I am very honored to be a regular contributor on the HIV Prevention Forum here at MH.  The forum is very busy, and we often get the same inquiries over and over.  I figured that putting together a journal entry covering the most popular topics, and just laying out the facts may be helpful.  I also invite Lizzie Lou and Teak to share their thoughts, and to cover anything I may have missed.

The Myths:

First of all, sadly, there is a very overlinflated view of HIV among a large portion of the general population.  I feel this is related to a lot of the "hype" and media around the virus.  The FACT is, HIV is a very difficult virus to transmit.  Comparable to other viruses (ie influenza), it is a very WEAK and unstable virus that succombs to the environment rapidly.  It needs basically a set of near perfect circumstances to allow for infection.  Therefore, a person CANNOT get HIV from environmental surfaces, like toilet seats, manicure/barber equipment, shower stalls, drinking glasses, toothbrushes, etc etc.  The virus quickly becomes inactive when it is outside of its host (the body).  This is why infection from inanimate objects is impossible.  This is also why mutual masturbation with exposure to a partner's gential fluids is also NOT a risk in any way.  This also is the case with cuts, abrasions, cracked cuticles, etc.  Those things make no difference when it comes to risk, as the virus is outside of its host, rendering it inactive.

"Delayed Seroconversion".  We have all heard horror stories of people who test negative for YEARS, even decades, somehow being infected without having a POS HIV test.  This is a bunch of "you know what".  It doesn't happen, it is an urban myth.  If a person has transmitted the virus, they will test pos, actually quite rapidly (usually within 6 weeks of exposure).  3 months will give a person with an exposure a conclusive result.  If a person does not test POS for HIV 3 months after an exposure, then they did not contract HIV.  The ONLY exception to this is people who have literally NO immune system who may take longer to produce antibodies.  This would include an extremely small portion of the population, and would include situations such as....a person taking anti-rejection meds post an organ transplant, a person on aggressive chemotherapy, or a person with terminal, end stage cancer, again...people who have NO immunity.  Even this "delayed" seroconversion among this small population is highly debated among medical professionals.  Even people in these categories usually test POS within the 3 month window period, but as a precaution, it is recommended that people with severely compromised immune systems test to 6 months post an exposure.  NO ONE ELSE NEEDS TO TEST BEYOND 3 MONTHS.  If a person was prescribed PEP ("Post Exposure Prophylaxis), then they need to test 3 months after their LAST dose of PEP.

"Autoimmune Disorders".   This is often confused with what I discussed above.  Autoimmune disorders (ie rheumatoid arthritis) are completely different from a person with a severely compromised immune system, from chemo, etc.  The presence of an autoimmune disorder does NOT change the testing guidelines whatsoever, and it will not affect the test results.

"Blood to Blood Exposures".  We get questions about this all the time.  HIV is classified as a "blood borne pathogen", which is where a lot of this fear comes from.  It basically means that the virus has to reach the bloodstream.  In sexual exposures, it does this through the mucous membranes of the vagina or anus, which are VERY vascular, with very easy access to the vascular system.  In a needle sharing scenario, a person is injecting infected blood DIRECTLY into their bloodstream.  These situations are VERY different from a superficial skin "exposure":

Someone has a cut and was exposed to someone else's cut.  This does not pose a risk for many reasons.  First, the skin serves as an EXCELLENT barrier to the virus.  The skin is comprised of several layers, and injuries, like paper cuts, etc...begin healing IMMEDIATELY from the inside out.  Therefore, even if there IS a superficial abrasion/laceration, it will not allow the virus to penetrate deep enough to reach the bloodstream, which is what has to happen for infection.  In a VERY severe scenario, there may be a risk....for example, two people being in a car accident with large major hemorrhaging injuries where there is HUGE exposure to the other person's blood through a very significant (deep) injury.  However, again...being exposed to someone else's blood in small amounts, even with a small cut, will NOT place you at risk.

The Great ORAL Debate.  This is probably our most common question.  Unprotected oral sex.  Is it a risk?  The short answer: NO.  The long answer....

There is often a difference in the answers given by the docs in the expert forum vs us.  People have to understand that medical professionals and the CDC have a responsibility to be ULTRA conservative when discussing risks.  Therefore, there is a MINUTE "theoretical" risk assigned to oral sex.  If oral sex was TRULY a "real" risk, there would be new cases all the time of HIV being transmitted in this manner.  There absolutely is NOT.  And a "theoretical" risk is VERY different from an actual risk.  The docs have BOTH said time and time again in the expert forum that neither of them, in their combined DECADES of being specialists dealing with HIV have EVER seen a case of HIV as a result of oral sex, nor have they READ any convincing cases.  There is a physiological reason for that.  First, the virus isn't present in the saliva, making infection impossible for the receptive partner (the person receiving oral sex).  Secondly, for the person GIVING oral sex, THEIR saliva contains enzymes that inhibit the virus, should they be exposed to infected genital secretions.  Secondly, again, the virus has been exposed to the air and elements, rendering it inactive in an oral situation.  This debate will continue, but again, for anyone worrying about an oral "exposure"...think of the facts.  If it was truly a risk, there would be newly reported cases ALL the time.

HIV is classified as an STD, which means, basically, one has to have SEX to be at risk.  This leads me to the primary REAL risks of becoming infected.  They are UNPROTECTED VAGINAL OR ANAL SEX, sharing IV drug works, and from mother to infant.  Sexually, there are certainly higher risks.  Homosexual men having sex with other men still remains a higher risk, with a "bottom" anal sex partner having unprotected sex being about the highest risk factor.  HOWEVER...despite this information....HIV is still on the rise among heterosexual partners.  While it is less of a risk, it is still a risk!  And, despite the "odds" out there, it IS possible to get HIV from only ONE episode of unprotected hetero sex.  Who wants to take those kinds of chances?  Therefore, remember to protect yourself at all costs.  ONE moment of pleasure for a lifetime of dealing with a chronic illness?  Seems like one heck of an exchange!

Protection.  HIV is a 100% preventable disease.  Condoms work.  Therefore, condoms used consistently and correctly will almost guarantee a future free of HIV.  Whether a person chooses to use condoms for oral sex is a personal decision.  It certainly is adviseable to protect against other STD's, which are far more prevalent, and easier to transmit via oral sex.  When engaging in a sexual relationship, follow a few rules.  First, have open conversations with a prospective partner about their history, and flat out ask their history, whether they have been tested, etc.  ANYone who is evasive about their answer, or refuses to answer....walk away.  UNLESS you have been mutually tested with a monogamous partner...unprotected intercourse should NEVER be an option.  Men, choose condoms that are the right fit, and use only ONE condom at a time.  Some people think that 2 condoms at a time offers double protection.  To the contrary, they increase the risk of condom failure.  Use plenty of WATER based lubrication, like KY jelly, and if you question the quality of a condom, use another one.  Make sure the condoms are not expired, as that also increases the risk of condom breakage.  When condoms break, they do so CATASTROPHICALLY.  There is no doubt.  Therefore, if you use a condom, and it is WHOLE after the act, the condom worked.  Always remember to hold onto the condom on withdrawl, this will prevent slippage, which overall isn't a risk for HIV, but may expose you to other STD's.  The fact that HIV virus can penetrate an intact condom is also an urban myth.  The ONLY exception to this is lambskin condoms...they are not efficient against HIV.  Use latex or polyurethane condoms only to protect against HIV.

Medical Exposures.  You cannot and will not EVER be infected by a medical procedure, like having your blood drawn, or an IV inserted.  Medical professionals do NOT re-use needles, period.  Mainly because if they did, they would be placing themselves at risk for all kinds of infections, and they simply wouldn't do that.  Secondly, most of the needle products out there today allow for a ONE time use only, and have safeguards in place to prevent re-use.  If you are worried about this...put it out of your mind, it is irrational.

Lastly, if you feel you've had a risk, then get tested.  There is NO reason not to.  Anxiety is NO excuse not to get tested.  "Not knowing" doesn't change your test result...it just delays possible life-saving treatment, not to mention, may keep you from the likely relief of a negative result.  HIV education is vital....and in this day and age, not ONE more person should be getting infected.  It is completely avoidable.


If you have been tested, and your result is NEG at 3 months, you do NOT have HIV, despite any "symptoms" you are sure you have.  One can NEVER EVER gauge a risk by physical symptoms.  Newly infected people many times do not experience any ARS symptoms, not to mention that ARS symptoms are also VERY consistent with thousands of other common, non-HIV illnesses, infections.  If you have had a NO RISK situation, or have tested NEGATIVE at 3 months, or both...and you simply CANNOT move on, cannot convince yourself that you do not have HIV, then it is time to seek professional help for yourself.  HIV phobias/anxiety is sadly pretty common.  One can see that by reading either of the HIV forums here on MH.  Continuing to search the internet is the absolute WORST thing you could do in that situation.  That would be synonomous with a person with a severe snake phobia throwing themselves into a snake pit day after day..  Doesn't make much sense, does it?

The "HIV Prevention" forum here at MH is to help people assess a risk.  The forum has rules in place because of the nature of the high levels of anxiety related to the subject.  People get a little upset with us when we tell posters to "move on", but it is absolutely a necessity.  We HAVE to maintain order in the forum, and once we have advised a poster that they have not had a risk, or they are conclusively negative, there isn't much more we can tell them.  There are hundreds, thousands of posts to search.  We cannot provide constant emotional support, that just isn't whay the forum is there.  Of course we recognize that people coming to us are highly anxious and of course we are compassionate, but there comes a time when enough is enough.  No one else would get their ?'s answered if we allowed every person to continue on and on, asking the same question in a different way.  Therefore, it deserves mention...if YOU are one of these people, be courteous to the other posters in the forum, and please follow the rules.  Again, the search option is available to you, you can review MANY threads discussing the same topic.

Hopefully, this information will help those who are looking for some insight into HIV and its risks.

Today was my monthly trip downtown...something I force myself to do to overcome a fear of a certain driving route where I had a massive Panic Attack last year.  I did pretty well today...I had a LOT of anticipatory anxiety this morning...whew!  One rocky time was getting off a highway exit that is a one lane ramp that is actually a bridge.  Totally stopped traffic due to road work.  I had a rough few seconds...but worked thru it...so that was good.  Overall a success...but a rough day.  I came home and crashed for a while....wow.  Other than that...a good day...minus the very sore sunburn on my shoulders and back...ack

For a person who is experiencing this for the first time...it can be VERY upsetting and disturbing.  I was there before as well...the first time I went through this, I was convinced there was something wrong with my eyes.  Everything just "looked" so weird, so odd.  I almost felt like I was having out of body experiences...or was watching the world through a movie projector, instead of through my own eyes and mind.  Therefore, I am going to share with you all what *I* know about these phenomena, and hopefully reassure some of you that this is par for the anxiety course...it while irritating, maybe even maddening...it is totally harmless.

Derealization and depersonalization are two terms that are sometimes used interchangably.  Truth is, they DO vary a little bit in their presentation....but overall, they also are VERY similar.  ONE important thing to remember that I learned, and have never forgotten is that these two effects CANNOT exist without anxiety.....but that anxiety can exist without these sensations.

Derealization is basically a change, an alteration in the PERCEPTION or experience of the external world....in other words...everything LOOKS very strange, very "unreal" (movie like, in my experiences).  Depersonalization is a subjective experience of unreality of one's self.  So the difference is...rerealization relates more to the external environment...our outside world, whereas depersonalization relates more to our sense of "self"...that "we" don't feel like who we are.

Both of these sensations are caused by a shift/change in the brain.  It occurs in the area of the brain that provides us with a "real" awareness of our environment.  The part of the brain is directly linked to the "Amygdala", which is the organ in the brain responsible for causing anxiety.

Of course, the fact that while having a high level of anxiety, we are SUPER sensitized to every sensation, feeling, symptom....adds to derealization and depersonalization.  Also, you can have one without the other.  Most of MY experiences have been with derealization, and I have a friend who suffered more from depersonalization...she explained it as feeling "numb' and more like an inanimate object than a person.  The great news is..once the anxiety is addressed, these feelings start to gradually fade into the bakground...until one day you realize it is gone.

I hope this helps some people that have experienced this can have a better understanding of this.  I know I felt sooo much better after finding out that I wasn't truly going insane...and that what I was experiencing were very common panic/anxiety symptoms.

This is another post that I am copying here....it contains some tips and ideas for working through agoraphobia.  These are the very things I personally have used, and do use to beat my OWN agoraphobia.  A lot of these tips have come from therapists, fellow sufferers, and even my own personal ideas.  Hope it helps someone:



Working through agoraphobia.  The things that worked for me are similar to what barfer said in her post.  You start small and work bigger and bigger.

Example, the grocery store again...while in the midst of a very agoraphobic time, I can get there, but it's like an Olympic friggin marathon for me....and I even go as far as to plan ahead very methodically...trying to minimize my time in the store.  You all may laugh at this...b/c I kind of find it funny myself...but I'll make a 3-tiered grocery list...starting with the ABSOLUTE must-have items....like milk, diapers, etc...then the second tier will include pretty important stuff....and the third will be stuff that would be good to have, but also easily skipped if I'm having a rough go of things.

That multi-tiered list has worked well for me...b/c it keeps me focused, and if I DO end up with an issue...at least I have gotten the most important things.  Plus, it is almost a way for me to gauge my success, in a way.  There will be days where I got through not only the ENTIRE list, but also manage to pick up things that were NOT on the list whatsoever.  I felt a HUGE sense of accomplishment on those days.

That's another thing...and not to sound like a broken record b/c I say it a lot...but EVERY accomplishment is to be celebrated when trying to overcome agoraphobia.  Instead, a lot of times...we find ourselves putting onesself down.....like "OMG, how pathetic, I didn't get past the milk on the list." instead of realizing what a huge feat that was to get there, go in, get the milk and leave.  EVERY step is vital, no matter if it is one pint of milk at the store or a round-the-world trip in an air balloon.

Also, some tips for these outings.  First, the more exposure to outings, the better.  So instead of doing one bigger one once a month...try smaller ones more frequently.  When I'm in the throws of agoraphobia, I REALLY try to force myself to go out almost every day, even if it is literally to the bottom of my driveway and back.  One day I'd go to the post office, the next day, the gas station, then the grocery store, etc.  I tried to pick places that would be low maintenence, sort of "in and out" places.  Choose a less busy time of the day to go...and YOUR good time of the day...some people have great mornings, some evenings.  Try to start the outings at the "good" times and then switch it up later on.  

If there were days that my anticipatory anxiety was thru the roof, I gave myself a pass.  It's OK to do that...not every day will be a good day.  There is no sense ruminating about it....just accept that these are big challenges...and just like a physical illness...there will be days with limitations.  We are SO hard on ourselves.

Also....try to work on DEALING with a PA when it strikes....trying to sort of ride it out as long as possible...gradually increasing the time we can withstand it.  If we can fight the urge to flee, that is a huge step in beating it.  Even minimizing the reaction time from PA to fleeing is good.  If you are in the store yet again and panic hits...walk around, breathe....maybe even set your items aside and walk outside for some air.  Keep in mind that the PA will NOT hurt you...it is just emotions.  ALSO....one thing we all worry about is what other people are thinking...and you know what?  Unless you are screaming on top of your lungs or rolling around on the floor...NO ONE has a clue but US.  *Our* feelings are over sensitized...not everyone else's.  I know in theory it all sounds great...but in the middle of a PA...it IS hard not to just get the heck out NOW.  The first few times you "ride it out", you may only last 30 seconds...but each time gets easier and easier until you actually get to the point where you do NOT have to flee....when you get there...you are REALLY breaking that fleeing/agoraphobic/avoidance cycle.

Gradually build up the outings to include places slightly farther away...bascially continue to challenge yourself.  Sometimes you don't get to the challenge yourself point for quote a while.  That is OKAY.  There is no time line that needs to be followed.

My last tip for now...is TRY to be honest with as MANY people as you can....not only for support, but also so you do not have to make up excuses as to why you can't attend functions, etc.  Learn that it is okay to say "NO".  We always accept invites thinking just MAYBE we'll be okay to go that day...hoping we will...then the day gets closer and it's impossible for us.  Then you get into the guilt feelings....which only serves to make yourself feel worse.  Don't push yourself too quickly.....but don't always give in to the fear either.  If you have planned a short and simple outing and are finding the anticipatory anxiety....switch things up a bit...ask for someone to go with you....but YOU be the one to drive.  The more we make goals for ourselves and continually break them...the more WE feel defeated and keep that cycle going.  It's a vicious one for sure.

So...basically...through all of this...be kind to yourself.  It's a rough ride...it's hard to face...but it's not impossible.  Support from a group like this is priceless...where we can all share our own tips and strategies.  Pat yourself on the back EVERY time you reach a goal.  It's SO very important.