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inheritance immune subclass deficiency and risk

Jun 23, 2008

Dear Dr. Bob,

I truly admire your work and your passion towards the topic of HIV/AIDS. I have been having this topic around me for a long long time as every now and then I fear I have infected myself with the virus. I am living in Vietnam and guess what, my name is Francisco, like your last name, but in my case it's the first name... I have a immune subclass defficiency which is inherited. As a young boy, I had to go through monthly substitution and there were a lot of side-effects... I was always very scared... I grew up with the fact that something is wrong with me and that i am sick and I have been under psychological treatment for years because of that. That also doesnt help when having sex with women, because even if I protect myself and I engage in oral sex with women, I am scared to death afterwards that I might have cought HIV... Also, living in Vietnam, even when using Durex condoms, I wonder... could the condoms be fake and not do it's job? But now to my recent encounter and something which makes me very scared. I have problems sleeping now, I feel my stomach is upset and I cant concentrate at work which is the worst, because I have a very demanding job.

I recently engaged in some kind of sexual activity, including intercourse... but it's a little more complicated. I was extremely drunk and met this girl at the bar which I then later brought back to my home... we kissed, we huged and while doing that I was grinding my penis against her vagina, she was wet, but I am not sure as to what extend that is important.. also, I felt that the tip of my penis was right where the entrance of her vagina is... meaning it wasnt really inside, but there must have been some kind of pressure; otherwise I cant explain why I felt the "entrance" ... anyways, I was very drunk and cant remember exactly, but would say that for a couple of seconds i was grinding right around her "entrance"... then she kissed my penis and I put on a condom to make love with her. However, it didnt really work, because the feeling was just half as good as when I was grinding her vagina, so I decided to take the condom off and continue grinding around her vagina....

Now, considering my inheritance disease and from the facts I have just explained to you.... how worried to I need to be? I clearly have a big psychological problem with this issue (i.e. I have had around 20 HIV tests over the past two years after similar exposures)... but now in Vietnam, where i have to guess that 90% of the girls i encounter and just come home with me are infected with HIV, it simply scares me to death... while I would assume that my exposure was "safe" and does not need HIV testing, I am still horrified and I wonder: does my immune subclass deficieny increase my risk?

Please help me, how would you assess my latest exposure and the risk of HIV regarding immune subclass deficiency?

I am desperate to get an answer, please tell me not to worry... my psychologists are getting at the limits of their power to help my problem... that makes me even more helpless.. It would be great if I could see some light --- from you!

Donation will be made, I dont promise like many others that it's on the way if it isnt, but definitely I will put a few hundred bucks into your fund when I found myself calm again and when I can think relaxed and focused.

Thanks so much! Francisco F.

Response from Dr. Frascino

Hello Francisco,

Well, our names may be similar, but they are not exactly alike. Mine is Frascino. But so many folks mistakenly say Dr. Francisco that it's easier for me to use Dr. Bob instead! Besides, I like it better.

Regarding your concerns related to immunoglobulin subclass deficiency, it's difficult for me to comment, as I have no way of knowing exactly what type and how severe your subclass deficiency is. There are many varieties of immunoglobulin subclass deficiencies as well as a range of severity within each type. You report having monthly treatments as a child. I'm assuming the treatments are no longer necessary, which would lead me to believe your problem is probably no longer severe enough to warrant replacement therapy.

As for your HIV-acquisition risk from frottage (grinding without entering), this would not be considered a significant HIV risk. I would agree with your assumption that this activity was indeed "safe." Would your subclass deficiency increase your HIV-acquisition risk? No, I would strongly doubt it would have any affect whatsoever.

I agree you certainly have psychological issues surrounding your health including specifically an irrational fear related to HIV. If your psychologists are no longer able to help you, I would suggest you seek evaluation and management from a psychiatrist. Psychiatrists are MDs (medical doctors), whereas psychologists are therapists who have not gone to medical school. Confronting and conquering your irrational HIV fears is essential for your overall mental health and future happiness. Sex is supposed to be enjoyable, not anxiety provoking.

Thank you for your pledged donation to the Robert James Frascino AIDS Foundation ( In return, I'm sending you my good-luck/good-health karma that your unwarranted fears will soon resolve and that you will indeed once again be "calm, relaxed, and focused."

Good luck, Francisco.

Dr. Bob

donation $50 please help

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