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Staggeringly Low HIV Transmission Rates--Sex Worker Intercourse
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Staggeringly Low HIV Transmission Rates--Sex Worker Intercourse

Hello.  First, let me comment that you are doing amazing work, and that this site, and the internet in general have been unbelievably helpful in providing me with real, and much needed, information after a potential exposure to HIV and other STDs after condom failure.  I have read all of the related threads, and they answer my questions around how "at risk" I am, and I do understand it is roughly 1 in 1000, provided my partner was confirmed HIV+.  Since her status is unknnown, I believe that my "odds" are slightly better.  My question is...How is it possible that HIV transmission occurs in so few instances?  I recall a 2004 story focused on the Adult Entertainment industry where a HIV+ male engaged in intercourse with 13 females.  Of the 13, three contracted HIV.  That transmission rate is more like 23% and not <0.1%.  Any thoughts.

Naturally, 9 Days after my exposure I have a cold, and night sweats which I am attributing to ARS/HIV. Human nature I guess.
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Good question.  I have answered it before, in fact fairly recently--but can't find my own reply (too many threads under search term "HIV transmission risk"!).

The mathematics of infection transmission in a population--or "transmission dynamics"--dictate that the AVERAGE risk of transmission, such as 0.1% (1 in 1000) for a single episode of vaginal intercourse, has less influence on speed of infection spread in the population (and overall proportion of the population infected) than does the VARIABILITY in the risk of transmission.  If two populations have the same overall transmission risk, but one of those populations has just a few people with a whopping risk, HIV will spread much more rapidly in the second population than the first, despite same overall risk.

The second scenario describes the real world.  In other words, the rare persons (at any one time) who are hyper-infectious, like the HIV+ sex film actor you site, have a disproportionate overall effect on overall numbers.  But it remains true that, even if any particular person is in the same population with that actor, his/her risk for any particular exposure still averages 0.1.

Of course, another consideration is what proportion of the population has particularly high HIV viral load, STDs, and other things that influence risk--that is, what proportion are efficient transmitters?  In most of sub-Saharan Africa for the past 2 decades, the answer is "a lot".  Thus, the chance of getting HIV is much higher than 1 in 1000 for a guy having unprotected sex with an unknown partner in, say, Johannisburg than in New York.

So such "average" figures as 1 in 1000 need to be taken in context.  If a person is unlucky enough to choose a partner who happens to have just acquired the infection and has a high viral load without antibody, and also happens to have an asymptomatic genital herpes infection, the risk of transmission may be as high as 1 in 5.  By the same token, a luckier person might have a risk of only 1 in 10,000.  But the average is still the average.

It is only a matter of time until I tell someone on this forum that his/her risk is only 1 in 1000 and that person returns a week later and says they have HIV.  (It already happened once, username Mackia, but there was good reason to believe Mackia was not being truthful about his infection.)  **it happens.

Best wishes--  HHH, MD
24 Comments
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Avatar_n_tn
1 in 1000 does not mean that you get to have sex 1,000 before being infected.

The statistics given by the CDC are to be read as "relative risks."  For example, a needle stick exposure is estimated to be a 1 in 300 risk for infection.   Insertive oral is estimated as 1 in 20,000.  Insertive Vaginal...say 1 in 1,000.

The purpose of these figures, I believe, are to show relative risk.  Thus, we can conclude that you have a greater chance of contracting HIV through a needle stick injury (tained with HIV-postive blood) than you do through insertive oral.

The statitics do not give you immunity to go out and have sex with 1,000.  Although one unprotected sexual intercourse incident is relatively low-risk, keep in mind that everyone who has been infected with HIV via sex was infected by ONE specific sex act.  

Before everyone freaks out with this previous statement, I am not saying that you will be infected after one sex act.  Read this
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Avatar_n_tn
You don't know what type of sex the people in the adult industry had. It could have been anal. Also, if they had been having a lot of sex there could have been abasions that made it easier to catch. Also, it is much easier for a woman to get it from a man than the other way around. We also don't know his viral load or anything like that. That said, you can't take a general stat and apply it to a specific circumstance. There is too much unknown. The 1 in 1000 is looking at millions of potential exposures.
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Avatar_n_tn
It might be looking at potential exposure, but I think the more practical use of the stats is to help people determine their relative risks.  Thus, I know that I am more at risk of being HIV-infected if I engaged in unprotected anal sex than in insertive oral.

Like I said in my past comment, please do not take these statistics as a license to have sex with a 1,000 people unprotected thinking you only have a 1 in 1,000 chance of being infected.  The risk is per episode, and I'll say it again:  notwithstanding the statistics, everyone who has been infect with HIV via sex was infected via "one specific sexual episode."
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Avatar_n_tn
Thanks for the commencts.  I fully understand the relative risk.  In no way do I think that I have 999 more instances to engage in high risk behavior before i contract HIV.  I know the low"er" relative risk is not carte blanche to go out and act irresponsibly.  If I could take one thing back in my life, it would be that drunken night.
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Avatar_n_tn
We've all messed up here and there.  I think one of the points that the doctor and everyone here try to make is that that odds are typically OVERWHELMINGLY in your favor.
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Avatar_n_tn
Doc,

As for my "symptoms" is nine days to early to have ARS/HIV symptoms?  I had night sweats 2 nights after the exposure, and again last night.  I, coincidentally, spent several hours reading about night sweats prior to going to bed.  Factors for my cold could include that I have been operating on very little sleep for the last week, have been working hard, and am jetlagged from an international flight.  As irrational as it sounds, just looking for some reassurance.
thanks
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Avatar_n_tn
I stood in your shoes.  I had every freaking symptom in the world.  Only a blood test will tell you.

You could take an HIV PCR DNA test (Qualitative) between 10-14 days.  It's expensive, but it will give you a good indication of your HIV status.
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Avatar_n_tn
Where does one get a PCR DNA Test?  Planned Parenthood?  Can you define expensive $250?  $500?  $1000?  More?

Thanks
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Avatar_n_tn
Call 1-800-774-1534.

You are at Day #9, right?  Why don't you wait until 27/28 days to take the test.

It cost $399.  Very expensive, but I think worth it.
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Avatar_n_tn
It's a testing site.  LabCorp runs the exam.

BTW, you are FREE to choose any testing site you want.  I'm just telling you which one I chose.
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Avatar_n_tn
Thanks.  I am in a situation where I would pay 10X the $399.00 for some anxiety reduction.  Is it anonymous? How long for results?

I will likely wait will the 27/28 day mark as recommended, but also get the traditional test shortly there after.
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Avatar_n_tn
It's anonymous.  Between 3 to 7 business days.

If you can wait for the traditional test, just do so.  The purpose of the PCR is to rule out infection. Nobody is ever diagnose by PCR.  Thus, as you can expect:  there is a great possibility of a false positive (between 2% to 8%).  That's pretty high.  The test is designed to be that sensitive, so it's major drawback is the possibility of a false positive.  Just food for thought.  I was willing to take that risk.
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Avatar_n_tn
Hi,

On this forum we need to strike a balance between reassuring people and giving them relevant information that may do the opposite (possibly alarm them). I know I've posted a few times about the problem of recent infections, knowing that some men may become alarmed to know that the odds increase from 1 in 1000 to as high as 1 in 10 if the woman you sleep with was herself infected within about 1-3 weeks before sleeping with you. I have tried to couch the information delicately so people do not run wild with their fearful imaginations. But it is important to know.

I've also posted the CDC figures on new infections in the US a few times because those are relevant, even though it may alarm some men to know that 1 in 9 new HIV infections were cases where men got the virus from vaginal sex with a woman, and 1 in 3 new infections resulted from heterosexual sex in general. Considering that there are about 44,000 new infections every year and over 1 million HIV+ people in the US, 1 in 9 is NOT a small percentage.

I sympathize with Dr. H because he has to field these high-stress questions from hyperanxious men every day, and he probably wants to avoid escalations like the kind we saw, a few weeks back, with Mackia. He does an excellent job. The only concern I have with the forum (not necessarily with Dr. H) is that sometimes, in order to calm down people who are freaking out, we present some misleading points about the risk to heterosexual men.

This is not a criticism by any means, but keep in mind where Dr. H is coming from and where he gets his statistical perspective. He is valiantly leading the fight against HIV and focusing his energies on the populations where the spread is deadliest and fastest -- gay males. He is a professor at the University of Washington and sees patients at an urban STD clinic in Seattle, Washington, on the West Coast, a blue state where there is a high concentration of gay men and a thriving underground sex scene full of reckless sex and designer drugs. His experience is heavily weighted toward a climate where gay men pose the highest risk, and few straight men will be turning up positive unless they injected IV drugs. But Seattle is not necessarily typical, and HIV is spreading rapidly through places like the Southern red states where, for religious reasons, discussion about STDs is kept to a minimum, there are few vibrant gay communities, and the majority of reckless sex takes place between men and women. Straight men in many of these milieus will not seek HIV testing as openly as gay men in large cities will. Dr. H is obviously going to be most worried about the spread of HIV and other STDs among the high risk groups that he sees. But don't confuse relative and absolute risk. Straight men are being infected at a slower pace than gay men and straight women, but they are being infected.

The bottom line remains: Straight men have to use condoms with partners of uncertain status and need to limit their number of partners. If they fear they have been infected, they need to remain calm and determine their status through a blood test, not through self-diagnosis of symptoms.

J
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Avatar_n_tn
Great posting, Johnny!  And this is not to alarm anyone either, but really...do we know the rate of infection among hetero men, if few are are getting tested...or women for that matter.

For example, I have many female friends who are Caucasian, middle-class, and thus, these folks never test, because their doctors have never recommended a test.  Many of them have promiscuous sex with men all the time without condoms.  

Like Johnny said:  protect yourself. ONLY you have the resposibility to protect yourself.
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Avatar_n_tn
Anal sex is the most risky of the lot. The transmission is 1 in 4 if the giver has HIV with no protection (From what I have read). Thats why quite a few women are getting HIV.

Read this site page: It has a great detail of information that appears to be taken directly from published articles. Its even written by "liberated Christians" and is actually very well balanced. It will answer a lot of questions.

http://www.libchrist.com/std/facts.html

Its the best laymans guide I have read...(no pun intended!).
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I see you are worried about your symptoms.  One of them being night sweats.  Many people feel that if they have a bit of sweat on their  neck or in their groin, or maybe in their arm pit region, this is considered "night sweats".  Night sweats are defined as drenching sweats that soak clothes, bedsheets, and come with high fever/body temps.  And even if one did have night sweats, such as i have described, there are many other causes for them, and the same goes for the other symptoms you describe.  You must understand, this time of the year, people get sick, flu, common cold, ect.  Dont try and associate your symptoms with an STD, your gonna die worrying about it.  In the end im sure you'll be ok.  Dont get over worried about symptoms, they mean nothing.  Tests are the determining factor.  Good luck to you.
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Avatar_n_tn
24 yr old female here. is it really possible to have asymptomatic herpes ? is this unusual ?
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Avatar_n_tn
Thanks for the link.  It seems a little extreme, or not extreme enough, depending on the take.  When reading I thought it was the exact opposite of the middle school propoganda that has guided my thoughts on HIV for the last 15 years.  Essentially, our sex ed instructors basically said that evey instance of non protected sex leads to HIV.  I think that the truth is somewhere between the two, but much much closer to the article you forwarded.  

When reading I kept thinking that there was some sort of hidden agenda behind that piece.
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Avatar_n_tn
With HSV2 I have read that only 20% get lesions. And I have read that it
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239123_tn?1267651214
Read the herpes article in the link on the STD Forum home page "STD Quick Facts and Articles".

HHH, MD
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Avatar_n_tn
i also read that its deeper in the vagina that it is most infectious? cervical fluids.

so does it mean the wetness in the vagina at the vaginal opening when your penis exposed with vaginal fluids on the top of your penis(urethra) is low risk?

my exposure was i inserted the head of my penis in the vagina for 30 seconds to 1minute. i have never had unprotected sex until this one. i only inserted it just to feel the difference without a condom. but i realised i must not doing that because there is a risk of impregnating the woman so i stopped and get a condom and inserted my whole penis.

i tested 11 weeks and 3days negative.(80days to be exact). the test used was abbott axsym. the reagent used abbott hiv1/2 gO eia. whats the difference of the 3rd generation made in 1994 and the 3rd generation made recently?
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97676_tn?1340408973
The whole HSVII virus is confusing at times since there are so many resources on the net and so many conflicting arguments regarding the virus.  I have been told that almost all persons infected with the virus will have a breakout within 10-15 days after an exposure.  Most people dont know they have it because the symptoms are so mild, and not because they dont get an initial breakout. And the first symptoms will almost always appear within 15 days of a breakout.  I heard this from my GP.  I want to know how much truth there is behind his statement.
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239123_tn?1267651214
Your GP may be technically correct in one aspect; it is likely that all initial genital HSV infections and most if not all recurrences cause ulceration of the skin or mucous membranes.  But he is wrong about symptoms; those ulcerations can be truly asymptomatic, not just mild and unrecognized.  This is expecially the case for internal lesions (vaginal/cervical in women, rectal area) but it also applies to skin lesions.

HHH, MD
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Avatar_f_tn
i would like to know if a condom can still protect a female if she sits on a man's organ and has intercourse.is it possible that seminal fluid can escape down the condom and infect the woman assuming the condom is not rolled all the way to the base or shifts up during sex but still covers a large area of the organ?
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