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Questions from a Male Heterosexual "circulating (recombinant forms, CRF A/E, HIV subtypes)
Oct 17, 2008

I am a male heterosexual with multiple partners. These women vary in sexual histories, with some of their sexual histories being very limited but others being extremely extensive. Some are American and other are from various countries abroad. None are officially prostitutes but some are looking for an American boyfriend to help them improve their lives and are economically motivated to couple up.

Like most men, I hate using a condom but obviously do not want to catch HIV. I want to be safe--as much as possible- but also want to engage in activities that are considered "high risk".

Here are my questions.

1. Can I get access to a PCR test to test partners before removing the condom? It seems the PCR test for HIV is generally accurate 12 days after potential exposure and maybe as soon as 72 hours. I have heard that the test is available for $160 in California, with results available about 3 days after testing. Why is it so hard to find a place to do that test?

Admittedly, it would be expensive but many of us would be willing to spend the money before having sex without a condom with a girlfriend (and maybe even for a 1 night stand). Of course, you would have to quarantine your partner for 12 days or take some chance but it is a lot better than the Eliza test with a 6-12 week window, which makes it relatively of little assistance. Yet the PCR test is not available in most places and so you cannot use what could be an effective method of screening partners which would allow you to have sex without a condom without worrying (too much) about HIV. Is there a practical way that a person could use a PCR test to screen partners at the present time and if not, why?

2. What about Orasure, which allows you to test saliva for HIV antibodies in 20 or 30 minutes. Why is it impossible to get private access to this? My understanding is that apparently the authorities are afraid people will freak out if they get a positive result, which could be a false positive, and might kill themselves. But it would seem that the public interest in giving people some tool to reduce their risk would override this concern. Of course, the 6-12 week window makes this test of limited value, but it would still be of considerable use in many situations. Yet it is unavailable. Am I correct?

3. I have heard that there is a much higher risk in Thailand than the Philippines, to take one example, because there is more of a certain type of sub-type of HIV in Thailand. True or false?

4. If you do not know the HIV status of a girl, it does not matter if you sleep with her every night or switch girls because either way if you are not using a condom you could be exposing yourself to HIV. 15 sex acts with 1 girl of unknown status is the same risk as 15 sex acts with 15 girls of unknown risk. True or untrue?

5. Wearing a condom on the end of your penis would reduce HIV risk a real lot because the virus almost always enters the male's body through the urethra. True or false?

I think that I and many other men would like specific information that could reduce our risk without curtailing our fun too much. Much of what we are told seems so extreme that we find it demoralizing and go to the other extreme.

Thank you!

Response from Dr. Frascino

Hello Male Heterosexual,

1. PCR testing is not recommended for HIV diagnostic screening, due to the rate of false positives, other technical considerations and cost. Besides, quarantining your partner for 12 days is a bit impractical, doncha' think?

2. A reactive (positive) OraSure test is only considered to be preliminarily positive. A follow-up confirmatory test (Western Blot or equivalent test) is required for the test to be considered a true positive. It's entirely possible folks getting a positive preliminary OraSure would indeed freak out! For proof of this, just read through the archives of this forum. There are loads of testimonials that demonstrate this. OraSure tests are available at medical facilities only, however, there is one FDA-approved home HIV test: the Home Access Express Test. You can read more about this test in the archives.

3. The "subtype of HIV" you are referring to is a specific "circulating recombinant form" (CRF). (See below.)

4. False. Statistical analysis is a bit more complex than that. The 15 different gals is more risky (number of sex partners is an independent variable when considering HIV-acquisition risk). Of course, if the one gal you have commando-Rambo sex with happens to be HIV positive, then this would be the riskiest situation.

5. True the virus enters by permeating the mucous membrane that lines the urethra. However, wearing a condom only on the end of your tallywhacker is not practical, as it will most likely come off during your horizontal mattress mambo activity.

I firmly understand your comment that you hate having to use condoms. However, from very personal experience, I can assure you that you'll hate having HIV/AIDS even more!

Stay safe. Stay well. It's that simple.

Dr. Bob

$100 donation soon to be father needs closure please help Oct 12, 2008

hello doc i write you once again because lately i have been getting very conflicting info i went from woo hooing!! to boo hooing i recently asked you a question about the oraquick study in seattle so i decided to call the hiv/std hotline talked to a gentelman told him about my eposure over in vietnam 1 time unprotected vaginal sex with a csw later confirmed to be hiv+ now since i have been back i have had the following tests elisa 8,10,12,14,22 weeks they all came back neg and oraquick advance at 6 months and 7 1/2 the gentelman i spoke to after telling him about my exposure saidthat the tests used in america are not likely to detect subtype E aka crf a/e and this was horrible news now im back at square one i still have folliculitus on my face scalp and arms and been having stomach problems and mouth ulcers as well my wife is having our first child due on the 17th and i need to be sure i did not infect her or my daughter if this is true is it true? if so what kind of test do i need that will accurately pick up this strain?he also stated orauick advance hiv 1/2 will not pick it up and it only detects subtype B doc im sooo stressed out please help

Response from Dr. Frascino

Hi,

This topic gets a bit confusing, but let me try to explain it once again. The strains of HIV-1 are classified into groups: the "major" group M, the "outlier" group O and the "new" group N. These three groups most likely represent three separate introductions of Simian immunodeficiency virus (SIV) into humans. The O group appears to be restricted to west-central Africa. The N group discovered in 1998 in Cameroon is extremely rare. More than 90% of HIV-1 infections belong to group M. Within group M there are at least nine genetically distinct subtypes (or clades) named A, B, C, D, E, F, G, H, J and K. Sometimes two viruses from different subtypes combine and create a new hybrid virus. (The process is analogous to sexual reproduction and is sometimes called "viral sex!") Many of these new strains are weak and do not survive very long. However, those that can infect people are known as "circulating recombinant forms" or CRFs. The classification of HIV strains into subtypes and CRFs is obviously quite complex and the nomenclature may ultimately be changed to simplify and clarify viral typing.

One CFR is called A/E, because it is thought to have resulted form hybridization between subtype A and some other "parent" subtype E. However, no one has isolated a pure form of subtype E yet. CRF A/E is prevalent in Southeast Asia, but originated in Central Africa. According to the U.S. Centers of Disease Control and Prevention (CDC), current HIV-1 EIA (enzyme immunoassays, such as ELISA) "can accurately identify infections with nearly all non-B subtypes and many infections with group O HIV subtypes." You can check with them if you remain concerned. Your negative ELISA tests at 8, 10, 12, 14 and 22 weeks followed by your negative OraQuick Advance tests at 6 months and 7.5 months are definitive and conclusive. No additional testing is warranted. If you need additional reassurance, consult a local HIV specialist. I have absolutely no doubt he will review your history and lab results and come to the exact same conclusion.

Stop stressing and start WOO-HOOing. HIV is not your problem.

Dr. Bob



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