You ask some excellent and important questions. Thank you for the opportunity to address an often confusing issue. I understand the anxieties you have been experiencing and will try to help.
First, and most important with respect to your health in the immediate future, your test results prove you weren't infected, despite being the partner of an HIV infected man. The negative antibody tests 6 months after the last exposure are completely reliable. You did not need the additional test currently in the works; assuming you haven't had other exposures, for sure it will also be negative. That answers all 3 of your numbered questions.
But you seem to know that. The second issue ("here lays the concern") is much more complex -- and for the long term equally important. As you realize, in the US the rates of HIV (and most other STDs) are several times higher in African Americans than in whites or Asian Americans; Latinos and Native Americans have rates between those extremes. The rates of HIV are somewhat higher in AA women than men, but that's a relatively minor difference, and part of that is just that women tend to be diagnosed sooner.
A natural assumption to explain high HIV/STD rates might be that AA populations have more partners (more "promiscuous") than other groups. This is definitely NOT the case. The average noumber of sex partners over time is not significantly higher in blacks than whites, Asian Americans, and others. Instead, the difference in HIV rates comes mostly from different characteristics of sex partner networks, i.e. the patterns of who has sex with whom and how partners are selected. While the details are the subject of active research, at least 3 concepts appear to be important. As an apparently knowledgeable (and perhaps well educated) woman with her feet in both white and AA communities, I think these explanations will ring true for you.
1) Concurrency: Sexual partnership concurrency refers to the frequency with which new partnerships start before previous ones end, i.e. overlapping partnerships. Epidemiologic research shows that the frequency of concurrency in a population is a much more potent determinant of HIV rates than number of partners per se.
2) Sex ratio in young people: It is a sad fact of American culture that death rates and incarceration rates are much higher for young AA men than those of other races. This means a reduced number of available male partners, which tends to result in women sharing partners (with or, more often without, each others' knowledge). Epidemiologic research shows that relatively small changes in the sex ratio of available partners can have a major effect on STD/HIV risk in the population as a whole. This factor feeds back to higher rates of partnership concurrency.
3) More people at risk but secret about it: A much higher proportion of black men than whites are at high risk for HIV but deeply closeted about it -- sex with other men (often "on the down-low), past or current injection drug use, and HIV risks in prison, both sexual and drug related. The attitudes of many blacks about homsexuality makes it hard for gay or bisexual men to come out of the closet, and secrecy and embarrassment foster high HIV transmission rates plus unwillingness to be tested or to seek care.
Once these partner network factors result in high enough rates of HIV, the problem can become self-sustaining. Since several percent of some groups of AA men have HIV (about 4-5% of all black men age 40-50 are infected), even men or women who are being careful about partner selection have a higher chance of a new partner having HIV, without his or her knowledge.
And some additional factors may contribute to the problem. These include higher rates of HSV-2 (due to many of the same sexual network issues) and lower rates of circumcision among men. Biological susceptibility ialso might be part of the explanation. Persons of African descent tend to have inherited genes that protect against malaria, an obvious evolutionary advantage in Africa, where all humans descended. Some research suggests that the same genes might increase susceptibility to HIV. But all these factors are relatively minor compared with the ones above; you need not worry that you are any more likely that anyone else to catch HIV if exposed.
What to do? Most important for sexually active persons like yourself is to be aware of these risks and take common sense precautions. Care in selecting partners; consistent condom use except and until a relationship clearly will be mutually monogamous for the long term; and frequent HIV (and STD) testing are crucial. While it is often recommended that all couples should consider mutual STD/HIV testing before becoming sexually active toghether, most people don't do it. But if I were AA and out there dating, personally I would insist on it.
Sorry for such a long reply, but the issue is important and complex, and I wanted to create a reply that others with similar quesitons can be referred to. One of these days we will create an FAQ section; this will be in it. Anyway, I hope this helps. For now, you definitely have no worries about your immediate health. You can be sure you aren't infected.
Best wishes-- HHH, MD
Dr. Hunter I just want to clarify one point in this very good explanation. I plan to send it to a number of friends. Do you mean that when you become a couple, prior to having unprotected sex you would have STD/HIV testing if you were AA or do you mean that in even non-monogamus sex where an individual practices safe sex you would still recommend that in these casual situations STD/HIV testing? If it is the latter wow a lot of my friends are going to need a personal doctor living in their homes with an onsite lab..
That advice for mutual HIV/STD testing is meant for couples embarking on an ongoing relationship. I think this is obvious from the context of my comments above. Of course this is impractical for brief flings and one-time contacts -- which is where consistent condom use is crucial.
Thanks, I wanted this thread to be clear, as I will be sending it to all my golf buddies who are a bunch of players who take significant risks and I mean significant risks. Happy Holidays.
Dr. Handsfield, since we're on the issue of HIV in the African American community, I'm just curious to know: What is your opinion on how Magic Johnson acquired his infection? He claims to be straight and that he acquired his infection through an incredibly high amount of unprotected one night stands with many women. Do you find this explanation believable?
Of course it's beleivable. Why not?
That is not an invitation to an ongping discussion about it.
Wow....! Thank you VERY much for your reply! It was so informative, and it was so refreshing to hear a Dr. like yourself step up and acknowledge this delima.
I agree with your statement 100%!! AA's need to get tested with any new partners. And need to stop hiding thier "down low" status. It's literally killing our race, especially our women...
I'm more than happy and joyus to report my 12 month test was NEGATIVE.
And to re-frase my iniial post. I actually found he was poz about 6 weeks after my last exposure to him! So, it's more than possible he got infected after him and I broke up.
But overall, I completely support your message of needing to test in the AA community! It's very much indeed needed. And I, more than ever want to get out there and reach out to the youth! And I will do so!!
Thank Dr.... For all that you do and teach! Hopefully with your response statement many people will read it and pass along the message!
Great answers to complex questions
Thank you all for being open minded in explaining this subject
Thanks for returning with that follow-up comment -- and congratulations both for your negative test result and your level-headed approach to the problem.
I have one last question in regards to my especially high risk exposure and situation.
In testing for HIV, are the antibody tests reliable on everybody? Or can one still be infected and never show positive to the antibody test? If I were a patient of your's , would you do another type of test on me as well?
I just want to be 100% sure I'm okay to move forward from this...
Thank you very, very much.
No, I would do no more testing. The tests are absolutely reliable. You have no worries based on your past exposures.