Do I Expose Her Or Let Sleeping Dogs Lie (hiv)

[jdinasia]

See Sheryl! We can agree in principal about many things! (Actually I agree with you more than 90% of the time ... I just tend to doubt statistics that are quoted but not cited!)

(I expect the HIV percentage in female sex workers is far higher than your numbers reflect --- I'll see what is available in stats later --- at least in the sex-workers that service farang)

[Jingthing]

While I agree that HIV positive sex workers are very common and nobody should be shocked by that, in fact the smart thing is just to assume everyone is potentially positive (including yourself) the x factor I wonder about is how common it is for HIV positive people to for whatever sad motivations DELIBERATELY try to infect their partners. In that case, that is a kind of attempted murder, but in a country like Thailand, you won't have a case.

Edited November 21, 2008 by Jingthing

[Sheryl]

This may not have been (I suspect most likely was not) her motivation. Rather, she may have been afraid to tell him her status and just "hoped for the best". Not a mature or responsible way of dealing with the situation but the head-in-the-sand denial approach isn't unusual, especially among people trapped in a situation where they don't perceive a viable solution.

She may also have been in denial herself, unable to face the reality of her HIV status. That too is not unusual.

Hate to generalize but I do find that denial and hoping a problem will just go away, or that a likely bad consequence will magically not come to pass, does seem to be especially common in this culture. The not so attractive flip side of "mai ben rai".

[Jingthing]

I didn't intend to imply that the OP was dealing with a person attempting an intentional infection. I just bring it up as a caveat to the personal responsibility credo that I advocate. If someone is really out to get you (or just back at the cruel world in general and you are at the wrong bed at the wrong time), short of celibacy, there is only so much you can do.

Edited November 21, 2008 by Jingthing

[mommysboy]

See Sheryl! We can agree in principal about many things! (Actually I agree with you more than 90% of the time ... I just tend to doubt statistics that are quoted but not cited!)

(I expect the HIV percentage in female sex workers is far higher than your numbers reflect --- I'll see what is available in stats later --- at least in the sex-workers that service farang)

I agree with Sheryl's excellent posting. I also doubt the official figures are accurate but unlike jdinasia I think it is an overestimate. I don't know though, but 1 in 15 sounds very high. Just my opinion.

It's so difficult to judge this subject. The thing is we bring a western perspective and assume that's how a Thai should think, moreover a Thai with probably a rudimentary education and poor life experiences, and possibly a poor future outlook too.

First and last, we are left with taking responsibility to ensure our own safety, and I guess all sexually acquired hiv infection starts with neglect of this responsibility. I'm not preaching after all I made the same 'mistake'.

Sorry to be a bore, but something still nags at me about the science of this disease and I still maintain female to male transmission is unusual, I mean myself, OP, and another contributor have come forward with the same story and thankfully none of us were infected. I chose the hue to reflect the fact that this a grey area in my humble opinion

[jdinasia]

There is data out there and with the high percentage (relative) of HIV infections in Thailand it is certain that the numbers are higher at least in some communities

Thailandguru had this on HIV and it was updated in 2006 (the most recent I could find online) Note to the mods, I am discussing HIV more than I am discussing prostitution but this topic is certainly about both

Some studies estimate that the percentage of prostitutes infected with HIV is approximately 10% in the ex-pat areas of Bangkok. However, these studies have uncertainties due to the biases of their samplings.

A Chulalongkorn study found that "disguised prostitutes", that is, ladies who freelance in shopping malls and the like posing as non-prostitutes but who extract presents (fashion items, mobile phones, etc.) and spending money from quasi-boyfriends in an extrinsically motivated relationship, had HIV infection rates of around 30%. The Chulalongkorn study speculated that the higher rates may be due to lower condom use in these relationships. However, the Chulalongkorn study notes that this was an unexpected finding and based on a statistically small and arguably insignificant sampling.

The best protection against HIV, besides abstinence, is condom use. Condoms are a highly effective protection against HIV.

The most often recommended condom is Durex, especially those with the N-11 spermicidal lubricant which may also help protect against some sexually transmitted diseases.

The numbers I have seen online so far suggest that HIV rates in farang oriented ... ummm... entertainers ... is far lower than in Thai oriented places upcountry. I so far have found nothing that appears to have measured HIV rates in places like those owned by Chuwit !

[Dakhar]

This woman must be pure "Smoking Hot" to have clients around the world.... I imagine it is her clients that are going to pay for her travel expenses...

To the OP:

The fear you must have gone through, the anger the amazement when you heard this woman was HIV positive by her doctor... and yet you stood by her....

This lady tried to kill you many times over!

Now regarding should you "expose" her.... My thoughts are this woman would have you knocked off in a heart beat if she so wanted. So if I were you, I would be in another country before I started contacting folks regarding her status.

Run Forest Run

[Dakhar]

There is data out there and with the high percentage (relative) of HIV infections in Thailand it is certain that the numbers are higher at least in some communities

Thailandguru had this on HIV and it was updated in 2006 (the most recent I could find online) Note to the mods, I am discussing HIV more than I am discussing prostitution but this topic is certainly about both

Some studies estimate that the percentage of prostitutes infected with HIV is approximately 10% in the ex-pat areas of Bangkok. However, these studies have uncertainties due to the biases of their samplings.

A Chulalongkorn study found that "disguised prostitutes", that is, ladies who freelance in shopping malls and the like posing as non-prostitutes but who extract presents (fashion items, mobile phones, etc.) and spending money from quasi-boyfriends in an extrinsically motivated relationship, had HIV infection rates of around 30%. The Chulalongkorn study speculated that the higher rates may be due to lower condom use in these relationships. However, the Chulalongkorn study notes that this was an unexpected finding and based on a statistically small and arguably insignificant sampling.

The best protection against HIV, besides abstinence, is condom use. Condoms are a highly effective protection against HIV.

The most often recommended condom is Durex, especially those with the N-11 spermicidal lubricant which may also help protect against some sexually transmitted diseases.

The numbers I have seen online so far suggest that HIV rates in farang oriented ... ummm... entertainers ... is far lower than in Thai oriented places upcountry. I so far have found nothing that appears to have measured HIV rates in places like those owned by Chuwit !

Regarding the use of spermacides: The research I have read is the opposite. The initial thought was that Spermacides are a good form of protection from HIV, but that was in a petry dish. The reality is that spermacides iriitate the skin, adding more risk in the long run. Google it and you will find more information regarding this subject. http://www.virusmyth.com/aids/news/reutnonox.htm

As for me spermicides irritate me big time, like battery acid or something.

No glove no love

[SnakeBite]

By you not speaking out, you are as guilty as her if anyone else contracts this disease from her. She is openly stating that she will continue to ply her trade and not care who she gives this disease to. Scary

[Sheryl]

She is openly stating that she will continue to ply her trade and not care who she gives this disease to. Scary

Yes. But not at all unusual.

Keep in mind that an HIV+ prostitute is not exactly well positioned to establish a new means of livelihood. Änd may have been abandoned by her family if they know of her HIV status.

And many are quite bitter towards male clients; after all, they infected her in the first place (and often some have done other things as well to engender anger and resentment.)

I'm not supporting this viewpoint at all, but I can understand it: "They didn't care about protecting me; why should I care äbout their risk?". "Niothing's stopping them from using protection" etc etc

I have conducted inteviews with HIV+ sex workers and the above are (paraphrades) things that they have said.

Of course, aside the fact that "2 wrongs don't make a right", one of the important things such attitudes miss is that the risk is not only to the male client but also to his wife or girlfriend, future children, and other as yet uninfected sex workers. This is usually the most effective argument one can use in trying to reason with such women,

But you are still left with their bottom line (again, paraphrasing): "I have no education, no skills or training, my health is poor and my family has abandoned me (or still needs me to support them); this work is all I know; I have to continue it to support myself"and "the men know how to protect themselves, if they refuse to do so it's their decision".

Believe me the last thing that is a priority in the mind of a sex worker who learns she has become HIV infected as a result of her work is the welfare of clients who won't use condoms. To put it mildly.

Think about it a bit, imagining yourself in their place. Its not morally right and it is also short sighted, but it is in human terms very understandable.

Although I have discussed this in terms of female prostitutes with male clients, the same holds true for male prostitutes with male clients. Exceopt that the percentage of those who are HIV infected is substantially higher.

[Sheryl]

. I also doubt the official figures are accurate but unlike jdinasia I think it is an overestimate. I don't know though, but 1 in 15 sounds very high. Just my opinion.

something still nags at me about the science of this disease and I still maintain female to male transmission is unusual, I mean myself, OP, and another contributor have come forward with the same story and thankfully none of us were infected.

The official figures are derived through regular surveillance studies conducted according to solid scientific research standards (in Thailand and in most countries with an HIV problem). They are in turn reviewed and compiled by UNAIDs/UNGASS and may be accessed by anyone at the following website:

www.unaids.org/en/knowledgeCenter/HIVData

The most recent report for Thailand is at:

http://data.unaids.org/pub/Report/2008/tha...s_report_en.pdf

And reviewing it I find that the 8% figure I gave, which was for 2004/5, is a bit higher than the latest one, which is 5% in 2007 (25% among "men who have sex with men", altho the nature of the sampling is such that formal and informal male sex workers are over-represented in that sámple, i.e. it may be higher than the true prevalence for all Thai male homosexuals as a whole).

So currently 1 in 20 rather than 1 in 15. Still a pretty good chance of encountering one and a high probabality if one makes a habit of commercial sex.

There is nothing at all odd about the fact that not every unprotected sexual encounter with an HIV infected person leads to infection, it is quite consistent with the science. I might add that most infectious disease transmission does not occur with 100% efficacy, e.g. not everyone exposed to someone with a cold is going to catch it, but some will. Not everyone who ingests water contaminated with the typhoid bacteria will get typhoid. Etc etc. There are many, many factors that play a role in whether an exposure results in infection. However, infection will not occur in the absence of any exposure.

In the case of HIV, male to male and male to female transmission is more effective than female to male, i.e. a higher percentage of such contacts result in infection. However in all cases, some exposures lead to infection and some do not. Other factors include the viral load of the infected person, specific sexual practices, presence of other STDs or any type of cut/abrasion/lesion on the genitals (which in women can, of course, be internal and not apparent to the man).

Overall, the odds of being infected as a result of any one sexual contact with an infected person are not large (although the exact odds are different for every specific encounter depending on the various factors just mentioned). But every infection resulted from a contact, it is possible to get it from just one contact, and, of course, the more contacts one has, the more accumulated risk.

The same is true of exposure from, for example, being accidentally stuck by a contaminated needle.

(Needle sharing by IV drug users runs a much higher risk since the blood may still be fresh on the needle and injection is into a vein).

The only type of exposure where one would expect all or most people to become infected would be direct transfusion of blood contamionated with HIV.

[jdinasia]

Sheryl

Care zto address spermicides as mentioned in post 68?

[huggybear]

. I also doubt the official figures are accurate but unlike jdinasia I think it is an overestimate. I don't know though, but 1 in 15 sounds very high. Just my opinion.

Sheryl, you seem knowlegable here, can you tell us regarding the HIV test, is a negative test result reliable? I've heard the virus can "hide" so if so, wouldn't all the statistics be flawed?

[Dakhar]

Sheryl

Care zto address spermicides as mentioned in post 68?

No, I am not Sherl, but here is some more info:

"The spermicide had been promoted as a means of preventing HIV, but a recent Lancet study (2002;360:971-977) found frequent use may in fact increase the risk of HIV transmission. "

http://www.thebody.com/content/treat/art18137.html

[jdinasia]

If we are worrying about the legal aspects. The beer garden on Sukhumvit Soi 7 regularly posts pictures of the girls who are known thieves. The owner doesn't have a problem, surely you could argue that that is defamation of character.

The Criminal Code - Chapter 3. Offence of Defamation

Section 326. Whoever, imputes anything to the other person before a third person in a manner likely to impair the reputation of such other person or to expose such other person to be hated or scorned is said to commit defamation, and shall be punished with imprisonment not exceeding one year or fined not exceeding twenty thousand baht, or both.

swiped from this thread ....

http://www.thaivisa.com/forum/Bail-Trespas...66#entry2347266

so apparently the owner of said place on Suk Soi 7 could get in serious trouble if someone filed a complaint.

[TexasRanger]

Let your conscience decide. I would grass her, she's one of the infected and knows it. Not a nice situation. My sympathy for her getting infected disolves if she is still flogging her wares.

[ilyushin]

I met a thai girl (a working girl) in 2007, fell in love, married her (Buddist wedding not registered) and had unprotected sex for a year and a half. On September 2, 2008 she had a headache and sore throat so we went to the hospital (Bangkok) to check it out. The doctor reviewed her file and noted that the last visit (2 years ago) she tested hiv positive and asked if she had told me (in thai). She told her that no but perhaps I should tell him now. I was shocked and immediately had a hiv test but negative. I was still prepared to accept this as a mixed relationship with some changes to our sex life.

However since that time, we have broken up and she is going back to work. This poses a health risk and I am aware of it. She is also planning a trip to Europe because the money is better over there. Should I just let it go as not my problem or should I expose her. I am weighing the health risk of others vs their family income (she is the breadwinner of the family mother, father, brother (who is jail but getting out in the new year) 12 year old daughter. any comments?

I am new at posting, hopefully this works

I see from your message that you tested for HIV and were not infected. Did she take another test? You should have had her take a new test to check again. Several years ago I was tested positive. I immediately did what I said I would do when interviewed "get a second opinion". I did and was confirm negative. I went a third time to make sure and was given a clean bill of health. I suggest you ask her to re-check and see. I met a young couple years ago that was tested and told positive. They stayed together trying to understand what had happened, they considered suicide. Then they finally decided to return to the hospital to find out that they were actually given the wrong results. This is why I have always told the doctor during an interview " I will get a second opinion if found to be HIV positive". I suggest the same.

Edited November 22, 2008 by ilyushin

[SpudIslander]

I met a thai girl (a working girl) in 2007, fell in love, married her (Buddist wedding not registered) and had unprotected sex for a year and a half. On September 2, 2008 she had a headache and sore throat so we went to the hospital (Bangkok) to check it out. The doctor reviewed her file and noted that the last visit (2 years ago) she tested hiv positive and asked if she had told me (in thai). She told her that no but perhaps I should tell him now. I was shocked and immediately had a hiv test but negative. I was still prepared to accept this as a mixed relationship with some changes to our sex life.

However since that time, we have broken up and she is going back to work. This poses a health risk and I am aware of it. She is also planning a trip to Europe because the money is better over there. Should I just let it go as not my problem or should I expose her. I am weighing the health risk of others vs their family income (she is the breadwinner of the family mother, father, brother (who is jail but getting out in the new year) 12 year old daughter. any comments?

I am new at posting, hopefully this works

I see from your message that you tested for HIV and were not infected. Did she take another test? You should have had her take a new test to check again. Several years ago I was tested positive. I immediately did what I said I would do when interviewed "get a second opinion". I did and was confirm negative. I went a third time to make sure and was given a clean bill of health. I suggest you ask her to re-check and see. I met a young couple years ago that was tested and told positive. They stayed together trying to understand what had happened, they considered suicide. Then they finally decided to return to the hospital to find out that they were actually given the wrong results. This is why I have always told the doctor during an interview " I will get a second opinion if found to be HIV positive". I suggest the same.

Hi ilyushin,

Yes, on September 2nd, we both were tested. She was confirmed positive and I negative. Question to Sheryl: You seem quite knowledgeable on this topic and I have been in contact with organizations here in Toronto (Casey House, Hassle Free Clinic and have spoke to counsellors from ACT), but one thing I haven't asked is " Is it possible that I may show negative, but the virus is there but dormant and could develop if my system became weak?" I know that this virus may not show on first testing and I was adviced to test 3 months following (I have moved my appointment up to December 5th). I am using the Hassle Free Clinic because I don't want my family doctor to know until I know the results.

[Sheryl]

There are different types of HIV test:

1) tests for the presence of antibodies (and within this group, several different techniques each with different levels of reliability and cost to perfrom, eg Elisa, Western blot etc). Because these tests depend upon the presence of antibodies, they will be negative in very early stages of the disease as the antibodies haven't developed yet. Majority (>90%, I forget exact figure) of people will be antibody positive within 3 months but a small minority will take up to 6 months hence the recommendation for a repeat test at 6 months if negative at 3. It is BTW standard practice tio repeat the antibody test ate least once (usually using a more accurate emthod) if it is positive before giving the results to the patient. If followed this procedure pretty well rukles out a "false positive"result unless somehow the lab results of 2 patients get mixed up.

2) tests for the presence of the virus itself - much more expensive and time-consuming to do. In people who have tested antibody positive, a "Viral Load" test should be done (along with CD4 count) to help determine how far advanced the disease is and whether there is a need to start treatment. This test will have the added advantage of identifying any mistake on the antibody test since, of course, no virus will be seen. This same test can also be done in people who are antibody negative to see if they perhaps have the virus but are in an early stage and have thus not yet formed antibodies. In that case, an additional technique called PCR is done first, which adds to the cost and time involved; what the PCR does is basically replicate any virus that may be present so that there is enough of it to be seen as a Viral Load may miss very minute quantities of virus, which is all there would be in someone so early in the course of infection that they did not yet have antibodies.

So in answer to your questions, Spuds, iif you are, as I understand it, in the 3-6 month period having been negative at 3 months, is possible but unlikely that you are in very early stages of infection, and if so this will show up at the 6 month testing, You can, if you want and feel it is worth the extra cost, get a PCR test, but if it is already close to the 6 month mark it may not make much sense.

If -- and the odds are strongly in our favor on this -- the 6th month test is negative too, the possibility that you nonetheless still harbor the virus are so minute (a fraction of a percent) as to be effectively nil, but if you want to be ab solutely sure beyond even a fraction opf a percent of a doubt, you could at that point have a PCR done.

To respond to 2 earlier queries:

1) spermicide -- yes, the research has shown conflicting results, and more research wuill probably be requiored to reach consensus on this. but should understyand that even the most favorable reports never shopwed spermicides to be as effective as condoms and they have never been proposed as a substuitue. the issue has been whether there would be an added benefit tio having the condoms lubricated with spermicide.

2) - prevalence rates: because of their public health importance considerable care is taken in the testing procedure, often with double testing by different (antibody) methods. Of course, among the people tested in surveillance studies there will be some who are infected but have not yet formed antibodies and thus show up as negative; that is a given, but unlikely to make a significnact statistical difference unless for some reason there has been a huge surge in infection within a period of a few months. And even in that rather improbable scenario, it will get picked uop at the next survey; these are done every 1-2 years for the purpose of tracking trends. If you read the report I referenced you will find a great deal of information not just on how prevalent HIV is in various groups in Thailand now but how this has changed over the years. ..and also what behavioral changes likely contributed to the changes. (The behavioral data, of course, is never as rfeliable as the prevalence data as it depends on people's statements of what they do/did rather than a lab test).

[SpudIslander]

There are different types of HIV test:

1) tests for the presence of antibodies (and within this group, several different techniques each with different levels of reliability and cost to perfrom, eg Elisa, Western blot etc). Because these tests depend upon the presence of antibodies, they will be negative in very early stages of the disease as the antibodies haven't developed yet. Majority (>90%, I forget exact figure) of people will be antibody positive within 3 months but a small minority will take up to 6 months hence the recommendation for a repeat test at 6 months if negative at 3. It is BTW standard practice tio repeat the antibody test ate least once (usually using a more accurate emthod) if it is positive before giving the results to the patient. If followed this procedure pretty well rukles out a "false positive"result unless somehow the lab results of 2 patients get mixed up.

2) tests for the presence of the virus itself - much more expensive and time-consuming to do. In people who have tested antibody positive, a "Viral Load" test should be done (along with CD4 count) to help determine how far advanced the disease is and whether there is a need to start treatment. This test will have the added advantage of identifying any mistake on the antibody test since, of course, no virus will be seen. This same test can also be done in people who are antibody negative to see if they perhaps have the virus but are in an early stage and have thus not yet formed antibodies. In that case, an additional technique called PCR is done first, which adds to the cost and time involved; what the PCR does is basically replicate any virus that may be present so that there is enough of it to be seen as a Viral Load may miss very minute quantities of virus, which is all there would be in someone so early in the course of infection that they did not yet have antibodies.

So in answer to your questions, Spuds, iif you are, as I understand it, in the 3-6 month period having been negative at 3 months, is possible but unlikely that you are in very early stages of infection, and if so this will show up at the 6 month testing, You can, if you want and feel it is worth the extra cost, get a PCR test, but if it is already close to the 6 month mark it may not make much sense.

If -- and the odds are strongly in our favor on this -- the 6th month test is negative too, the possibility that you nonetheless still harbor the virus are so minute (a fraction of a percent) as to be effectively nil, but if you want to be ab solutely sure beyond even a fraction opf a percent of a doubt, you could at that point have a PCR done.

To respond to 2 earlier queries:

1) spermicide -- yes, the research has shown conflicting results, and more research wuill probably be requiored to reach consensus on this. but should understyand that even the most favorable reports never shopwed spermicides to be as effective as condoms and they have never been proposed as a substuitue. the issue has been whether there would be an added benefit tio having the condoms lubricated with spermicide.

2) - prevalence rates: because of their public health importance considerable care is taken in the testing procedure, often with double testing by different (antibody) methods. Of course, among the people tested in surveillance studies there will be some who are infected but have not yet formed antibodies and thus show up as negative; that is a given, but unlikely to make a significnact statistical difference unless for some reason there has been a huge surge in infection within a period of a few months. And even in that rather improbable scenario, it will get picked uop at the next survey; these are done every 1-2 years for the purpose of tracking trends. If you read the report I referenced you will find a great deal of information not just on how prevalent HIV is in various groups in Thailand now but how this has changed over the years. ..and also what behavioral changes likely contributed to the changes. (The behavioral data, of course, is never as rfeliable as the prevalence data as it depends on people's statements of what they do/did rather than a lab test).

Hi Sheryl,

To add a little more insight to the first post, as I had indicated we were both tested on Sptember 2nd but of course this is only a short version of the story in order to post. She confessed to me later that she had contracted the virus at least 6 years ago while working in Malaysia (she was pregnant). Around October 5th before I left for Canada, we tested again because I was worried about the level of viral load and whether she needed to take medication or not. All the things you say about the culture of this situation are very true. She lost her virginity at 10 by her father, married at 16, a baby at 17, sold to Singapore at 20, jailed and returned to Thailand and then sold again in Malaysia. She speaks english very well and also chinese. I met her in Hong Kong and I remember her changing her name and id card upon her return. And what sticks out most of all, I remember her always asking me, if I die, would you take care of my daughter and her family. I am not bitter about our break up (at least I don't think I am) and this is why I have not acted out so readily. I am not naive enough to think that this site is not monitored by some authority and although to some that it may seem to be anonymous, it is not. I am just a guy who wants to do the right thing.

This is an part of an email I received from the Doctor when I returned. Any thoughts on this?

I got the blood test results. You are negative for antibody to HIV while your wife is positive. The level of viral load test is 2280 copy/ml, and her CD4/CD8 is 321/1086 cells/mm3. We don't know suptype of the infection but it should be HIV1 which is aggressive. The internist will decide to give antiretroviral agent when CD4 is less than 200 but consider in CD4 less than 350. In my opinion, your wife should get antiretroviral agent until CD4 more than 200 and undetectable viral load

[Scott]

I wouldn't waste a lot of time trying to expose her because you will have limited success. Since she is a working girl, most people should know they are taking their chances if they have unprotected sex.

[Sheryl]

Hi Sheryl,

I remember her always asking me, if I die, would you take care of my daughter and her family. I am not bitter about our break up (at least I don't think I am) and this is why I have not acted out so readily. I am not naive enough to think that this site is not monitored by some authority and although to some that it may seem to be anonymous, it is not. I am just a guy who wants to do the right thing.

This is an part of an email I received from the Doctor when I returned. Any thoughts on this?

I got the blood test results. You are negative for antibody to HIV while your wife is positive. The level of viral load test is 2280 copy/ml, and her CD4/CD8 is 321/1086 cells/mm3. We don't know suptype of the infection but it should be HIV1 which is aggressive. The internist will decide to give antiretroviral agent when CD4 is less than 200 but consider in CD4 less than 350. In my opinion, your wife should get antiretroviral agent until CD4 more than 200 and undetectable viral load

Your wife should indeed start ARV at once. I just hope that she will be compliant. She does not need to die, if she is. She can get the ARV trhough the government at no or very subnsidzed cost but will of course lose that option if she goes abroad, a factor she should take into account in her plans.

Going on ARV and getting her viral load down (and if she is compliant, it can be brought down to undetectable or nearly so) will also make her less infective, important since, let's face it, she seems prettu certain to stay in this line of work. And as has been discussed there really is not anything you can do to prevent that in Thailand.

In etrsm of you -- if I were you, and able to afford it, I'd go ahead and have the PCR test just to put the question of whether or not I was infected to rest once and for all. The odds are very much in your favor given that yiou are antibody negative, but since you had certain exposure and to a woman with a significant viral load, need to be sure.

The Hassle Free Clinic won't be able to do the PCR themselves but they may be able to draw the b,lood and send it to a hospital that can, or refer you to one.

So sorry to hear there is a child involved, how old is the girl?

And are you still in communication with your wife? I'm just wondering if there is any hope you cvan persuade her to (1) not go abroad, since she needs to stay here for her treatment and (2) understand that if she has sex with a man without using condoms she m ay be indirectly doing to other women, and even to those women's children, what was done to her.

There are also groups in Thailand who help women in her circumstance to seek other tyoes of liveliuhood. I can give you some contacts buit it's only worth doing if you think she would act on it, as only she can take that first step.

I hope those who expressed such strong condemnation of her as a person will take note of the background you just provided. This is a woman who is deeply, deeply damaged. That doesn';t make her actions right but it does make it understandable (at least to me!)

I wouldn't worry too much about authorities monitoring and acting on this thread. If there are any "authorities"monitoring this forum I can assure you they are not in the least suprirsed by or concerned about a Thai sex worker who is HIV+. She is one of many thousands out there, and the official response has, quite appriopriately (and effectively, if one looks at the data over time) dealt with by promoting condom use and providing ARV rather than trying to somehow round up such women.

[OxfordWill]

dunno about toronto- in the uk its bloody hard to get a PCR test nested or otherwise- in bangkok if you go direct to the lab through a kind doctor, its about 800 baht and 24 hour turn around time.

[SpudIslander]

Hi Sheryl,

I remember her always asking me, if I die, would you take care of my daughter and her family. I am not bitter about our break up (at least I don't think I am) and this is why I have not acted out so readily. I am not naive enough to think that this site is not monitored by some authority and although to some that it may seem to be anonymous, it is not. I am just a guy who wants to do the right thing.

This is an part of an email I received from the Doctor when I returned. Any thoughts on this?

I got the blood test results. You are negative for antibody to HIV while your wife is positive. The level of viral load test is 2280 copy/ml, and her CD4/CD8 is 321/1086 cells/mm3. We don't know suptype of the infection but it should be HIV1 which is aggressive. The internist will decide to give antiretroviral agent when CD4 is less than 200 but consider in CD4 less than 350. In my opinion, your wife should get antiretroviral agent until CD4 more than 200 and undetectable viral load

Your wife should indeed start ARV at once. I just hope that she will be compliant. She does not need to die, if she is. She can get the ARV trhough the government at no or very subnsidzed cost but will of course lose that option if she goes abroad, a factor she should take into account in her plans.

Going on ARV and getting her viral load down (and if she is compliant, it can be brought down to undetectable or nearly so) will also make her less infective, important since, let's face it, she seems prettu certain to stay in this line of work. And as has been discussed there really is not anything you can do to prevent that in Thailand.

In etrsm of you -- if I were you, and able to afford it, I'd go ahead and have the PCR test just to put the question of whether or not I was infected to rest once and for all. The odds are very much in your favor given that yiou are antibody negative, but since you had certain exposure and to a woman with a significant viral load, need to be sure.

The Hassle Free Clinic won't be able to do the PCR themselves but they may be able to draw the b,lood and send it to a hospital that can, or refer you to one.

So sorry to hear there is a child involved, how old is the girl?

And are you still in communication with your wife? I'm just wondering if there is any hope you cvan persuade her to (1) not go abroad, since she needs to stay here for her treatment and (2) understand that if she has sex with a man without using condoms she m ay be indirectly doing to other women, and even to those women's children, what was done to her.

There are also groups in Thailand who help women in her circumstance to seek other tyoes of liveliuhood. I can give you some contacts buit it's only worth doing if you think she would act on it, as only she can take that first step.

I hope those who expressed such strong condemnation of her as a person will take note of the background you just provided. This is a woman who is deeply, deeply damaged. That doesn';t make her actions right but it does make it understandable (at least to me!)

I wouldn't worry too much about authorities monitoring and acting on this thread. If there are any "authorities"monitoring this forum I can assure you they are not in the least suprirsed by or concerned about a Thai sex worker who is HIV+. She is one of many thousands out there, and the official response has, quite appriopriately (and effectively, if one looks at the data over time) dealt with by promoting condom use and providing ARV rather than trying to somehow round up such women.

Hi Sheryl,

This thread is getting deeper and deeper into an area, far greater than I had expected. Let me address your last post as best I can.

Your wife should start ARV at once.

· We visited the closest hospital (still a little primitive) near her village. The health care worker took blood samples and was content to monitor her progression. (I believe her CD4 counts showed 305 (this seemed to be the only concern to decide whether medication was required) on her 1^st visit (She has a male friend who is hiv positive for some time and is taking medication. It was their idea that I not attend for fear that if medication was prescribed, the price would go up if they knew she was married to a farang.) During their visit the health care worker talked about how when she (the health care worker) started her position there, she had reservations about taking the position. She also attends some local schools in the area to talk to students about condoms and STD. She asked my wife if she would be interested in going along and talking about her life experiences. When my wife told me about this suggestion she was so happy and excited about doing something positive and making a difference and a contribution to society (this was a good day).She was asked to come back in 2 weeks.

· On the second visit where I did attend, her CD4 count was 321 (if I remember correctly). Still a decision was not prescribe for medication. I didn’t feel comfortable about the progress and communication was difficult due to language, I had questions regarding viral load (I had spent some time googling on the internet earlier as hiv was not a part of my life and I didn’t know much about it and L had many questions regarding hiv). Again no medication was prescribed. She was asked to come back in 6 weeks. I am no longer in the picture here and whether she went or not I don’t know. I have a feeling she probably did not go back.

· On October 5^th (or there about, I left for Canada on October 7^th), we attended a hospital near Pattaya for further tests (because of my unanswered questions regarding viral load). Please refer to the excerpt in my earlier posting. This testing was not cheap (about $530.00 CAD).

· Bottom line: I doubt very much that she will get the help she needs. You see she has 2 different personalities (as we all do) but hers are more distinctive and extreme. One is kind, loving, generous, caring for herself and others, the other is anger, denial, f---- it, I don’t care about anything. This is probably due to her life experiences mentioned earlier. But to answer your question: No I don’t think she will get the help she needs.

In terms of you – if I were you and able to afford it, I’d go ................PCR

· This would involve seeing my doctor and convincing him that I would need this test. In Canada, this test might be covered by our government provincial medical plan. I may need to wait for a long time to get it but I think it could be done. I will call him for an appointment tomorrow. Thank you.

Note to OxfordWill: Thank you for your input

Sorry to hear there is a child involved..............

· You are probably referring to her first discovery that she was HIV positive 6 years ago. She lost this baby during the pregnancy. She has only the one child (a 12 year old daughter who is healthy as far as I know.

Are you still in communication with your wife? Can you persuade her to not go abroad and seek treatment..............

· No, I am no longer in communication with her currently. I could however attempt to communicate with her of course. A lot of bad things were said over the internet, telephone and text messaging before the break up. I believe that in her line of work in order to survive (if you can call it that) is to cut all knowledge of someone who has gotten close to their heart. Try to erase them from their memory, destroy photos, break all communication and try to block any memories that they even existed (that is my theory anyway). All of this is protect and suppress her feelings. I think most of us are similar in some respects but more drastic measures would be taken here.

· Can I convince her not to travel abroad and stay here and follow up on seeking medical help in terms of treatment? I don’t know, not the way things are now.

· Can I help her understand the chain reaction of transmission from men, to their other partners, to their wives and finally to children through pregnancy. Same answer, I don’t know.

There are groups in Thailand ..................... re: other types of livelihood

· During the time we were together, I was giving her 52, 000 baht a month, 12,000 baht was for the payment of a truck and the balance went towards living expenses for the mother, her mother’s husband (her father lives in Bangkok) and education of her daughter. In addition, she with help of her family had a little business of buying a pig, butchering it up and selling it at a local market on Mondays. The margins were about 3,000 baht a week. This may have been a little exaggerated but let’s say about 9 to 10 thousand baht a month.

· I think that the breakup has put her into a tailspin and as a result she has gone back into the sex trade industry. She was a freelancer, very attractive, good command of English and Chinese. She has become accustomed to big money (by Thai standards), this would be hard for her accept something less. If she could somehow understand the risk factors more, it might appeal to her kind and good side. I don’t know.

I wouldn’t worry about authorities monitoring.........................

· I am not so concerned about this; I have mostly left a trail about me, not so much her. I was actually referring to earlier posts by other people in terms of my being careful of exposing her “harassing the woman” “court action” “defamation of character” I guess I got a little paranoid for a moment (“Neo, there is a knock at the door” – The Matrix).

· Truly, there is a part of me that wishes to continue paying money to her and her family. But, I am not a (Bill Gates) rich man. The economy is hitting hard globally and particularly North America. My business is real estate and I have been hit pretty hard. Myself, like most, are holding down the fort preparing for more bad news (tip of the iceberg) and just how long for this rocky ride, who knows for sure.

[Tolley]

Sheryl

I agree with your post about clients refusiing to wear condoms and infecting girls with HIV.

In Thailand there there seems to be many men both Thai and farang who actively refuse to wear condoms and try to cajole women into having sex without a condom.

I know this is the case from punters I have spoken to and girls who have verified this.

In the majority of cases it is the woman who is the original victim but it being Thailand many do not want to face the facts nor do they want to lose their source of income and of course their is also the social stigma of the disease.

All in all a sad situation but one that is mostly preventable.

I think that infection rates are higher in Thailand than official figures indicate purely because most Thais would never admit they had the disease and many wont get tested because they fear they might have it.

[Samuian]

Sheryl

I agree with your post about clients refusiing to wear condoms and infecting girls with HIV.

In Thailand there there seems to be many men both Thai and farang who actively refuse to wear condoms and try to cajole women into having sex without a condom.

I know this is the case from punters I have spoken to and girls who have verified this.

In the majority of cases it is the woman who is the original victim but it being Thailand many do not want to face the facts nor do they want to lose their source of income and of course their is also the social stigma of the disease.

All in all a sad situation but one that is mostly preventable.

I think that infection rates are higher in Thailand than official figures indicate purely because most Thais would never admit they had the disease and many wont get tested because they fear they might have it.

Ever conducted a trial/field research on this particular matter, you/one might not be much surprised that many sex workers in the realm are aware of the possibility of getting infected, but less then 1% actually has condoms at hand and as a result a minute amount is actually questioning/considering the use of condoms!

Sad but very true!

[Digger]

At CD4 of 321 the govt scheme will NOT start treatment unless there are underlying reasons why they should (maybe Hep B co-infection as an example). Standard treatment in Thailand begins I believe when CD4 level is down to 200. Another reason why they wont start treatment is her viral load is very very low, which actually may reflect a more recent infection. Maybe at that 2 year point of initial testing she had just sero-converted but maybe not, maybe her body is effective at fighting the virus.

As to the moral dilemma, my view would be to try and encourage her onto drugs for her own sake but she may prefer to do that away from her home town - i.e. in Bangkok or another large city in which case she would likely not qualify for the government paid medicines. There is an issue about disclosing her condition under Thai law, for example, this information could NOT be used in a court - as it falls under patient confidentiality rules - likewise if you were to create an email trail, thats somewhat naive in my opinion. Whats gone on before you is not your responsibility to deal with - those guys knew the risks and played them. If they have been caught out, they will likely know soon enough, or conversley may not even care until it hits home. Thai law will not even consider payment issues in this regard - but they will focus on defamation as there is a trail. The odds of anything happening are extremely remote - but they exist - it just requires her to make a police report - the fact that its true is academic - your breaking the law in breeching private medical records, unless she has signed a document allowing the information to be passed into the public domain (which is unlikely). Therefore I would not even go anywhere near that one.

I wont even bother commenting about the lynching bandwagon comments - they are foolish beyond belief given that in my anecdotal evidence at least 80% of these forum members will have been paying for sex before - an amazing case of double standards - but there you go.

My personal view would be to try and motivate her to look after herself but I suspect if she is used to a 52k month payment, thats not likely as you say, she is used to the big money and the only way to achieve that again is to go back working on the game.

[Samuian]

............edit...

I wont even bother commenting about the lynching bandwagon comments - they are foolish beyond belief given that in my anecdotal evidence at least 80% of these forum members will have been paying for sex before - an amazing case of double standards - but there you go.

My personal view would be to try and motivate her to look after herself but I suspect if she is used to a 52k month payment, thats not likely as you say, she is used to the big money and the only way to achieve that again is to go back working on the game.

...truly amazing...so if the bank gets robbed, the people in it are guilty of being at the wrong time, at the wrong place, why to take care of an TB infection, just keep coughing, it's the stupid ones exposing themselves, not taking care, not wearing a face mask and rubber gloves all the time...why change the worn tires on the car, it's the others, stupid, why they take the risk to engage in public traffic, why fix worn brakes, is the extended message,why care, if I KNOW that there is something wrong, isn't it, amazing point, really!

I am simply baffled by so much care for others... !

[Tolley]

Sheryl

I agree with your post about clients refusiing to wear condoms and infecting girls with HIV.

In Thailand there there seems to be many men both Thai and farang who actively refuse to wear condoms and try to cajole women into having sex without a condom.

I know this is the case from punters I have spoken to and girls who have verified this.

In the majority of cases it is the woman who is the original victim but it being Thailand many do not want to face the facts nor do they want to lose their source of income and of course their is also the social stigma of the disease.

All in all a sad situation but one that is mostly preventable.

I think that infection rates are higher in Thailand than official figures indicate purely because most Thais would never admit they had the disease and many wont get tested because they fear they might have it.

Ever conducted a trial/field research on this particular matter, you/one might not be much surprised that many sex workers in the realm are aware of the possibility of getting infected, but less then 1% actually has condoms at hand and as a result a minute amount is actually questioning/considering the use of condoms!

Sad but very true!

I don't know where you get the 1 percent figure from but sorry I don't buy it.

Sure some women don't worry about condoms but i would think it is the minority not the overwhelming majority as you have painted.

[mommysboy]

At CD4 of 321 the govt scheme will NOT start treatment unless there are underlying reasons why they should (maybe Hep B co-infection as an example). Standard treatment in Thailand begins I believe when CD4 level is down to 200. Another reason why they wont start treatment is her viral load is very very low, which actually may reflect a more recent infection. Maybe at that 2 year point of initial testing she had just sero-converted but maybe not, maybe her body is effective at fighting the virus.

As to the moral dilemma, my view would be to try and encourage her onto drugs for her own sake but she may prefer to do that away from her home town - i.e. in Bangkok or another large city in which case she would likely not qualify for the government paid medicines. There is an issue about disclosing her condition under Thai law, for example, this information could NOT be used in a court - as it falls under patient confidentiality rules - likewise if you were to create an email trail, thats somewhat naive in my opinion. Whats gone on before you is not your responsibility to deal with - those guys knew the risks and played them. If they have been caught out, they will likely know soon enough, or conversley may not even care until it hits home. Thai law will not even consider payment issues in this regard - but they will focus on defamation as there is a trail. The odds of anything happening are extremely remote - but they exist - it just requires her to make a police report - the fact that its true is academic - your breaking the law in breeching private medical records, unless she has signed a document allowing the information to be passed into the public domain (which is unlikely). Therefore I would not even go anywhere near that one.

I wont even bother commenting about the lynching bandwagon comments - they are foolish beyond belief given that in my anecdotal evidence at least 80% of these forum members will have been paying for sex before - an amazing case of double standards - but there you go.

My personal view would be to try and motivate her to look after herself but I suspect if she is used to a 52k month payment, thats not likely as you say, she is used to the big money and the only way to achieve that again is to go back working on the game.

This is a very sensible posting in my view.

I'd personally try to encourage some form of reconciliation. It sounds like her 'other' personality has got hold of the reins for a while, that's distressing for OP, but the storm will blow over in time. She'll need support in years to come. Just a thought, and sorry I know this situation is hel_l for you.

I had a similar hiv problem. Upon my return to UK I was retested as they gave no credance to the Thai test I think. One advisor in particular was quite adamant that I would not be positive, having discounted homosexual sex and drug use. I was so beside myself with worry that they gave me another test after 6 weeks. At this point the counsellor laid the cards on the table and pointed out that a positive is very quick to reveal itself and the 3 months was a precaution. A 6 month check was not mandatory. I had it done anyway.