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He is Positive: Black Swan Theory
Sep 12, 2010

Good evening doctor. Thank you for your time. I am a 21 year old woman. I live in a small town in Mexico called Acuña. I had a kind romance ( I was falling for him) with a healthy 24 year old man who claimed to be negative before we had unprotected vaginal sex. He didnt ejaculate inside. He is a MED student and he said that all med students had to be checked (panel) constantly. I was such a stupid and trusted him, assuming he recently had a negative test result I had sex. Just because of weird symptoms I got tested. One week after sex I developed a cough and sore throat lasted 1.5 weeks and a painful palate ulcer (Ive never experience this before, similar to those we had after we eat pizza and burn ourselves).I tested negative with a MEIA at 2.25 months made by a particular lab, then an INSTI rapid test (offered here for free) at 3 months also came back negative. I was so happy and relax after this but then he told me he just was confirmed to be positive and that I was his last partner. At 4 months and 1 week after the exposure I got an Elisa made by a nonprofit organization and another free Insti test. The rapid test was negative and Two weeks later the Elisa results came back negative as well. Im trying to relax, but Im concerned because of three things: 1. Right now after 4 months and 3 weeks I have a real sore throat and diarrhea (For sure is nothing I eat). 2. The symptoms that I just comment above (one week after exposure, palate ulcer etc) are also worrisome for me. 3. My last Elisa was made in NOT an exactly prestigious lab in this small town, even though they specialize in HIV dont know if I should trust them (add to that the fact that they say I have to test for 1 year in my situation), guys from the RAPID INSTI test dont want to make another one to me, they say 3 months is enough in any case. 4. And mostly WORRISOME the fact that he is a positive Hiv man. As long as Ive read in your archives, even without ejaculation in this kind of CONFIRMED exposure testing at 6 months is warranted. It is a kind of extenuating circumstance as long as I understand. I just want to know your advice and the odds I have right know after my 4.25 tests, according to your experience. My mom just dreamed I died, my 16 year old brother suddenly wants to be a scientific in order to find the cure of HIV, and those are weird things happening around me exactly in this moment of my life!! Ive always believe in the Black Swan theory, instead of the statistics. Right now Im changing my mind, I dont know what to believe deep inside, Im just wishing to be part of the people who actually dont get the virus in my situation. It was a real risk and I feel terrible. Please do not believe you have nothing to offer because of the archives. Your personal advice will be very helpful. I send to you a huge hug and I honestly hope everything is going great and stable with your viral load. Thank you for everything. Liz

Response from Dr. Frascino

Hello Liz,

The Black Swan Theory was developed by Naissim Nicholas Taleb to explain the disproportionate role of high-impact, hard-to-predict and rare events that are beyond the realm of normal expectations in history, science, finance and technology. The chance this theory applies to your situation is beyond remote.

I agree unprotected sex does place you at risk for STDs, including HIV, particularly now that you know your partner is virally enhanced. Current guidelines suggest that for a significant HIV exposure you get an HIV-antibody test at both the three- and six-month marks. Your repeatedly negative HIV tests of various types out to 4.25 months are extremely encouraging, but not conclusive. The vast majority, but not all, of HIV-infected folks will have detectable levels of anti-HIV antibody in their blood within four to six weeks of acquiring the virus.

Your mom's dreams and your brother's career plans have nothing to do with your unprotected nookie, your lapse in judgment or black swans!

I'm sending my good-luck karma that your definitive six-month HIV test remains negative. I'm quite confident it indeed will.

Good luck.

Dr. Bob



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