The answer to the main question is simple: Most of those million infected people are not those who have the low risks you cite. 70-75% of them are gay men who have had many, many partners with frequent unprotected anal sex. Another 10-20% (I don't recall exact percentages) are injection drug users who have shared injection equipment. The 5-6% who claim heterosexual exposure includes many people who in fact were men who had sex with men, injection drug users, or female partners of men with other risks--but who denied their real risk behaviors, or didn't know about their partners' risks. The likelihood is that each year literally nobody in the US, or at most a small handful, acquire HIV after heterosexual exposure events involving vaginal, anal, or oral sex.
The differences are great between Sub-Saharan African populations compared to western Europe or North America in sexual behavior, stage of the HIV epidemic (the proportion of infected people with high viral loads), HIV treatment, background STD rates, circumcision, and other factors that explain the differences.
The likelihood of getting HIV from a single encounter with an 'upscale' escort in Europe is probably less than that of being hit by lightning--literally. I cannot help resolve your anxiety and paranoia. It does not follow that just growing up the the 80s is enough to explain it; 99% of your peers do not have the HIV fears that you apparently do. Presumably you have been HIV tested and know you are not infected. If not, of course you need to do that. Otherwise, all I can suggest is that you get the emotional/mental health professional care that you clearly need.
Best wishes-- HHH, MD
I think like so many on here, including myself (30 y/o), that we are a product of the many health classes, etc. of the 80's. Where health classes and the news propogated unwarranted risks related to HIV. After all, cannot we all remember in the early 80's when Peter Jennings and other news commentators were always on the national news talking about this "new" epidemic that has grown out of proportion, killing hundereds, then thousands (and today millions) of people? I do.
Yet, I think one needs to take a "realistic" approach to sex today. When any one person decides to engage in sex with someone whose status is unknown, it is suggested and needed to always protect yourself from any "real" threat, whether it be HIV or any other STI. In your situation, you were with a prositute, which very well may have been your first time, and caused issues of anxiety, conceptions or misconceptions of the inflated possibilities of HIV and other STI's. If you indeed are having sex with someone whose status is unknown, nonetheless a prostitute, it is always practical and warranted to use protection. No less, even with someone you may know well, who does not know their status, it is always a good idea to use, as what we all learned in the 80's, "condom" sense.
There is a typo in the first paragraph of my response. The last sentence is meant to read "The likelihood is that each year literally nobody in the US, or at most a small handful, acquire HIV after heterosexual exposure events involving *one-time exposures of* vaginal, anal, or oral sex."
Yes, I think we can all remember when it was predicted that HIV would soon become a wildfire epidemic in the heterosexual community in the United States. How could we not, as it was predicted on an almost nightly basis. And is still predicted.
The name of the game in HIV/AIDS advocacy lo these many years has been to personalize the risks for *everyone* in America, heterosexual and homosexual alike. It loosens the purse strings, and also helps destigmatize this particular disease. It is far easier to drum up support if everyone believes they may be affected by this disease, rather than a few marginalized groups.
I am of two minds about this approach. On the one hand, it is a terrible disease, and deserves as much support as it can get. The people who have it deserve our support and do not deserve to be outcasts or marginalized in any way. On the other hand, well, the approach isn't really fact based, is it? And most people can see that, which leads them to discount any information having to do with HIV. Because the simple fact of the matter is that you cannot treat possible heterosexual and homosexual transmission in the same way in this country, because they do not happen with anywhere near the same regularity or frequency.
So, where does that leave us?
I posted a question on the forum earlier this week about HIV and abnormal pap smears. Dr. HHH answered all of my questions, but deep down, I was wondering the same thing as you. ALL of these forums say that the risk is very very low for one time unprotected sex, but it is confusing to think that so many people have it. In Uganda, for instance, 33% of people are believed to be infected with HIV or already have AIDS. This is astounding to think that the risks in the United States are so different. I am glad that you asked your question, because I was wondering the same thing.
In regards to your questions about Africa, I am planning to volunteer in Kenya very soon, and so I researched the exact social differences that lead to increased rates of HIV there. If you are interested, they are as follows: (some of them anyway)...In many African societies, there is a belief that has been propagated over several generations that having intercourse with a virgin (purity) will cure any disease. In this way, many men who are already infected with HIV or some other STI have sex with virgins, often babies or children, and spread the disease this way. The education systems that we have here (as you mentioned about he 80s) are not extensive as they are here. Also, the place of women in society is very different in many parts of Africa. There is no condom use, there are no drug stores to run down the street and buy a condom. Even women who know that their husbands are having extramarital affairs would not dare to try to use a condom because this is grounds for divorce or beating. Many of the programs in Africa started by government health organizations are aimed at handing out condoms and educating people (especially women) about HIV, as opposed to treating the HIV. The education is focused at preventing more cases from occuring. Prostitution is very high in some parts of Africa because of extreme poverty. Men are forced to send their wives and young daughters to prostitute themselves for money so that the family can eat. There is not GOOGLE in Africa, not like there is here anyway. People cannot simply sit at a computer and ask someone like Dr. HHH or Dr. Bob from TheBody forum to answer their questions and assess their risk. Many people do not even have running water, let alone a computer or electricity to run it.
Please do not get the impression that people are savages in Africa, that they run rampid having sex and orgies even though they know the risks. People often ask why they don't just stop having sex, which reflects their ignorance concerning many points of culture in many African societies. This is not the United States. Women often cannot just say no. There are no Eckerd's or Walgreen's on the corner to buy condoms, and there certainly are not a multitude of doctors to ask online or in person. The educational systems often leave much to be desired and that is where much of the work is focused. We are still trying to get many people away from the cultural myths (like sleeping with a virgin) that propagate the spread of HIV/AIDS.
I sincerely hope that this helps. I was born in the 80s, and although I do not remember Peter Jennings talking about it, I know that on every forum, there are hundreds of people like you and me who worry. Every where that I turn, I feel like there is something about HIV, and of course it makes us paranoid. Thanks for asking such a great question and best of luck to you in the future!!!
This has been an interesting post, and this would be a question for the doctor. Isn't the reason for the high HIV numbers in sub-sahara Africa due also to malnutrition already lowering the immune system in many people? So that it takes fewer actual HIV viruses to become infected and seroconvert that compared to people in other wealthier countries? I'm sure that the background level of other diseases like STD's, tuberculosis, Malaria, etc also play into this as they also depress the immune system.
Thanks for the reply, everyone. I think this is a really good discussion, and it helps when a reputable doctor throws out statistics, because that's what it boils down to with something as potentially catastrophic as HIV.
As a famous comedian once said in the 80's, 'It's not like when venerial disease was simple anymore'. We are dealing with something that can cause a slow, painful, debilitating, socially stigmatizing death. And yet we are all human, we all have a want and desire and NEED for sex. And it comes down to HIV being in the back of everyone's head. I guess it all comes down to faith, and knowing that the cards aren't stacked against you if you are heterosexual and want to have protected sex. Based on statistics, you'd have to be very unlucky every time you had unprotected heterosexual sex. 1 in a 1000 if she is infected while having vaginal sex, and multiply that by the 1% or so chance that she even is infected, and what does that come to? A 1 in 100,000 chance for every heterosexual encounter with an unknown status. Like you said, you'd have a better chance of getting hit by lightning. I think a big misconception out there is if you have sex (vaginal) with someone who has HIV, you'll automatically become infected. There's so much fear out there it's hard to discern what is true.
Just out of curiousity, does anyone know how they come up with the 1 in 1000 chance for every encounter of vaginal sex with a partner who is infected. I'm just curious how that number came to be. Thanks again doc and everyone else.
thanks, that really opened my eyes on the actual cultural lifestyles that africa actually deals with on a more personal note rather than a society as a whole. good post.
Just to answer your question about how they come out with the 1 in 1000 stats. I've read about "blinded" studies from Africa, where they work out the level of transmission over a period of time (eg. 4 years) between stable heterosexual couples, one with HIV and one without. By blinding the questionnaires, they can work out those couples which report similarly and are therefore most likely to be telling the truth. There's one from Uganda which recorded a 25% HIV transmission rate over 4 years with on average, unprotected sex twice a week. Thus 400 unprotected exposures gives a 1 in 4 chance of transmission. Thus 1 exposure gives a 1 in 1600 chance of transmission.
Could you direct me to the website for that report? I think dstaf56 raises a good point about malnutrition, other STD's, malaria, etc. playing a role in Africa's heterosexual HIV explosion. I'm not an immunologist, but it makes sense that if the immune system is already compromised due to those factors, one would be more apt in contracting a virus that destroys the immune system.
this is some great information, thank you to all.