HIV-positive man sentenced to 25 years in prison for not disclosing status before unprotected oral sex and protected anal sex.

http://www.cnn.com/2012/08/02/health/criminalizing-hiv/index.html?hpt=hp_bn12

Posted this in another thread- thought is was worth its own journal page.

From my experience on HIV forums, it's clear that for a substantial portion of posters, the forums just don't work for them. For the highly anxious, words on a computer screen have limited reassurance power. The poster may receive a small reduction in anxiety, and then it comes back, so they return to the forum to try to receive that small benefit, without addressing the root of the problem, and the cycle continues...Many seem to use these forums as sort of a psychological support line, which is not their intent.

For those with a need to continue to post after being assessed as not having a risk, etc., I think the best next step for them is to seek a more personal format for advice. Visit your local Planned Parenthood or county health department and talk out your concerns with an HIV counselor there. If the anxiety is severe and interrupting their life functioning, visit your primary care physician. Or seek a professional therapist (I would recommend someone who would have knowledge about HIV, like a nurse practitioner). Just being able to talk to another human being in person is almost certain to reduce HIV Anxiety, because a substantial portion of the anxiety comes from the isolation involved.

These forums were never meant to substitute for professional advice (i.e. read the disclaimers) and too many people seem to try to use them that way, because the nature of their concerns can be embarrassing to talk about. But the professionals I've mentioned have heard it all before- there is no reason to be embarrassed about talking about sexual stuff to professionals in this day and age.

Many of the posters in the HIV Prevention Community get hung up on the 1 in 10,000 figure often cited for the risk of receptive oral sex (and the 1 in 20,000 figure for the risk of insertive oral sex). But where did these numbers come from? It seems that a lot of people seem to think that there was some kind of massive study involving thousands of people where transmission of HIV was observed in 1 in 10,000 acts of oral sex. Not even close.

The numbers come from the journal article, "Reducing the Risk of Sexual HIV Transmission" by Varghese et al. (link to the paper below):

http://www.aegis.com/files/AskDoc_refs/varghese2002-29-1.pdf

Here is a direct quote from the article that explains how the number were calculated:

"Although there are few data on the relative risks associated with fellatio (oral-penile contact), most investigators suggested that it is safer than vaginal sex. We assumed that insertive fellatio was 10 times less risky than insertive vaginal sex and that receptive felatio was 10 times less risky than receptive vaginal sex, per act."

In other words, since the risk of receptive vaginal sex is estimated at 1 in 1,000, the risk of receptive fellatio was assumed to be 10 times less risky- 1 in 10,000, and since the risk of insertive vaginal sex is estimated at 1 in 2,000, the risk of insertive fellatio was assumed to be 10 times less risky- 1 in 20,000. In Table 1 of the paper, the risks of fellatio have an asterisk next to them, with the asterisk qualifying them as "Best-guess estimate".

In science, risk assessors will use 'fudge factors' when they are required to extrapolate from a figure that is based on data to one for which no data exist. For example, in toxicity testing, toxicologists will arrive at 'safe' levels of a substance in part by extrapolating from the lowest dose that is observed to produce an adverse effect in the test animals, and apply "uncertainty factors" (which are usually also 10x) based on the characteristics of the study. The use of 10 as an uncertainty factor is convenient for scientists because it represents an order of magnitude. The risk assessors in the Varghese paper are doing something similar, except that they are just assuming that oral sex is 10x less risky than vaginal sex.

The paper came out in 2001, and since then there have been several well controlled studies that have failed to show any instances of transmission of HIV through oral sex. If you're still confused about these numbers, I encourage you to read the paper.

J.

It seems that recently people have been compelled to post reports or publications of extraordinarily rare, isolated events in an attempt to "disprove" the advice of the HIV Prevention Community experts. Recent topics include delayed seroconversion, false negatives, and oral sex. Thanks to the Internet, publications of such freak occurrences can be easily found with enough searching. What is important to understand is that when you educate yourself about HIV through "Google University", you will inevitably misinterpret the significance of what you are finding.

The reason why these incidences are published in the first place, is because they are so unusual. The very fact that these are being published as case reports means that they fall outside of the scope of accepted medical knowledge. Nobody is going to publish a case report about somebody getting infected with HIV through having unprotected anal or vaginal sex, because we know that that these are established routes of infection. Using a journalism metaphor, these reports fall into the category of "man bites dog", rather than "dog bites man."

The doctors on the expert forum frequently talk about "exceptions that prove the rule". The fact that something that happens at a frequency of 1 in several million is reported does NOT prove your belief in delayed conversion, transmission through oral sex, etc., it simply reinforces the fact that it is completely contrary to the huge body of evidence that indicates that such events do not take place with any measurable frequency. In contrast to well controlled, repeated studies that prove the exact opposite, case reports are the weakest scientific evidence available by their very nature.

When you take isolated publications out of context in view of the MILLIONS and MILLIONS of cases in which seroconversion was detected within 12 weeks, etc., and argue that such exceptions PROVE that conventional wisdom is incorrect, you are completely distorting the picture. It is the equivalent of arguing that, because there was an incident where somebody died as a result of a plane hitting their house, living above ground is not safe, and therefore we should all live below ground.

Unfortunately, when you post this stuff in the HIV Prevention Community, all you are doing is fueling people's anxiety (not to mention your own). People with HIV Anxiety almost always have the irrational belief that they are somehow the exception. Anxiety distorts people thoughts and makes them think out "what if" scenarios; when you post crap about false negatives, etc. all you are doing is feeding into people's fears. The people who come to the HIV forums need to hear the TRUTH, not the rare exception. These reports do not provide relevant information for people's concerns, and can be very harmful.

I urge you to please THINK about the significance and consequences of what you are posting before you post links to articles in the HIV Prevention Community. Finding an article through a search engine does not make you an expert on the topic. If you want to educate yourself and others about HIV, your best sources of information are the repeated comments of MH's doctors.

J.