee hole) do come in contact with the HIV-positive cervical/vaginal secretions. The urethral mucous membranes can absorb the virus; however, the amount of love canal HIV+ love juice and the amount of HIV-negative urethral mucous membranes exposed to the infectious juice are both considerable less than in the reverse situation, right?!? Hence, the up to eight-fold difference in male-to-female, compared to female-to-male, transmission.

2. Quoting true statistics is never irresponsible. The facts are the facts. The science is the science. The critical piece here is understanding what those statistics and facts mean. You are absolutely correct that each and every similar type of exposure would carry the same degree of risk. A sexual "Russian roulette" analogy might work well for understanding that each time you pull the trigger, you have the same risk of having a disastrous and very messy outcome. Is that a risk anyone, hetero or gay, wants to take, considering a thin piece of latex is all it takes to drastically alter the odds? Odds do matter. They help rationalize safer sexual behavior!

I prefer to think of you as a "friend" rather than "fiend."

Stay well!

Dr. Bob



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