HIGH RISK IN THAILAND :(((

[welshaz]

Hi guys, (please take the time to read and reply)

I know you have probably heard all this before but i would very much like to hear anybody who has extensive knowledge in this area feedback!

I am a young male with a very limited sexual history. However very recently i was VERY foolish and engaged in vaginal sexual intercourse (as male) with a CSW in Thailand!! I did where a condom however it splt and i didnt realise until the end.. She seemed just as concerned as mysekf when seeing that it had split and insisted she was clea (i assume they all say the same).. I was unable to afford the PEP treatment as im out of my home country which is making me worry even more as i am now past the 72 hr mark!!..

QUESTIONS

From what i understand its 1 in 2000 if she is hiv+ and 1 in 6 Thai sex workers are HIV+

1) Mathematically when these twi figures are multiplied, what is the liklihood that i have caught HIV from her?
2) Why is it that 5 years ago the stats were 1in 500 now they are 1 in 2000?
3) How are these stats worked out and how reliable are they?

4) How fatal is it that i was unable to purchase the PEP?

5) Are Thai sex workers behind those in Africa the most likly to have HIV in the world?

6) Do you think that the way she reacted after sex was a positive sign? she noticed it had split before me and rushed to the toilet to wash, however seemd only concerned about being pregnant and NOT HIV.

7)) Is there any further advise or feedback you have for me and how do you advise i approach the next 3 months until i can get tested? as i am really really really worried sick to the stomouch!

Regards

A stupid and regretful lad

[joggen]

As both Rob and Dr. HHH indicated, it is wasted energy for you to concern yourself with HIV subtypes at this point. That is all I have left to say.

[welshaz]

Thanks a lot all for your feedback and your time!!
I will DEFINITLY get tested on the 10th December at the 3 month mark and will worry every day up until that point which i deserve for being so stupid!! however i must try not to let myself get to low.

I checked those links out, one of which was almost identical to myself! the Doctor suggested that he doesnt know a lot about differences in liklihood of transmission between subtypes and that the statistics he details are for the US and other industrialised western countries only.. I don understand that i have placed myself at a greater risk due to the area but i do hope it isnt anything as high risk as the following site details. if its a 1 in 30 chance and i am uncircumsized which doubles liklihood, that could mean a 1 in 15 chance!!! wow!! i really do hope this site is a load of rubbish.

www.thailandguru.com/hiv-aids-thailand.html

What do you think?..

I am determind after this week to calm down and lay off the browsing on the topic...

Thanks guys

[westofengland]

yeah the only way to know for sure is to get tested. You have been betting around stats like a pro so you can see that the 'chances' are in your favour but get tested anyway.
Don't waste time looking online either you will drive yourself crazy.

Strange the condom split and you didn't notice until the end. Take your own next time rather than relying on Thai ones or ones she provides!

[joggen]

This question and mistaken belief on subtype E has come up before on the Expert forum.

Neither doctor is aware of any data that suggests that the subtype makes any significant difference in transmission efficiency. There might be a small difference, but definitely not to the extent that you quote, and your risk would still be 1 in several thousand. There are other factors that influence the spread of HIV in a particular region that are much more important than the genetic makeup of the virus.

See the threads below for the doctors' views on subtype E.

http://www.medhelp.org/posts/HIV-Prevention/Subtype-E-transmission-risk/show/589119

http://www.medhelp.org/posts/HIV-Prevention/High-risk-unprotected-vaginal/show/959981

[Rob73!]

Subtypes and clades of HIV-1 and HIV-2 (HIV-2 is largely contained to a certain area of West Africa) are irelevant in this scenario. Regardless of what you think you have read all you need to concern yourself at this point in time is getting an HIV test at three months to conclusviely know your status.

Focus on what needs to be done rather than scaring yoursefl by reading and then not having the ability to interpet you you have read. Also, while the internet is a valuable source of information there is also false and misleading sites out there.

You have been given answers; briefly by me and a more in depth one by Joggen.

[welshaz]

Hi there Joggen,

Thankyou very much for taking the time out to reply so extensively and thoroughly.

It really has made me feel a more optimistic. However, i just came across this website which has panicked me quite a bit!! I was unaware that there were different 'types' of HIV and that in Thailand the most common form is hiv type E which is the most easily transmitted among hetrosexuals. they say that the liklihood of catching HIV (type E) from a Thai Prostitute is 1 in 30-50!!!!!! This has made me feel really worried!

Do you know anything about this? these different 'types' of HIV?

Thanks

[joggen]

1) Surely you are capable of multiplying two fractions together! Anyway, your estimate for HIV prevalence in Thai CSWs is outdated. Prevention campaigns have dramatically lowered it in recent years. The most current estimate is 5% (1 in 20). So, when you do the math, your risk is 1 in 40,000.

2) To my knowledge the transmission statistics have not changed in the last 5 years. 1 in 500 is the risk to a top during anal sex; perhaps you are confusing the two numbers.

3) Epidemiological studies. They are really just rough estimates and represent an average. There are many factors that can increase or decrease the chance of transmission.

4) You would not even qualify for PEP, at least under most guidelines in the United States. Your risk is too low- you do not even know that your partner had HIV. And receiving PEP can actually be fatal in itself, if you have an adverse drug reaction. It is potent stuff with substantial risks and therefore not given to just anybody.

5) See my comment in #1. Prevalence in Thai sex workers is relatively low.

6) Yes, sex workers require condom use to protect themselves, not to protect you.

7) Your anxiety is not commensurate with your risk. You are 20x more likely to die in an accident within the next year, but you aren't stressing about that, are you? The odds are dramatically in your favor.

   You can have an initial test at 6 weeks. When, as I would expect, that test is negative, it will serve as a good indication of your HIV status, as tests taken at that time are very accurate. Then get your conclusive result at 3 months. There is only a remote chance of the result changing at that time.  

[Rob73!]

Odds are for the betting shop. We just do the facts here.......

You've had unprotected sex. You should get a single HIV antibody test three months post this exposure for a conclusive result.

In the interim I would suggest a full STI screening panel to rule out any STI infections that you may have cbeen infected with.