Hiv Scare

[turfied]

Eight days ago, I had unprotected sex with a bar girl in Bangkok. Since then, all of my thoughts have been consumed with the possibility that I have HIV. I literally can't think of anything else, and I'm completely terrified. Logically, I know it's very unlikely that I have it. Based on my internet reading, I estimate 200:1, based on the following facts:

20% infection rate among Thai sex workers (this seems high, but conservative)

0.05% chance of transmission of Subtype A from intercourse (seems right)

50 times higher transmission rate for Subtype E vs. Subtype A (this seems to be a controversial point, but I'll go with it).

so, 0.2 * 0.05 * 50 = 0.5%, on the high side. Higher than I'd like it to be, but still pretty unlikely for me to have HIV. Even knowing that though, I can't shake the emotional burden of the possibility.

I've read that it typically manifests itself in flu-like symptoms. Everything that happens to me that could fit the bill, I wonder if it's caused by HIV. When I was sweating in Phuket, my rational mind knew it was likely because of the hot, humid climate. But was it really a feverish sweat caused by HIV? I felt muscle soreness for a while in Asia, probably from not exercising and from bouncing around in the back of a tuk-tuk and from flying around on planes so much. Or was the soreness caused by HIV? I just got home to the US yesterday. I know that my exhaustion is almost definitely because I spent 30 hours in planes and airports, and I know I feel cold because it's 20 degrees colder here and much less humid (duh). But are either of these caused by HIV? I can't get tested yet, because it's not soon enough, but I honestly can't wait much longer. I can't function like this, and I don't see how I'm going to be able to work or get through my life. I can't tell my friends or family about this.

Some of the threads on this forum have been helpful, knowing that other westerners have gone through similar things in the past. I can't say what a relief that is. Still, the possibility is driving me mad. I guess I'm just looking for someone to tell this to, and for someone to talk some sense into me and tell me what to do regarding testing, treatment, coping &c. Thanks for anything you can share, can't tell you how much I appreciate it.

[turfied]

Btw, if anyone can comment on the accuracy of the numbers, that'd be appreciated as well.

[manarak]

Btw, if anyone can comment on the accuracy of the numbers, that'd be appreciated as well.

Infection rate among bargirls in bars catering to foreigners is estimated to be around 2%, not 20%.

Infection risk for a man from an infected woman is 5 per 10.000, not 5%

and the higher transmission rate for subtype E is only a rumor.

Your statistical risk is 0.0005 * 0.02 = 0.000001 or one in a million.

Some reading:

Thailand HIV - Country situation analysis

http://www.unaids.or...a/ASITHA_en.pdf

Thailand HIV - 2010 Country Progress Report

http://www.unaids.or...s_report_en.pdf

Thailand HIV - epidemiological fact sheet

http://158.232.15.29...n&pdfoption=epi

Thailand HIV - 2012 Country Progress Report

http://www.unaids.or...port%5B1%5D.pdf

[Sheryl]

Not one in a million. But if it was a single exposure, on average risk would be less than one in a thousand if she was HIV positive and of course nil if she wasn't.

However there is really no such thing as an "average" risk except as a statistical calculation on paper. In real life, infected partners vary greatly in how infectious they are, depending on viral load, presence of any sores or abrasions etc, and people exposed to HIV also vary in their susceptibility depending on a host of factors...in other words each encounter between an HIV+ and HIV negative person has its own unique odds and no one can tell you really what yours was.

And in any event whatever the odds, they are of no comfort if you are on the losing end of them. You can comfort yourself with the knowledge that it is very unlikely you contracted HIV, and then as soon as you hit the 2 week post-exposure mark go on over to the Thai Red Cross Anonymous Clinic where NAT tests are done for all the antibody specimens at no extra charge, these test for microscopic amounts of virus and thus are accurate at early stages. While you are at it, should be tested for other STIs and also Hep B, which is more easily transmitted than HIV (especially if you have not been vaccinated)

And goes without saying, from here on out, always use condoms. And get the hep B vaccine if you haven't already had the series.

Please ignore what you read on the web about various symptoms at the onset of HIV infection. I have worked clinically with many thousands of people with HIV and have yet to meet anyone who experienced these signs, it is rare. If you start to feel like you have the flu. most likely you have -- the flu..

[cheeryble]

Did you roll off in a drunken stupor or jump in the shower for a scrub and have a good pee?

I agree with Sheryl every case is individual a person is quite infective when they've just caught and incubated it, also when they're in late stages, but very mildly infective for the years long period in between.

To make you feel better, during a regular check we discovered my gf, a respectable girl with a very limited previous sex life, was long term Hep B. I had been sleeping with her 18 months with no antibodies.....and I was lucky enough not to catch it (have now had the course of injections and am antibody +). Hep B is somewhat comparably dangerous to HIV, takes a long time, but right now I have a friend waiting for a liver transplant from it.

It may surprise you to learn the average life expectancy after HIV diagnosis in the UK is now 46 years. How they worked this out I cannot imagine.

Feel better?

Well next time be careful...and check Hep B and the rest too!

Edited May 20, 2012 by cheeryble

[lopburi3]

Poster is already back in the US but as said should get tested.

[turfied]

Thanks to the responders, I'm feeling a little better, especially in light of the 2% stat. I'm pretty sure I've been vaccinated for Hep B before, but I'll get the whole battery of STD tests all the same. I think I will wait a week or two until the HIV test can prove conclusive with no chance of a false negative. FWIW, the sex wasn't that rough or frictiony (even though she dried herself out), which hopefully means there were few to no cuts that would allow for blood contact. Hopefully. In any case, I feel a bit better based on the responses. I'll wait a week or two and then get tested, with my fingers crossed.

[Soutpeel]

The other thing that hasnt been mentioned is that some establishment make the girls get regular health checks including HIV, further on from that most bar girls are very scared of catching something from the customer, not the other way around...

[lomatopo]

Infection rate among bargirls in bars catering to foreigners is estimated to be around 2%, not 20%.

The links provided would indicate that the 2% figure may be under-estimated and/or out-of-date.

I think the gen-pop infection rate is ~ 1.7% diagnosed/receiving treatment so the actual rate might be a bit north of 2%. For FSW's, assuming the OP was not with a post-op TG, the actual rates would probably be above those of the general population?

[poanoi]

I can't tell on HIV, but i got infected by gonorrhea 5 times out of 10, so a 50% chance.

(10 bargirls in total, of which 5 gave me that <deleted>)

Suffice to say i've never gotten drunk enough to do that to myself ever again, and i used to drink a whole lot.

Edited May 21, 2012 by poanoi

[Sheryl]

If you are in the US, getting a NAT or PCR tests 9the only ones that can detect in early stages, before antibodies form) will be an expensive luxury. If you have the money and insist, they can do it, but expect to instead be advised to wait until the 3 month mark and then get an antibody test (free or low cost), to be repeated after 6 months if negative at 3.

Regarding HIV prevalence in Thailand, the most stats I have seen are:

1.3% of the general population (2009)

19.0% of "freelance" sex workers (as opposed to brothel-based, most "bar girls" fall into this category) in the Bkk area (2007)

4.3% of brothel-based sex workers in Bkk area (2007)

The reason prevalence is so much lower among brothel-based sex workers is that most establishments follow the "100% condom use" policy introduced by the Ministry of Public health. Whereas there is really no way to make that happen among freelancers.

So indeed the 20% risk that the girl had HIV mentioned by prior poster is more or less correct. However, that is not your risk since the vast majority of times a single hetrosexual contact does not result in infection, especially for men.

For an overview of HIV in Thailand, this is a good source

http://www.avert.org/thailand-aids-hiv.htm

[turfied]

Regarding HIV prevalence in Thailand, the most stats I have seen are:

1.3% of the general population (2009)

19.0% of "freelance" sex workers (as opposed to brothel-based, most "bar girls" fall into this category) in the Bkk area (2007)

4.3% of brothel-based sex workers in Bkk area (2007)

The reason prevalence is so much lower among brothel-based sex workers is that most establishments follow the "100% condom use" policy introduced by the Ministry of Public health. Whereas there is really no way to make that happen among freelancers.

So indeed the 20% risk that the girl had HIV mentioned by prior poster is more or less correct. However, that is not your risk since the vast majority of times a single hetrosexual contact does not result in infection, especially for men.

Perhaps I'm misusing terminology. She may have been a brothel girl, I selected her off the wall at a dance club after talking with the manager. Are bar girls just the ones that you go out to a bar and they proposition you? Would this girl fall into the 4.3% category? Also, it seems like that 4.3% figure may have dropped some since 2007 based on the evidence, no? Is it a very bad sign that she didn't make me use a condom? Regarding gonorrhea, isn't it likely that I'd have symptoms after 10 days? One other thing I forgot to mention is that I very likely got HPV (which I understand is highly transmissable and not that big a deal). How does that impact all of these other risks?

Regarding transmission rate, is the poster above correct that Subtype E has roughly the same rate as Subtype A?

Edited May 21, 2012 by turfied

[Sheryl]

What you describe does sound more like brothel based but clelary one where the "100% condiom use policy" is strictly enforced.

Yes, it is a bad sign that she agreed to forego a condom. And yes, if you had gonorrhea you'd likely be symptomatic by now.

As for the HPV, a risk factor only if you had any sort of lesion at the time.

There is no point driving yourself crazy with statistical games. For sure the odds of not having contacted HIV are strongly in your favor, but it is not impossible. You'll have to wait and see. In the meantime, try not to obsess over it. What is done is done, odds are you'll be fine, but you will have to wait and be tested.

re the subtypes I think the truth is no one knows. Bear in mind that we can't exactly conduct clinical trials exposing people to HIV to see which strains are most infective. All we can do is look at the background characteristics and behaviors of people already infected. In countries where subtype E predominates, most infections are contacted through hetrosexual intercourse but whether this is because the strain is somehow more infective or whether it is simply due to behavioral factors (societies where hetro men commonly frequent prostitutes) is a matter of speculation.

[turfied]

What you describe does sound more like brothel based but clelary one where the "100% condiom use policy" is strictly enforced.

Yes, it is a bad sign that she agreed to forego a condom. And yes, if you had gonorrhea you'd likely be symptomatic by now.

As for the HPV, a risk factor only if you had any sort of lesion at the time.

There is no point driving yourself crazy with statistical games. For sure the odds of not having contacted HIV are strongly in your favor, but it is not impossible. You'll have to wait and see. In the meantime, try not to obsess over it. What is done is done, odds are you'll be fine, but you will have to wait and be tested.

re the subtypes I think the truth is no one knows. Bear in mind that we can't exactly conduct clinical trials exposing people to HIV to see which strains are most infective. All we can do is look at the background characteristics and behaviors of people already infected. In countries where subtype E predominates, most infections are contacted through hetrosexual intercourse but whether this is because the strain is somehow more infective or whether it is simply due to behavioral factors (societies where hetro men commonly frequent prostitutes) is a matter of speculation.

Sheryl, thanks for your reply, I will try not to stress and will wait to get tested. At what point should I have an antibody test? 4 weeks? How about the following testing schedule:

4 weeks: get tested for all STD's, including antibody test for HIV. If negative, get tested for HIV again at 3 months and at 6 months. What should I do differently than that?

[edwardandtubs]

You want to get tested immediately for STDs as most whores are carrying them and the bacteria could be doubling every few hours in your body. As for the "don't stress", you very much do want to stress.

In Thailand, HIV-1 subtype E (accounting for almost 95% of total HIV cases) is transmitted primarily through heterosexual sex, with a predominance of female-to-male infection.

http://www.ncbi.nlm..../pubmed/9240008

Edited May 21, 2012 by edwardandtubs

[turfied]

You want to get tested immediately for STDs as most whores are carrying them and the bacteria could be doubling every few hours in your body. As for the "don't stress", you very much do want to stress.

In Thailand, HIV-1 subtype E (accounting for almost 95% of total HIV cases) is transmitted primarily through heterosexual sex, with a predominance of female-to-male infection.

http://www.ncbi.nlm..../pubmed/9240008

June 1997. Got anything more recent to scare the crap out of me with?

As for "most whores are carrying them," the highest figure I've seen ANYWHERE is 20%. Got any evidence for >50%?

Edited May 21, 2012 by turfied

[23962323]

One thing for sure if anybody on this planet was a candidate for HIV it would be I.

I get tested on a regular basis,and utterly refuse a rubber,the only thing I am in Thailand for is the ladies. I am the wrong side of 65 now (just) but still in good shape, whack my heart up to 150 each and every day for half hour or so at the gym,keep myself clean and informed. I have"been at it" throughout India for years and here in Thailand for 5 or so years, sometimes twice a day. I do not accept HIV is easily catchable,I must have had partners who were HIV,but the only thing that I caught was genital warts which I had burnt out.

I do not want lecturing or advising on anything,have a good income and intend to enjoy sex for all its worth. So there,I am circumcised,so probably helps. If,and I repeat if I do become infected I will cease forthwith or revert to a rubber

[edwardandtubs]

You want to get tested immediately for STDs as most whores are carrying them and the bacteria could be doubling every few hours in your body. As for the "don't stress", you very much do want to stress.

In Thailand, HIV-1 subtype E (accounting for almost 95% of total HIV cases) is transmitted primarily through heterosexual sex, with a predominance of female-to-male infection.

http://www.ncbi.nlm..../pubmed/9240008

June 1997. Got anything more recent to scare the crap out of me with?

As for "most whores are carrying them," the highest figure I've seen ANYWHERE is 20%. Got any evidence for >50%?

I said most of them are carrying STDs, not HIV. Statistics are not necessary. If she took your unprotected penis up her just think how many other other unprotected penises she's had up her. These women are a walking laboratory of chlamydia, syphilis, gonorrhoea, herpes, warts and God knows what else.

Edited May 22, 2012 by edwardandtubs

[Sheryl]

Sheryl, thanks for your reply, I will try not to stress and will wait to get tested. At what point should I have an antibody test? 4 weeks? How about the following testing schedule:

4 weeks: get tested for all STD's, including antibody test for HIV. If negative, get tested for HIV again at 3 months and at 6 months. What should I do differently than that?

You can do the above, but 6 weeks is more reliable for the HIV test. by that point more than 90% of people who have been infected will have detectable antibodies. (By 3 months it is around 95% and by 6 months pretty well 100%).

You might though want to go ahead and get seen sooner to check for STDs and Hep B.

Edwardandtubs: could we please refrain from using the derogatory term "whore" ?

[edwardandtubs]

Edwardandtubs: could we please refrain from using the derogatory term "whore" ?

The problem is, being wishy-washy and using terms like "ladies" and telling people they're very unlikely to catch anything makes it more likely they're going to go out and do something stupid. Unprotected sex with a "lady" or a "bar girl" seems less suicidal that unprotected sex with a "whore" but they're all the same thing. Why not call a spade a spade instead of using ridiculous and inaccurate euphemisms?

[manarak]

Edwardandtubs: could we please refrain from using the derogatory term "whore" ?

The problem is, being wishy-washy and using terms like "ladies" and telling people they're very unlikely to catch anything makes it more likely they're going to go out and do something stupid. Unprotected sex with a "lady" or a "bar girl" seems less suicidal that unprotected sex with a "whore" but they're all the same thing. Why not call a spade a spade instead of using ridiculous and inaccurate euphemisms?

Everyone knows what a "bar girl" or a "prostitute" is.

Furthermore, I expect 'easy' girls from discos to have higher HIV rates than bar girls - whose HIV rate is consensually estimated to be under 2%.

Being "wishy-washy" is more like throwing all risk groups into the same pot.

[TommoPhysicist]

As Manarack suggested infection rate for unprotected sex with infected woman is 5 in 10,000

If you assume Sheryl correct where 20% are infected, then your risk of infection is 1 in 10,000.

Very small, don't worry.

[mommysboy]

One thing for sure if anybody on this planet was a candidate for HIV it would be I.

I get tested on a regular basis,and utterly refuse a rubber,the only thing I am in Thailand for is the ladies. I am the wrong side of 65 now (just) but still in good shape, whack my heart up to 150 each and every day for half hour or so at the gym,keep myself clean and informed. I have"been at it" throughout India for years and here in Thailand for 5 or so years, sometimes twice a day. I do not accept HIV is easily catchable,I must have had partners who were HIV,but the only thing that I caught was genital warts which I had burnt out.

I do not want lecturing or advising on anything,have a good income and intend to enjoy sex for all its worth. So there,I am circumcised,so probably helps. If,and I repeat if I do become infected I will cease forthwith or revert to a rubber

I concur, I really believe HIV is not at at all easy to catch and this poster's story is the norm not the exception in my opinion.

Figures! what can you say? Figures don't lie, but liars can figure!

It's nonsense to quote odds, because transmission rates aren't really known for this disease as far I'm aware, or at least vary greatly from source to source, and probaly more importantly as has been pointed out, virus' do not work by mathematical equations.

Talking in general. some people are super spreaders of bugs, ie, they can infect a great number of people very quickly, at that point then the actuarial table is just not valid. "Typhoid Mary" springs to mind as an example.

It's not necessarily a bad sign that the girl in question did not insist on a condom. She was most likely desperately in need of money, and aware that guys don't like to wear them. I doubt she would be clued up on the dangers of HIV.

OP, Like many I think you have very little cause to worry. Obviously this has rattled you and I empathise fully. I think in the west we tend to be a little overly protected from events like this, and it comes as a mighty shock when our illusions are shattered.

[fredge45]

It's now long after the fact... wait for the incubation period and get some testing done. You're doing way too much damage to yourself wringing your hands and being a worrier... what's done is done.

Now grow up and deal with the facts, whatever they may be - probably nothing. Think of all of the time you have taken off from just living and enjoying life!

[louse1953]

The other thing that hasnt been mentioned is that some establishment make the girls get regular health checks including HIV, further on from that most bar girls are very scared of catching something from the customer, not the other way around...

And you believe this?

[louse1953]

You want to get tested immediately for STDs as most whores are carrying them and the bacteria could be doubling every few hours in your body. As for the "don't stress", you very much do want to stress.

In Thailand, HIV-1 subtype E (accounting for almost 95% of total HIV cases) is transmitted primarily through heterosexual sex, with a predominance of female-to-male infection.

http://www.ncbi.nlm..../pubmed/9240008

June 1997. Got anything more recent to scare the crap out of me with?

As for "most whores are carrying them," the highest figure I've seen ANYWHERE is 20%. Got any evidence for >50%?

You seem scared of statistics,if you got,too late now.Just get tested.You could have had retro virals up to 48 hours after unprotected sex.

[louse1953]

One thing for sure if anybody on this planet was a candidate for HIV it would be I.

I get tested on a regular basis,and utterly refuse a rubber,the only thing I am in Thailand for is the ladies. I am the wrong side of 65 now (just) but still in good shape, whack my heart up to 150 each and every day for half hour or so at the gym,keep myself clean and informed. I have"been at it" throughout India for years and here in Thailand for 5 or so years, sometimes twice a day. I do not accept HIV is easily catchable,I must have had partners who were HIV,but the only thing that I caught was genital warts which I had burnt out.

I do not want lecturing or advising on anything,have a good income and intend to enjoy sex for all its worth. So there,I am circumcised,so probably helps. If,and I repeat if I do become infected I will cease forthwith or revert to a rubber

Well,we all feel a lot safer now.Over 65 and still irresponsible.What about the women you may pass it onto between tests.

[HazyAz]

if it's not all that easy to catch then how are so many people getting infected with it? Don't kid yourself people!

[how241]

Not one in a million. But if it was a single exposure, on average risk would be less than one in a thousand if she was HIV positive and of course nil if she wasn't.

However there is really no such thing as an "average" risk except as a statistical calculation on paper. In real life, infected partners vary greatly in how infectious they are, depending on viral load, presence of any sores or abrasions etc, and people exposed to HIV also vary in their susceptibility depending on a host of factors...in other words each encounter between an HIV+ and HIV negative person has its own unique odds and no one can tell you really what yours was.

And in any event whatever the odds, they are of no comfort if you are on the losing end of them. You can comfort yourself with the knowledge that it is very unlikely you contracted HIV, and then as soon as you hit the 2 week post-exposure mark go on over to the Thai Red Cross Anonymous Clinic where NAT tests are done for all the antibody specimens at no extra charge, these test for microscopic amounts of virus and thus are accurate at early stages. While you are at it, should be tested for other STIs and also Hep B, which is more easily transmitted than HIV (especially if you have not been vaccinated)

And goes without saying, from here on out, always use condoms. And get the hep B vaccine if you haven't already had the series.

Please ignore what you read on the web about various symptoms at the onset of HIV infection. I have worked clinically with many thousands of people with HIV and have yet to meet anyone who experienced these signs, it is rare. If you start to feel like you have the flu. most likely you have -- the flu..

Good post. Thanks for that info.

[manarak]

Not one in a million.

Correct Sheryl, sorry for the mistake, I put a zero too much.

The correct statistical odds are one in 100.000

If the prevalence rate is estimated at 20%, the odds are still only one in 10.000