sabio Posted August 31, 2003 Author Report Share Posted August 31, 2003 Says interviews: Do you have a concise collection of the information you have collected? I included this information as a link in a previous message in this thread, but it seems that the link has become password-protected in the meanwhile. The following is a rewrite of the information and the links. To calculate the protection provided by the HIV antibody test kits with high accuracy such as OraQuick, MedMira Reveal, and Abbott Determine, one needs to consider two factors. 1. The risk that the test returns a negative for someone who has the HIV antibodies. This is one in 250 for OraQuick and a comparable number for Reveal and Determine. 2. The "seronegative window" risk, that is the initial period after infection when a person can infect others with the virus, but has not developed the antibodies yet (see thebody website). The risk is affected by the length of the window, and the infectiousness during it. It is the second component that took most of the research. The one in 250 sensitivity is so large that the risk mostly comes from the seronegative window. First, I thought the only factor of that risk was the length of the seronegative window compared to the professional lifetime of an HIV+ provider (since this would give us an estimate of the percentage of HIV+ providers in their seronegative window). Then came bad news for test kits: Providers are more infectious during the seronegative window because of the high viral load. The viral load measures how much HIV there is in the blood stream. The higher the viral load, the more infectious the person is, which makes sense since there are more viruses to go around. It also makes sense that the viral load gets high during the seronegative window since the antibodies that fight the virus have not formed yet, hence the virus is having a field day multiplying. Then came some good news for test kits. The profile of the viral load is high only for a short period, and the resulting infectiousness increases slowly with the viral load. By calculating the average infectiousness from the profile, we get that the seronegative window is equivalent to 80 days of post-window infectiousness. If the professional lifetime of an HIV+ provider is about 5 years, we arrive at an estimate that using test kits is more than 20 times safer than not using them. As you correctly point out in the other thread, there are symptoms for the HIV seronegative window. The most common symptoms are fever and rash which should be somewhat notable. Although this factor magnifies the edge of test kits, it was not considered in the calculation as it is a bit subjective.a bit subjective. One more factor that favors test kits but was not considered in the calculation is that higher viral loads seem to trigger antibody formation, hence shortening the dangerous "blind" period for the test kits. Link to comment Share on other sites More sharing options...
sabio Posted August 31, 2003 Author Report Share Posted August 31, 2003 Says flyonzewall: a hypothetical, but not unrealistic case: imagine that the girl you are just testing has a positive result, did not know about it yet, and is collapsing in front of your eyes, going suicidal? are you equipped to deal with that? administering those tests on others is IMHO nothing an amateur should do. You bring up the most important practical point in using the test kits. I do not have a complete answer yet, but let me point out some issues. 1. In the case you are referring to, the alternative if you didn't do the test is to sleep with someone who is HIV+. I would guess that this is something a lot of people would go to a great length to avoid. 2. Since the test is not 100% accurate, you can truthfully tell the girl that you are not sure about the result and that she should see a doctor to see if there is a problem. You may even opt to take her to the doctor yourself. 3. If indeed you take her to a doctor, you will have done a great favor to her (treatment), and to many others (would be future customers). Link to comment Share on other sites More sharing options...
kamui Posted August 31, 2003 Report Share Posted August 31, 2003 Says sabio: Says flyonzewall: a hypothetical, but not unrealistic case: imagine that the girl you are just testing has a positive result, did not know about it yet, and is collapsing in front of your eyes, going suicidal? are you equipped to deal with that? administering those tests on others is IMHO nothing an amateur should do. 2. Since the test is not 100% accurate, you can truthfully tell the girl that you are not sure about the result and that she should see a doctor to see if there is a problem. You may even opt to take her to the doctor yourself. 3. If indeed you take her to a doctor, you will have done a great favor to her (treatment), and to many others (would be future customers). Sabio, I admire your emphaty for the girls life and I presume that you speak Thai (or the language of the country where you are going to use the test like Khmer, Spanish, Mandarin e.g.) very well to explain the situation carefully to a girl you just tested positive and I presume you have good sense for Thai BG psychology. And I am glad that you do not refuse the responsibility which comes with a positive result. I just try to put myself in this situation. It is late at night, I had two or three bottles of beer, the girl maybe too. We return to the hotel room and I take out the test. First to get the girl testing is a little bit difficult, because I don't speak any Thai. Anyway I solved the problem and than the result: The girl is positive. What shall I do: I don't speak Thai, she does not speak English well. I say in English: No Sex tonight. I have just found out that you probably have HIV. First I am not sure if the girl understands what I am talking about, after a while the girl understands that I am talking about HIV and breaks down. I try to explain her that the test is not 100% perfect and she should visit a doctor ASAP. But she is not listening anymore and anyway, she does not understand my explanation.... This will be a hard night. Maybe the girl leaves after some time, maybe I need to keep her in the hotel room to prevent her from doing something stupid. And whats next? Since I have brought the message to her about an illness which will destroy her current life and cause her death sooner or later, I think I should take the responsibility to bring her to a doctor to get a confirmation. I presume this would cause some trouble too, because I don't know adoctor, I have to pick her up again, need to convince the girl to go with me to a clinic e.g. And after she received her confirmation? What ever happens next, my relaxed holiday would be over. I am not that hardcore punter, that I could move on by changing bar next evening and forget about her. My conclusion, I am not in the position to test a girl, since I am neither have a deep knowlegde about HIV testing nor I am able to take on the responsibilty which comes with the results of a positive test. I'd better stick to condoms. Sabio, did you actually went through this situation or do you talk about theory? :: IMHO your promotion of this kind of tests is absolutely irresponsible. Maybe because your detailed knowledge you will be able to work with it, but this test in the hands of a drunken, ignorant punter? I hope that this test will NOT be available over the counter in the near future. Link to comment Share on other sites More sharing options...
jacko Posted August 31, 2003 Report Share Posted August 31, 2003 [color:"red"] IMHO your promotion of this kind of tests is absolutely irresponsible [/color] Sorry, but IMHO I feel these tests are a great idea. There must be plenty of people in the world that would like to test themselves in a discrete and private way. Said person may postpone an alternative test for a long period. A positive result will likely change the persons behaviour - for the better. Link to comment Share on other sites More sharing options...
kamui Posted August 31, 2003 Report Share Posted August 31, 2003 Says jacko: [color:"red"] IMHO your promotion of this kind of tests is absolutely irresponsible [/color] Sorry, but IMHO I feel these tests are a great idea. There must be plenty of people in the world that would like to test themselves in a discrete and private way. Said person may postpone an alternative test for a long period. A positive result will likely change the persons behaviour - for the better. What a man does with himself is not we talked about, the question is about the responsibility of testing BGs. Link to comment Share on other sites More sharing options...
sabio Posted August 31, 2003 Author Report Share Posted August 31, 2003 Says kamui: What a man does with himself is not we talked about, the question is about the responsibility of testing BGs. I understand your concern. However, IMHO, I believe that the absolute priority here is avoiding further infection. As long as there is adult consent, the question of testing remains a personal decision. Some people will choose to do it, while others will not. I am not recommending for it or against it. I am just trying to facilitate an informed, civilized discussion about the relevant issues. Your post is a good part of this discussion. Link to comment Share on other sites More sharing options...
rickfarang Posted September 1, 2003 Report Share Posted September 1, 2003 I think that this could be valuable to customersof bargirls if marketed responsibily. If bargirls were aware that customers were testing them, they might be more up-front about their HIV status (HIV+ bargirls sometimes keep working). Those who managed to avoid testing might start testing to avoid the embarassment of having a customer tell them. On the other side of the coin, it would be very dangerous for people to think that a negative result from this test is a green light to charge ahead with abandon. RickF Link to comment Share on other sites More sharing options...
Guest Posted September 1, 2003 Report Share Posted September 1, 2003 Dear Kamui, IMHO your promotion of this kind of tests is absolutely irresponsible IMHO, denying access to these tests will cause easily preventable deaths. I just try to put myself in this situation. It is late at night, I had two or three bottles of beer, the girl maybe too. We return to the hotel room and I take out the test. First to get the girl testing is a little bit difficult, because I don't speak any Thai. Anyway I solved the problem and than the result: The girl is positive. What shall I do: I don't speak Thai, she does not speak English well. I say in English: No Sex tonight. I have just found out that you probably have HIV. First I am not sure if the girl understands what I am talking about, after a while the girl understands that I am talking about HIV and breaks down. I try to explain her that the test is not 100% perfect and she should visit a doctor ASAP. But she is not listening anymore and anyway, she does not understand my explanation.... Now, I appreciate your complex hypothetical scenario, I cannot respond to every hypothetical situation one might devise, so I would like to relate to you my actual experiences with these tests here, including a girl who tested positive late one night. First let me say that when the tests are finally made available to the public, over the counter, at every pharmacy, they will then contain items similar to these which I hope would allay most of your fears: -Instructions in Thai, English, German, French, Italian, Spanish, etc., as well as pictorial instructions. -Information that NO HIV test is 100 percent accurate. -Negative results in the literature would be stated as "Likely Negative"" and Positive results as "Re-test" , with instructions to call for counseling and be re-tested if the result is "Re-test". -Phone numbers to a 24 hour hotline available for Thai speaking persons so they could be counseled in the event that the tests results were questionable. I know Thai Doctors and Nurses who would and have volunteered for this duty. -Every test would contain a condom, and advice to use it, as well as other useful information about STD's, and counseling services. Let me also say that the proper place and time to have an HIV test is in the privacy of your home, before you have sex with a new partner. NOT AFTER you have been infected by, or infected, them; Just as the proper place to to have a glucose test is in the privacy of your home, before you inject yourself with insulin. It is also accepted that this is the proper place for pregnancy tests, ovulation tests, cholesterol tests, colorectal cancer tests, and others. The US FDA believes that it is acceptable for people to receive the information that they have HIV without a doctor or counselor present, in the privacy of their home. They do not believe people will go suicidal and kill themselves. The US FDA has approved home test kits for HIV; although these require a three day wait for the lab to process, after which you call in with a unique PIN number and the tests results are given to you by an answering machine. Privately. WITH NO COUNSELOR PRESENT! There is little difference between this test and the rapid test except the factor of time, which is critical if one is hoping to stop the risk of infection. NOW BACK TO MY STORIES - when testing the viability of providing access to these tests, we would have entire bars filled with girls sticking their fingers out at us asking us to test them. We tested entire bars. They would generally giggle and laugh alot, then run and hide in the bathroom while their tests developed. Oddly enough, none of the girls we tested in this manner were positive (we were not in Bangkok or Pattaya). The bar girls were the most eager to be tested by us. Why? THEY DID NOT WANT A THAI DOCTOR OR MEDICAL AUTHORITY TO TEST THEM!!! If they were positive, they did not want anyone else to know, especially the Thai medical community! They would avoid testing for this reason. They believed they would suffer some type of repercussion if this were on their medical history. THE POSITIVE GIRL - Ja - One night, on Songkran, I met the girl of my dreams at a disco, she was 19, and a picture of health. She charmed me, I was hooked, I really liked her. When we arrived at my house she cleaned the whole place, washed the dishes, cooked a meal, took a shower and came bouncing out in her tiny towel. I prayed to God that everyone was wrong and it could work out between a Thai and a falang. I asked her if she would test and she cheerily agreed. She was positive. We tested her again. She was positive. I told her that she needed to be retested at a hospital and I put her on the phone with my partner who is a Thai MD. They spoke for about 10 minutes. I was completely distraught. This angel of a girl - 19 - had HIV. She smiled and calmed me down and comforted me all night. The next day we took her to the local clinic and she tested positive again. She told me not to cry. She left that day to go home without saying a word. She got in touch with a friend of mine who sent me her photo and cell number after I returned to America. As of two years ago she was working, but now her cell phone number is not. Should I have stayed with her anyway? I don't know. But, if I had not found out this information on that night, I could easily have stayed with her long enough to have have had an accident while in using a condom. Also, after we parted, she could have wound up unknowingly infecting many others (she said she always insisted on a condom after she found out she was HIV+). Yes, it was a difficult experience, but I am HIV negative.... Now another case. A friend of mine is a male nurse in Miami. He took a girl home on Pattaya and while they were having sex, the condom broke, and he finished anyway. When he turned on the lights there was alot of blood. She was on her period and informed him that she was HIV+. He wished he had brought tests with him on that trip and used them. He is still HIV- today. Those are some of my experiences. I hope the general public starts using these tests regularly soon. Allowing the general population access to these tests WILL help stop the spread of HIV. If someone you know tests positive please provide them with the following phone#'s - The following organizations claim counseling support for Thai people: #1) Wednesday Friends Club Hotlines 02-255-7893, 02-255-7894. ALSO: Counseling Centre & HIV/AIDS Clinic Hotline Tel. 02-276-2950, 277-7699. Fax 02-691-4057. Bodang Drop-in Center 830 Galaxy Lane, Thanon Rama IV, Bangrak, Bangkok. Tel. 02-255-7893, 02-255-7894. Hours: Mon.-Fri. 12.00 to 17.00; Sat. 09.00-12.00 Anonymous Clinic ? Thai Red Cross 1871 Thanon Rama IV, Bangrak, Bangkok. Tel. 02-256-0410 Other resources here - AIDS Resources Link to comment Share on other sites More sharing options...
jacko Posted September 1, 2003 Report Share Posted September 1, 2003 Good posting. Sad and profound. Link to comment Share on other sites More sharing options...
sabio Posted September 2, 2003 Author Report Share Posted September 2, 2003 Says interviews: IMHO, denying access to these tests will cause easily preventable deaths. I agree with you, and I appreciate the fact that you substantiated your opinion with real experiences. I also second your suggestions about the test kit instructions and support infrastructure. Link to comment Share on other sites More sharing options...
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