Issues on sex with

Discussion in 'The Healthy Penis' started by Meniswallow, Jun 30, 2004.

  1. Meniswallow

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    there's this guy i like, we haven't had sex yet, and he's hiv poz, i just wanted to know the do's and don't's, i know we can kiss thats fine, but when it comes to oral sex, i'm not so clear on that, i kno we will wear rubbers, i wanna kno what u guyz would do or talk about if u were in my situation. any response would be greatly appreciated
     
  2. ericbear

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    I had an HIV positive boyfriend for several years, and remained negative when we parted. For various personal reasons, he refused to take his meds (one of the contributing factors to our breakup), and was therefore walking around with a vital load in excess of 200,000 (essentially off the chart). Today, meds generally reduce the viral load to near zero. It is not clear that a low viral load reduces the risk of transmission, although logic says it would. However, even with my partner's very high viral level, transmission did not take place.

    Here are things to consider:

    Kissing, even wet, is fine. There is some evidence that saliva even destroys the virus, and in any event is not a potent transmission mechanism. However, both of you should keep in good dental health, so there are no open fissures in the gums, etc, to avoid any possiblity of blood transmission. From time to time, my ex would have cold sores and similar lesions. During this time, or if I had a similar problem, we avoided mouth kissing, and settle for a snuggle on the cheeks. The biggest concern with kissing is to remember that your partner's immune system may not be highly effective, and you need to take care not to tranmit anything to him (cold, flu, etc.)

    Fellatio is considered low in risk, but perhaps a better word is lower risk, because it has not been proven safe. I very rarely suck, and do not believe I ever sucked my ex. He often sucked me. He also produced utterly astonishing amounts of precum, which got all over and in everything. He would cum on (not in) me all the time. We just took precautions that my skin was unbroken where he was going to shoot.

    I do not receive anally. When I penetrated my partner, we always used condoms and ample lubrication, with the exception of two times when he sort of just took me in unexpectedly, and I foolishly continued.

    Some precautions need be taken in the event of cuts or injuries, etc, which lead to bleeding. Here it's just necessary to use common sense.

    I believe it is perfectly possible to remain negative in a long term relationship with a positive partner. However, the risk is not zero, so you should consider how you really feel for this person.
     
  3. Meniswallow

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    thanks eric i appreciate ur reply, very well thought out. but what about the other way around, i'm bottom, he's top. any suggestions ?
     
  4. jonb

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    Actually, sex with a partner you know is HIV-positive with a condom is riskier than sex without a condom with a partner whose HIV status is unknown. It's because HIV/AIDS is a rare disease; it only occurs in a little over 3% of MSM, and less than 1% of everyone else.

    Basically, the rule for HIV is that penetration is a Bad Thing. Mutual masturbation's completely safe, provided he ejaculates on healthy skin. Other than that, not much. Avoid anal at all costs; it's 50 times riskier than fellatio for the receptive partner, and 13 times riskier than fellatio for the insertive partner.

    Also, don't share razors, toothbrushes, syringes, needles, or "works". (While we're here, get a special container for these items when he discards them and slap a biohazard sticker on it.) Toothbrushes are less likely, but for any of the other items mentioned here, the probability is close to 1 that you'll get AIDS from sharing these once with an HIV-infected partner.

    Oh, and also make sure to minimize his risk for infection from other diseases. Once you contract HIV, you have to be very careful not to get infected. So if you think you're sick, stay away from him until you get better.
     
  5. ericbear

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    The statistics presented by Jon can be misleading.

    First, from his previous previous posts, I believe that he places little faith in the efficacy of condoms. There are in fact many studies, which if taken on the basis of the summary data, appear to support that condoms fail some 30% and even 40% of the time. That wouild make condoms appear next to useless. However, it is necessary to understand how these numbers were generated to understand their applicablity to a given situation.

    It is important to understand how the researchers define "condom users" and "condom failure" in many studies. The layman might presume that a condom user is someone who actually has a rubber on his dick, and that condom failure represents some mechanical breakdown of said rubber. But this is not how the statistics are compiled in most research. A condom user is any person who says he uses condoms, buys condoms, or makes condoms available. Condom failures include having sex without using a condom. Thus, by these definitions, HIV transmission which occurs because no condom at all was used, but by a person who considers themself a condom user, is called a condom failure.

    This is in fact a correct way to analyze the efficacy of condoms, because it includes all failure modes in the condom usage chain, including ones that happen in someones brain, not the latex. It therefore gives an good picture of the overall efficacy of the "condom method."

    However, in such studies as do break down the individual failure causes, it becomes clear that the failure to put the condom on in the first place is one of the more dominant mechanisms. A strong second cause is misue of the condom, resulting in slippage or breakage, which would not have occured had it been used correctly. These factors have the effect of significantly lowering the effectiveness of condom use. However, according to who you are, how tight your head is screwed on, and where and how you have sex, these human failings may not apply in your specific case.

    If you believe that you can use a condom consistently and properly, rather than considering the data from studies of the general population, which include inconsistent/improper condum users, you should consider the data for consistent users. However, such studies also have a problem in interpretation. In may cases, analysis of the data uses the so called "continuity correction" factor, which in some cases makes the efficacy appear drastically lower.

    The continuity correction is applied because of an issue in sampling. The usual method of doing eficacy data analysis is to construct a 2 by 2 matrix, the "contingency table" of numbers. One column is the condom users, the other the non-users. One row is the number of people who seroconvert, the other is the number that don't. These 4 numbers are then used to calculate the risk ratio, indicative of the effectiveness of condom use. However, the raw data in many of these studies, particulary ones modest sample sizes, show zero of the condom users seroconverting. In this case, to obtain a conservative estimate, the statisticians frequently add a "continuity correction" to the zero values. For example, in Weller's 1993 study, 10 sets of data from published studies were analyzed. In 9 of the studies, there were zero cases of seroconversion among the condom users. However. Weller replaced each zero value with 0.5, and then she proceeded to calculate that condoms were only 69% effective in preventing HIV transmission. This is in fact a valid statistical technique, used to arrive at a conservative estimate in the presence of the sampling error. However, particulary when the sample sizes are modest, this can lead to a very pessimistic estimate of the risk.

    Such methods of conservatively analyzing data are well received by many. They have played a heavy part in the arguments of the Catholic Church, among conservatives, etc. (These same methods, and similar results, have been used for predicting the ability of condoms to prevent pregnancy, too.) By using pessimistic estimates, conservative groups are able to promote the idea that the only safe way is abstinance, or its equivalent.

    Strictly speaking, they are correct. However, abstinance denies you certain basic human joy. Most things that are fun bear a risk factor. You could go skiing, but if you have an accident, you might end up paralyzed for life, or even dead. But people still ski, because time has shown that the risk of these things happening is adequately balanced by the enjoyment it brings.

    Therefore, no one is doing you a favor by overstating the risks. Yes, if you don't fuck, you may have zero risk of ever getting HIV. But, if you insulate yourself too much, you may also never meet the man of your dreams, who could end up being you lifelong partner, too. So, rather than being ultra-conservative in the assessment of risk, it is probably better to attempt to make the most accurate determination possible, not the most conservative one.

    Some researchers have revisited the data, in an effort to extract more realistic projections. In part, this is possible because there is now a larger body of data, which allows sampling uncertainties to be reduced, provided that the individual data sets meet statistical tests which allow them to be pooled. Pinkerton and Ambramson write the following in their 1997 paper (Soc Sci Med May, 1997 Vol. 44, No.9 pp. 1303-1312 "Effectiveness of condoms in preventing HIV transmission" Stephen D.Pinkerton and Paul R. Ambramson):

    Table 2 presents the studies evaluated in the present analysis of condom effectiveness. The nine sources of data include four studies (Fischl et al., 1987; Goedert et al., 1987; Johnson et al., 1989; Laurian et al., 1989) analyzed by Weller, two that were explicitly excluded from her analysis (Roumelioutou-Karayannis et al., 1988; van der Ende et al., 1988), an updated report by the European Study Group (1992) and two recently published studies (Allen et al., 1992; Saracco et al., 1993). Four additional studies have been identified that, though relevant to the present analysis, were published too recently to be included (de Vincenzi, 1994; Guimaraes et al., 1995; Nicolosi et al., 1994a,b ). Although Warner and Hatcher (1994) identify Goedert et al., (1987) and Laurian et al. (1989) as the only two of Weller's original studies to measure consistent condom use, and therefore the only two relevant to evaluating the method effectiveness of condoms, closer inspection of the remaining studies suggests that several apparently did, in fact, assess consistent use, although in some cases under the rubric of "regular" condom use (European Study Group, 1989, 1992; Roumelioutou-Karayannis et al., 1988). The remaining studies examined by Weller were excluded from the present analysis because consistency of condom use was not reliably assessed.

    Overall, in the nine studies listed in Table 2 there were only four seroconversions reported among 277 (1.4%) steady partners of HIV-positive men and women who consistently used condoms. In contrast, when condoms were used inconsistently or not at all, 171 of 867 (19.7%) sexual partners seroconverted. A crude measure of the overall effectiveness of condoms at preventing the transmission of HIV is provided by the complement of the pooled risk ratio, 1-(4/277)/(171/867) = 0.93. Thus, according to this simple analysis, condoms are approximately 93% effective when used consistently.

    The effectiveness estimate based on the Mantel-Haenszel relative risk (calculated with a 0.01 continuity correction) is similar in magnitude, Eff. = 1 - RRMH = 0.94, with a 95% test based confidence interval (Hennekens and Buring, 1987) of 0.87-0.97. For male-to-female transmission only, the effectiveness estimate is nearly identical with a slightly wider confidence interval, Eff. = 0.94 (CI:0.87-0.98). Unfortunately, the male-to-female data are too sparse to permit reliable estimation of condom effectiveness for this transmission route; however, in the two relevant studies there were no seroconversions reported among 13 consistent condom users, whereas 21 of 169 inconsistent users became infected (European Study Group , 1992; Allen et al., 1992). Thus, based on the data summarised in Table 2, the overall effectiveness of consistent condom use for HIV prophylaxis is at least approximately 90 to 95%.


    Thus, this work puts the effectiveness of CONSISTENT and PROPER condom use at about 93%, a far cry from the 60% claimed by other, ultra-conservative analysis.

    BUT the remaining ~ 7% risk estimate is still quite high! As Jon pointed out, you might as well fuck without a condom in the general gay population, which averages around 5% positive, and you would be less likely to get HIV, or so it would seem.

    However, there is more to the story. First, if you are going to fuck with a partner other than absolutely known negative, it is worth using a condom, as the properly estimated risk reduction is by a factor of 15 or 20 over not using a condom. Many of us are not so lucky as to be able to find an HIV negative partner, so we have to make the judgement. Someone can tell me all they want that I should only have sex with HIV negative people, but if there is no such person willing to share their life with me, that's not an option.

    Second is that the statistics which show only aproximately 4 to 5% of the gay male community, and about 0.8% of the general US population as being HIV positive may not be entirely correct. The federal statistics do not include HIV cases in New York, Florida, and California, because these states refuse to disclose the names of the infected persons when they report cases. Under current federal policy, cases without names are ignored. However, the reason these states do not disclose is because they have large numbers of people living with HIV, at least in certain cites, and these people had enough political power to get their privacy rights protected.

    For example, the city of San Francisco reports about 18,000 residents living with HIV or AIDS, and a population of around 780,000 (both city only, not SF county). That works out to 2.3% of the general population being infected, triple the national average. (Source: SF Aids Fondation, http://www.sfaf.org/aboutaids/statistics/). I've heard rumor that the gay population of San Francisco is about 15% of the total. The source cited above says that 76% of the cases are male homosexual. Putting these numbers together suggests that about 12% of the gay male population of San Francisco is HIV positive.

    So, it you happen to live in San Francisco, or a similar city demographic (LA, NYC, etc.), the probable rate of transmission with a condom and a known infectious partner is about half of what you would have with random bareback fucking, not higher as Jon suggested.

    Further, there are other factors that tend to make the rate of infected people higher in groups where you might either have casual sex, or go husband shopping. One of the ways of staying negative is to have a long-term, stable monogamous relationship. As such, a certain portion of the negative people are spoken for in such relationships, and are less likely to be in the "available" population, making for a higher positve rate among the "availables" than the statistics suggest. If you are looking for casual sex, rather than looking for a mate, this is even more so.

    My third, and real objection, to Jon's comment is something that I didn't really want to get into, because it is very easy to imply the wrong thing. In the last few years, HIV therapy has advanced dramatically, to the point where zero viral load is a commonly attained goal. However, much of the transmission data, and analyis of risk, comes from a while back, when this was not the case.

    It seems logical that a low or zero viral load would inhibit transmission of the disease, since the bodily fluids commonly transferred have few if any virus particles. (Please understand that the virus remains in other cells of the body.) However, until recently, researchers have been very reluctant to make any statement of this type, and instead maintained that infected people, even with zero viral load, should be consided as contagious. There were a number of reasons for this conservative approach, including that no one really knew for sure, and the possibility that making such a statement would lead people to pop a few pills then go on bareback fuckfests (which is why I am reluctant to get into this).

    However, it is now becomming apparent that there is a dramatic reduction in HIV transmission risk when the viral load is reduced. Statements to this effect are now being made by public health authorites. When a dramatic spike in syphilis rates occured over the past two years in LA, SF, and NY, authorities expected a synergetic spike in HIV rates, since the increased syph was indicative of unsafe sex practices, and syph sores themselves are gatways to HIV infection. The HIV spike didn't materialize, which is now attributed in part to reduced HIV transmission because HAART therapies are today so effective at reducing viral load.

    Back to protected sex with an known-positive partner vs. unprotected sex in the general population. If your partner knows he is positive, he is probably receiving HAART therapy, or at least you can be sure he is, and can know what his viral load is. If his load is undetectable, the risk of sex, particulary with protection, is significantly lowered. However, in the general population, people often don't know they are infected. (Some people remain asymptomatic for a decade after infection. Recent studies, although I believe them to be flawed, indicate most positive people don't know it.) Therefore, an unknown person in the general population, while he may have whatever possibly small chance of being infected, may also have a very high viral load, and be potently contageous.

    Therefore, the risk of unprotected sex with the general population is probably vastly greater than protected sex with a know-positive, but undetectable viral load partner.

    In assessing the risk of having a relationship with a positive partner, you should speak with your and their doctor (go to the office together) to understand his health, his treatment plan, and his viral load. One of the things that led to the split with my ex was his refusal to be honest (in fact he lied outright) about this sort of issue. However, do not depend on a low viral load alone. Also use whatever protection, precautions, and common sense you can. Each of these factors incrementally reduces the risk. At some point you might still contract the disease. But, there are risks in everything we do, and you have to seek out the correct assessment of them so that you can make the decisions that are right for you.
     
  6. BobLeeSwagger

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    I think I would split the difference here. One the one hand, when used correctly, condoms are pretty effective at blocking HIV. And HIV is not a disease that transmits easily. It needs an almost perfect transfer of bodily fluids at body temperature to infect another person. So the risk from sex with an HIV+ partner is greatly reduced with a condom.

    But it's still there. And what if this partner is not taking the proper medications to reduce the presence of the virus in his body? And can you assume that he'll use a condom every single time? Even if you're both drunk or something? And in the heat of passion, there can be a temptation to not use a condom. (As a straight guy, I've had that happen too.) And although the low presence of HIV might reduce the risk too, that might be balanced by the risk of having sex with an HIV-infected person repeatedly. Mistakes can happen and, once in a while, condoms DO fail even if you're using them correctly.

    My opinion? It's a bit too risky to receive anal sex from someone with HIV, even with a condom. This is the most risky sexual behavior for transmission and, even with protection, you're still rolling the dice. Be careful out there.
     
  7. chris88

    chris88 New Member

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    Are you willing to die a painful death for the pleasure you are having with this guy? You can become infected by oral sex (fellatio, only cunninglingus if he has a cut or something.) Condoms are not foolproof, they can break and slip, and the evidence isn’t even completely conclusive that latex is truly effective. Pursuing sexual activities is truly dangerous, including oral, as you asked. The virus is not totally predictable. There is even a documented case of someone catching it from a shared razor. There is no infallible way of protecting yourself if you pursue these activities. Is he worth it? If he really is, then proceed with caution. If not, then no protection will be enough short of not going ahead.
     
  8. jonb

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    Eric, dearie? I got my stats from the Center for Disease Control, thank you very much. The Center for Disease Control says that condoms fail 5% of the time. Now, assuming the oft-cited 10% figure, only 3% of MSM have HIV, also from the CDC. Do I really have to school you in remedial math too?

    Of course, your odds of getting AIDS from one case are fairly rare.

    Oh, BTW, defining "condom user" as including those who sell condoms? Do you honestly think anyone's that stupid?
     
  9. KinkGuy

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    Are you willing to die a painful death for the pleasure you are having with this guy?
    Is he worth it? If he really is, then proceed with caution.
    chris88


    Just about to celebrate our 8th anniversary. He's HIV Poz and I am not. We have plenty of sex. Everything in life carries a risk. We are careful and loving and concerned with each other's well being. He has been HIV+ for 15 years and is extremely healthy. There is one factor which may play an important role...I do not bottom and haven't in many, many years. Not receiving anally is documented to be somewhat safer. We do perform mutual oral sex. That's a calculated risk.
     
  10. ericbear

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    Jon:

    I appears you are being tricked by inapplicable data, despite that it may be from the CDC. With regard to my analysis of HIV in a particular city, I prefer to use data from the local health agencies or organizations, due to the politics of reporting to federal agencies.

    However, to humor you, I will present the correct CDC data. I refer you to the CDC Morbitidty and Mortality Weekly Report, vol 50, #21, the section beginning on page 440, avilable online here:

    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5021a4.htm.

    You will find a study of young MSM HIV infection incidence rates for 7 major US cities. The overall pooled average young MSM HIV infection incidence rate for these cities is 7.2%, with New York being the highest at 12.1% (see table I), straight from the CDC. (Many other CDC documents cite this data from this report, suggesting that this data has withstood critique and review.)

    The 3% figure that you cite is obtained by considering the entire US population, including rural areas, and by considering all ages. It does not reflect reality for young men in an urban environment, such as the original poster.

    The 7.2% and 12.1% figures cited above are for MSM in the age range of 15 to 22. While breakdown by age within each city is not provided, for the pooled results the incidence rate is 53% higher for a subgroup 20-22 than for the 16-19 year old subgroup. This makes sense, since as people become older they begin having more sex, and have more time to contract the disease. However, if someone, say, 21 years old seeks to date other people within plus or minus one year of their age, the 7.2% and 12.1% are low estimates, since they are diluted by the younger population included.

    Since the original poster is about 22 years old, and lives in New York City (according to his profile, which I checked before answering), it seemed most relevant to consider the infection rates in his age group and location. By the CDC estimates in the document cited above, the MSM HIV incidence rate is over 12% in his city and age group, the same as I had approximated using San Francisco's city data. In fact, the incidence rate is likely to be higher, because of the age factor noted above, but without more data on the demographics of the study group in each city, the exact number cannot be determined.

    By the way, I said nothing about selling condoms. As you can verify, I said that in the mixed consistent/inconsistent use studies, anyone who buys condoms with the intent of using them, or makes the effort to have condoms available where he has sex, is considered a condom user, even if the condom does not get placed on his penis (he is then considered an "inconsistent" user in the jargon of the reports.) As I pointed out, for certain purposes, it is entirely correct to consider such people to be condom users, because the statistics then capture one of the important failure modes of condoms, the failure to put them on in the heat of the moment, despite the best intentions when buying them. Bear in mind that the study techniqes used to evaluate condom performance against HIV are based on the methods used to evaluate their contraceptive ability, since these are the methods that have withstood peer review in the past. This makes considering "didn't put it on in the heat of the moment" as a failure mode make more sense, since this is a failure mode avoided by other contraceptive means, such at the pill.
     
  11. chris88

    chris88 New Member

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    I did not mean to imply a certainly, but was making it clear that it would be unwise to proceed if the negative potential result of the risk was not worth it. What you are doing is indeed proceeding with caution, and carries the risk you have obviously accepted.
     
  12. Imported

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    Tender: ...
     
  13. jonb

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    Major cities. Did I forget to mention that most Americans don't live in major cities, or that AIDS infection rates are going to be higher in major cities? In a major city, of course AIDS rates are higher. As a general rule, your odds get even better if your partner tested negative last time; that only leaves a window from six months before that test to today that your partner could be positive.

    The bottom line is, condoms fail, so you shouldn't really rely on them unless you're gunning for Darwin Awards.
     
  14. chris88

    chris88 New Member

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    One in a million? I would think there is more than a .00000001 chance of failure.
     
  15. ericbear

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    It doesn't really matter where most people live, because there was a specific question from a person who does live in a large city, and I bothered to find this out before answering, so as to give the correct specific answer, instead of a generalization not applicable to his case.

    By the way, you may be interested in the population data from the 2000 census, which shows more people live in cities than you think:

    United States Population:

    Total: 281,421,906

    Urban: 222,360,539

    Rural: 59,061,367
     
  16. Imported

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    maverackstud8: I can't speak much on this,but my cousin and boyfreind dies of aids.
    I think it was stupid of him to be so careless.The whole thing was sad.
    The two could been around,if somebody took some care and remained royal.Not much else I can say.
     
  17. jonb

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    Well, the good news is, you can't get AIDS from mutual masturbation unless he ejaculates on an open wound. Now, from there, relative risk (RR) is a formula: Multiply your risk by the amount here.

    Heterosexual partner
    HIV-negative......................1
    Unknown status................47
    HIV-positive..................4706

    MSM partner
    HIV-negative.....................1
    Unknown status...............43
    HIV-positive..................430

    Activity
    Insertive fellatio...............1
    Receptive fellatio.............2
    Insertive coitus..............10
    Insertive pedication........13
    Receptive coitus.............20
    Receptive pedication.....100

    Condom use (Use only one.)
    Yes.................................1
    No................................20

    Source: "Reducing the Risk of Sexual HIV Transmission," Varghese et al, Sexually Transmitted Diseases, January 2002

    Basically, what it means is this: If you're having sex with a woman (if male) or a man who doesn't have sex with men (if female), your risk is 47 times greater if you don't know their HIV status than if your partner tested negative last time, and a full 4706 times greater if you know he or she tested positive last time. If your partner is a man who has sex with men, and thus is already at higher risk, if you don't know your partner's HIV status, it's 43 times riskier than if he tested negative last time; and if he tested positive last time, it's 430 times riskier than if he tested negative last time. Note that these do not tell the relative risk between MSM and non-MSM: For that, you have to divide the MSM partner's relative risk index by 430 and multiply by 4706.

    Now, on to activity: Fellatio's the safest, mainly because there isn't much thrusting involved and thus less risk of rupturing the orifice. The risk is twice as much for the receptive partner as for the insertive partner. With coitus, the risk is ten times greater than fellatio for both partners; the healthy vagina is actually quite difficult to damage, but still not as safe as fellatio because thrusting is involved. But with pedication, the risk is 13 times greater than fellatio for the insertive partner and fifty times greater than fellatio for the receptive partner because the anus is thinner.

    Finally, if you don't use a condom, multiply by 20.
     
  18. Imported

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  19. jonb

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    About an AIDS cure or vaccine: A vaccine's a pipe dream. The damn thing mutates so much that you can't possibly vaccine HIV-positive couples. Similarly, no one's ever cured a virus: As I see it, the only way to cure a virus would be to

    1) Raise T-cell count.
    2) Inhibit reverse transcriptase.
    3) Purge the body of the virus.

    I know of drugs which can do the first two, but I don't know much about 3. Prevention's still the easier route: That can only be done via needle exchange programs and social acceptance of gay marriage, neither of which is legal because of politics. (Statistically speaking, Indian MSM are less likely to get AIDS than white MSM; my hypothesis is that it's because there's more of a network supporting same-sex couples staying together.)
     
  20. Imported

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    maverackstud8: That is what this site said.Crap nobody has cured diabetes either -something I know alot about.Family member.There are things can done to aid the decease,but no cure.If have a family member with it pretty bad and life long-always in the back of your head.


    --------------------

    Maveric stud-8 inches-handsome stud.
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