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Woman to Man HIV Transmission
Dr. Handsfield,
I appreciate your willingness and patience to respond to the concerned people in this forum, despite the fact that many questions appear exceedingly redundant and/or involve risks of a trivial nature.
My question certainly isn't unique, but I was hoping for some clarification regarding my aggregate risk of having acquired HIV after repeated instances of heterosexual intercourse, a topic that I don't see posted very often. I am a 33-year old completely straight, non-drug (of any kind) abusing male with on the order of 20-30 lifetimes sexual partners. With at least half of these partners, condoms were used only sporadically; in the other half, condom usage was consistent.
The vast majority of these women were extremely low risk of having been infected, information I gleaned from knowledge of their personal histories (maybe 10 of these women were my steady girlfriends at the time). I would, for example (as I have seen you quote in a different context) put my life savings up against that chance that any of my lifetime sexual partners has injected drugs or received anal intercourse from a bisexual or drug using man. Furthermore, at least half of these women had been tested for HIV right before or when we were sexual partners.
My questions are twofold:
1) Given this information, is it irresponsible for me to not be tested for HIV? On an earlier post (8/4/2006), I believe that you quoted that "around 600-800 cases of AIDS occur each year among males whose apparent risk factor was heterosexual exposure," and with many of those there was reason to suspect their claim of unique exposure via heterosexual intercourse. Even if that number was doubled or tripled (to allow for HIV but not AIDS cases), it still seems an exceedingly rare event for a guy like me: i) to have even been exposed to HIV, and ii) to have seroconverted from only vaginal sex. You seem to (forgive me if this is not true) have hinted as much by quoting that cases of men acquiring HIV through heterosexual exposure has been virtually non-existent at your (very busy) STD clinic in Seattle.
My own ad-hoc calculations resulted in my aggregate risk being on the order of 17 in 100,000, and that was assuming that each of my partners was infected with frequency 1/2000 (higher than the actual infectivity rates for the demographic of my typical sexual partners).
2) This question I cannot imagine a health professional, especially someone of your profile and visibility answering any other way, but here goes. The usage of condoms is, to me, a non-trivial cost associated with sex. Aside from the interruption it imposes, it provides nowhere near the sensation of unprotected intercourse. Assuming that I continue to choose my partners from a low-risk pool, is it absurd for me to continue having unprotected sex? Straight guys such as myself often have a difficult time "suiting up" to protect against a risk that is very difficult to percieve.
Many many thanks.
I appreciate your willingness and patience to respond to the concerned people in this forum, despite the fact that many questions appear exceedingly redundant and/or involve risks of a trivial nature.
My question certainly isn't unique, but I was hoping for some clarification regarding my aggregate risk of having acquired HIV after repeated instances of heterosexual intercourse, a topic that I don't see posted very often. I am a 33-year old completely straight, non-drug (of any kind) abusing male with on the order of 20-30 lifetimes sexual partners. With at least half of these partners, condoms were used only sporadically; in the other half, condom usage was consistent.
The vast majority of these women were extremely low risk of having been infected, information I gleaned from knowledge of their personal histories (maybe 10 of these women were my steady girlfriends at the time). I would, for example (as I have seen you quote in a different context) put my life savings up against that chance that any of my lifetime sexual partners has injected drugs or received anal intercourse from a bisexual or drug using man. Furthermore, at least half of these women had been tested for HIV right before or when we were sexual partners.
My questions are twofold:
1) Given this information, is it irresponsible for me to not be tested for HIV? On an earlier post (8/4/2006), I believe that you quoted that "around 600-800 cases of AIDS occur each year among males whose apparent risk factor was heterosexual exposure," and with many of those there was reason to suspect their claim of unique exposure via heterosexual intercourse. Even if that number was doubled or tripled (to allow for HIV but not AIDS cases), it still seems an exceedingly rare event for a guy like me: i) to have even been exposed to HIV, and ii) to have seroconverted from only vaginal sex. You seem to (forgive me if this is not true) have hinted as much by quoting that cases of men acquiring HIV through heterosexual exposure has been virtually non-existent at your (very busy) STD clinic in Seattle.
My own ad-hoc calculations resulted in my aggregate risk being on the order of 17 in 100,000, and that was assuming that each of my partners was infected with frequency 1/2000 (higher than the actual infectivity rates for the demographic of my typical sexual partners).
2) This question I cannot imagine a health professional, especially someone of your profile and visibility answering any other way, but here goes. The usage of condoms is, to me, a non-trivial cost associated with sex. Aside from the interruption it imposes, it provides nowhere near the sensation of unprotected intercourse. Assuming that I continue to choose my partners from a low-risk pool, is it absurd for me to continue having unprotected sex? Straight guys such as myself often have a difficult time "suiting up" to protect against a risk that is very difficult to percieve.
Many many thanks.
I didn't know that lambs skin condom was no good unto someone told me . And I had sex with a woman with hiv do that mean that I have it please help me I'm going crazy now I know about lambs condom
MEDICAL PROFESSIONAL
I forgot to reply to one question: No, it isn't particularly irresponsible to not be tested for HIV. But CDC recently recommended that all Americans be tested at least once, the next time they get health care. So may as well do it once.
HHH, MD
HHH, MD
Your advice to use condoms in one-night stands and in brief relationships makes sense for many reasons, not the least of which is that for such brief encounters, any ability I have to assess my partner's risk (for HIV or other STDs) is severely compromised.
I also hear your message about being aboveboard with my partners about their risk (i.e., by having sex, protected or unprotected, with me). It has been my practice to do this, but that's always a good reminder to hear.
Thank you again for being accessible in this forum -- I still find it remarkable that for $15, I can communicate personally with someone of your experience, caliber, and compassion.
I also hear your message about being aboveboard with my partners about their risk (i.e., by having sex, protected or unprotected, with me). It has been my practice to do this, but that's always a good reminder to hear.
Thank you again for being accessible in this forum -- I still find it remarkable that for $15, I can communicate personally with someone of your experience, caliber, and compassion.
MEDICAL PROFESSIONAL
Three comments/responses. Clearly your risk for HIV is low, and you correctly cite some of the data that support that conclusion.
Second, however, no numerical data or estimates exist for STDs other than HIV, but you clearly are at risk for some of them, especially HPV, herpes, and probably chlamydia, which are common in people with conservative sex lives. Your judgment that your partners are at low risk almost certainly is not reliable for these infections.
Therefore, third, in response to your specific question: I think you should use condoms for one-night stands and brief relationships. At a minimum, you owe it to your partners to discuss it with them. You're judging their lifestyles, so help them judge yours--i.e., it should be a joint decision, not yours alone. If she says OK to no condom, you're taking the risk together, but it isn't fair or ethical to exclude your partner from the decision.
Good luck-- HHH, MD
Second, however, no numerical data or estimates exist for STDs other than HIV, but you clearly are at risk for some of them, especially HPV, herpes, and probably chlamydia, which are common in people with conservative sex lives. Your judgment that your partners are at low risk almost certainly is not reliable for these infections.
Therefore, third, in response to your specific question: I think you should use condoms for one-night stands and brief relationships. At a minimum, you owe it to your partners to discuss it with them. You're judging their lifestyles, so help them judge yours--i.e., it should be a joint decision, not yours alone. If she says OK to no condom, you're taking the risk together, but it isn't fair or ethical to exclude your partner from the decision.
Good luck-- HHH, MD
O.k. The next time I get a physical, I'll get tested for HIV. Thanks again.
Wow- you just want to play the numbers game eh? On a one time encounter the risk is low, but as you continue the risk grows-So I would say if you continue to engage in sexual activity with multiple partners you should suit up-
Also, is you are sexually active you should test for STDs, including HIV once per year-Many std's, including HIV, may not produce any symptoms- so you could be passing it on without even knowing it. Further HIV-can be managed- if detected early- do you really want the first sign an infection that shows you have an advanced infection when early detection could have extended your life?
You may be willing to accept the odds, but will the next woman you have sex with being willing too?
My opinion, and I am not a doctor, is if you want to play wear the appropriate uniform and have the physical done clearing you for action.
Also, is you are sexually active you should test for STDs, including HIV once per year-Many std's, including HIV, may not produce any symptoms- so you could be passing it on without even knowing it. Further HIV-can be managed- if detected early- do you really want the first sign an infection that shows you have an advanced infection when early detection could have extended your life?
You may be willing to accept the odds, but will the next woman you have sex with being willing too?
My opinion, and I am not a doctor, is if you want to play wear the appropriate uniform and have the physical done clearing you for action.
You are reading content posted in the HIV - Prevention Forum
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