Just ask?

[malamu]

Dear Doctor,

My questions are related to general thoughts rather than concerns.

1)You frequently say ask your partner or the person with whom you have had a sexual encounter (or best, before) about his or her HIV status? You state that most people, when asked directly, will not lie.  But, if the person says no, how do you know whether he or she has told the truth? I suppose this assumes that most people are as concerned about HIV as the next girl/guy, and are pretty decent folks, or at least somewhat rational?

2)I am still amazed at how different the data/statistics you present are from what the average HIV/AIDS informational source produces. In one of your posts, you note that people are mis-educated about risk, etc., and yet, when looking for information, you are confronted by some scare tactics, it seems. For example, most sites/sources say you can become infected after one exposure...and I am sure that happens, but how often? I suppose a conservative stance is the way to curb risky behavior, but then everyone who has sex or who has experienced a broken condom is at risk...and is perhaps even a risk for a nervous breakdown!


Thanks...I appreciate you and in a sad sort of way, that I am not the only frightened puppy out there...

Many thanks...

Malamu

[H. Hunter Handsfield, M.D.]

1) In many cases, you cannot know for sure that someone is telling the truth, and I have never said asking always works or that getting a negative answer prooves a partner isn't ifnected.  It just changes the odds.  That's all safe sex is, playing the odds.  The only certainty against sexual acquistion of HIV is celibacy or permanent, lifelong mutual monogamy.  But when you consider the actual prevalence of infection in various population groups plus human nature, a straightforward question with a non-evasive reply clearly improves safety in the long run.

2) I agree with your assessment of the available information.  In my opinion, it isn't only (probably not even mostly) because of overt (and intentional) biased by religious or political conservatives.  Clearly that explains some 'educational' messages, but many others probably are just naive, with the writer, or the agency the writer works for, unthinkingly saying what they been told, without real understanding.  Others may be developed by non-epidemiologists who don't really understand how to incorporate perspective instead of absolute risk statements.  Still others are driven by a legalistic, CYA perspective--i.e., to take no chance of liability if someone reads the information and gets infected.  In most cases, probably several of these dynamics are at work simultaneously.

Thanks for the thanks, and for the opportunity to comment on this.

Regards--- HHH, MD

[bigdummy]

people lie especially escorts or sex workers who want to get paid.

[malamu]

As always, Dr. HHH, thanks for your response.

I am with you with regard to human nature (though I have sometimes misjudged...haven't we all?). I figure that in the circles in which I run (not running around in circles, which I also do), most people are pretty afraid of STDs, etc...not that everyone always takes precautions...but I feel confident that  folks are often up front, especially about HIV/AIDS...it's scary for all involved.  I had a recent situation where I asked someone about his status...nothing evasive about his response...told me when and why...and he did the same with me...I imagine that for most people, it's a serious enough issue to lay on the line (but I tend to be altruistic!).

Anyway, enuff said...until the next time (hopefully for discussion and not because I need to address a fear!)

All the best...thanks for the good work...and the education.

Malamu