AIDS

[andrewfi]

I am of the generation that has grown up in fear of HIV and I think that like many of my generation we have come to realise that we have been lied to in the interests of politics and 'gay rights'. If the truth were to have been made plain a generation ago then the backlash against homosexuals would have been horrid to have seen. The bottom line is that in Western Europe and the US HIV/Aids IS a gay plague.

In the FSU it is largely a drug injecting thing and given attitudes toward drugs around here, it is thus overwhelmingly an economic issue - only the poorest use injected drugs. This means, in practical terms, that one is much, much more likely to get run over and killed than to contract HIV as a result of an isolated, non-anal, heterosexual sex act with a random woman. The risk falls considerably if one avoids ethnic Russians and effectively disappears if one has sex only with women who have regular employment and don't live in Narva. A similar situation applies in Russia.

My concerns are much more about herpes and other 'normal' stds. Given that prevalence of herpes is similar to the US at about 40% of the population, I count myself lucky to have gone over half my life and not contracted the virus - or if I have I am a carrier and not displaying symptoms. Thus, one covers up to avoid pregnancy, or stds, Aids is not an issue, unless you enjoy rough sex with poor women.

[smartcat]

My concerns are much more about herpes and other 'normal' stds. Given that prevalence of herpes is similar to the US at about 40% of the population, I count myself lucky to have gone over half my life and not contracted the virus - or if I have I am a carrier and not displaying symptoms. Thus, one covers up to avoid pregnancy, or stds, Aids is not an issue, unless you enjoy rough sex with poor women.

Well, scientists still vary in their estimation of HSV-2 ("genital herpes") and HSV-1 ("oral herpes"), their role in genital infections. While in University I once asked our professor giving us lectures on immunology, does the principle of "solitaire" work with these varies? I mean, if a person is infected with HSV-1  since childhood, does it mean that he/she is of low risk to be infected with HSV-2? She had difficulties to answer, as other practising doctors later too.

There's something some men can find interesting. As you perhaps know, it was "no sex in USSR". No porn, no sexual movies, no erotic photo in magazines, etc.  Early 1990s had gradually changed people's mind while all became available. For instance in late 1980s or early 1990s people used oral sex less. The more they were educated - the more they were feeling relaxed at this point. But countryside people, or small town populations often found it "sinny", "dirty", related to gays or prostitutes. I read once quite interesting article with statitistics that HSV-1 on genitals started to appear much more often as far as people became "sexually relaxed".

About condoms. No, they don't chew them. But for some stupid reason soooo many FSU men say- "what the hell I use it, I never sleep with "bad" girls, thus I am free of any infections." Sometimes women say the same. When they get into a laboratory detecting STD ( I was working at one) and they find something positive, first they do - they try to guess wild who looked as "good" from their past and appeared "bad".

We discussed it sometimes gathering for a party with friends. And almost all the time you can hear from some men "I choose the good girls to sleep and I hate condoms".

At least it would not be bad to have anticeptic solution at hand. Russian not bad brand is Miramistin solution. Could be used as in-urethral postcoital application or in any other cases, like sore throat.

[jb]

Smart Cat,

You have given me too much information, there is no way possible I can keep all of my love life straight if I have to follow your rules.  Well,,, actually, I can,,, because I only have sex with the one who is legally authorised to sleep in my bed.  The wife, or the mommie of the family, that's who.

Well, gee whiz, it's easier than I thought, just be faithful to the one you married.  How hard is that?

[smartcat]

JB, this section is not for married but for "starting out", right?  I still guess all are adults and might be very possible making "test-drive" for sexual compatibility while still dating. Of course, it can vary for religious or any other reasons. But I am still talking about majority.
I still have doubts that this majority marry virgins from FSU. If they don't marry virgins, very likely their previous sexual past included some local partners. Also very likely you can be said that you are "just second" after her husband or boyfriend. Which is not the truth often, sorry to say. Or it could be just not discussed by ethical reasons. In any case it would not harmful to know that if you are sleeping with somebody - you are sleeping with her-his past. And her-his partners' past too. And, as I mentioned, many of them find condoms boring... It's up to you to have conclusions, it's YOUR health.

[andrewfi]

The concept that one is having sex with all a person's previous partners doesnot really fly for HIV, although it was one of the early scary stories when governments were trying to persuade us that anyone could catch AIDS (usually they did not use the term HIV back then!)

It is more valid for the more readily transmitted STDs though, including Herpes, but in reality, Herpes is almost normal in the population, it is probably not even worth while trying to avoid it.

[lindochka]

The PCR is not widely used to detect HIV because it's extemely expensive, particularly compared to the standard antibody testing. Standard antibody testing is highly accurate when performed and interpreted properly. Generally a PCR is done only when standard antibody testing (ELISA followed by a Western Blot if the ELISA is repeatedly reactive) provides a questionable result.

According to US military statistics, the ELISA is 99% accurate for positives as confirmed by the Western Blot. There is only one specific Western Blot result which would strongly indicate the need to do a PCR, and the test would have to come out that way more than once before a knowledgeable physician would order a PCR. (A physician who is not knowledgeable might just tell the patient he has HIV -- I've seen that on multiple occasions in the US.)

I would be surprised if the presence of active TB were to be used as some sort of evidence of a person "having AIDS," since it's pretty standard to rule out HIV via antibody testing when a person is shown to have TB (or hepatitis C, for that matter). All my patients who are positive for TB exposure or hepatitis C antibodies are automatically sent for HIV antibody screening and vice versa because the presence of any two of those diseases together makes the treatment of both of them much more complex.

Anyone entering the US as a lawful permanent resident alien has been tested for HIV antibodies in their immigration physical. Immigrants from Africa are screened for both HIV I and HIV II. In general, persons with a positive result are not admitted, but this is not always the case. I currently have three patients, two from Africa and one from Ukraine, who were admitted despite being HIV+. They were admitted for purposes of maintaining family unity and had to agree to obtain and remain in appropriate medical care. (This is monitored jointly by USCIS and the CDC.)

All the Russian-speaking patients currently in my HIV clinic are natives of Ukraine. Only one (who happens to be a gay man) became infected in the US. The other men caught it in Ukraine, via sex with women. They are not injectible drug users, though injectible drug use is not a new phenomenon in Ukraine, which was a way station on the opium trade route even in the days of the Tsars.

Pack some condoms and plan to use them unless and until you can be sure you don't need them. STD is on the rise over there -- women generally don't have symptoms of nasty stuff like gonorrhea and chlamydia and many men aren't aware of that fact. You'll also reduce your risk of being part of an unplanned pregnancy and its consequences with someone who might not be the woman you want to spend your life with.

JMHO.