My HIV Story
HIV is a fact of life in Thailand. What you don't know about it can kill you.
This is my story. Names have been changed to protect the innocent. Other than that, the following events are true to the best of my recollection. Anything less would be socially irresponsible.
A couple weeks ago, I met Lina online. She was knockout gorgeous, and very friendly. We chatted a bit. Seeing how popular she obviously was on the website, I basically gave up on dating her, and just tried to make friends with her, so that I could learn about how best to find a girlfriend amid the increasing "female deforestation" of Thailand, which I alluded to in a previous post. After explaining the problems that I've encountered in the dating scene, she unfortunately offered no suggestions, and instead modestly offered to "pray for" me.
Suddenly, she had to quit chatting in order to attend to something. She disconnected before I could ask her anything else. Fortunately, she had given me her number, so later that night I invited her out for coffee via SMS.
On occasion, Thai girls return SMSes more than a day later. But 2 or 3 days elapsed, and I did not hear back. Ironically, a few hours after my previous post to Stick, I got a bizarre SMS from her. She said that she was alone for the weekend, and wondered if I would like to join her to go out for fun. The offer was so out-of-sync with our relatively platonic relationship, that I assumed it was an SMS broadcast to all her friends, in order to arrange a party. But I wasn't sure, so I called her.
To my surprise, she confirmed that it was to be just the both of us. I happily accepted, still somewhat suspicious that this was some sort of bar girl scam. As she lives in another city, I took the bus and arrived to meet her at the bus station. She arrived a few minutes after I got there, on her motorbike. She was as gorgeous as advertised, and quite helpful, considering that I didn't know my way around this unfamiliar place at all.
We found a decent hotel shortly thereafter, so I could clean myself up for going out. You can imagine my surprise when the first thing she requested is that we go to a bar. I was sure at this point that she was a bar girl.
As it happens, I could not have been more wrong. It is simply that her friend owns the bar, and she likes to go down there for drinks on occasion. She actually owns her own business, which takes most of her time. She later related to me a story about how she had been offerred work in a local bar for THB40K/month base salary (plus whatever else she might earn on the side, if you know what I mean), but refused because she detests the idea of selling her body. (I'm not against prostitution. I don't think she is, either. But evidently she has just found better ways to make a living through her business.)
The more we talked, the more I learned about her. She was of mixed background, including Thai, European (and grew up in Europe), and Middle Eastern. This might account for her unique and stultifying good looks, not entirely Thai in appearance, her eyes a penetrating hybrid of East and West. She explained, furthermore, that she wanted a guy who could accept her girlfriend. Yes, girlfriend. She was bisexual.
In general, I think bisexuality is good for a girl. It teaches her to understand women from the perspective of an outsider, just as a man attempts to understand his girlfriend. For this reason, I've found that bisexual women are often able to relate to men more effectively, resulting in a better relationship. So I let her know in no uncertain terms that I thought it was wonderful that she also had a girlfriend, and had no issue with jealousy in this regard.
She had met her girlfriend, Karen, online. Karen is an Asian porn star in the USA. If I gave you her name, you could Google her and find her website in seconds. She's hot enough to melt asphalt! Naturally, it would be a disaster if her sexual orientation (lesbian) were to become public, as she poses in name-brand men's magazines as a heterosexual. She visits Thailand every month or so, and rents a hotel room in order to have sex with Lina. And yes, they do of course go out and socialize like any other couple.
You can imagine the skepticism I felt when I heard this. However, Lina showed me her photo collection, and beyond the shadow of a doubt, she had taken photos of Karen with her own camera, which precisely matched the girl on her own porn star website which I had Googled. Even the photo defects were consistent with Lina's low-quality camera, as opposed to the polished material available on the Internet. Numerous other trivial but logically consistent details convinced me of the truth of her story.
Lina explained to me that Karen allowed her to have a boyfriend because, apparently, Karen had very little interest in men and considered them "dogs". Karen did, however, occasionally engage in 3-somes with Lina and a man, because she knew that Lina liked men as well as women.
Things heated up quite fast. Lina actually asked me to be her boyfriend about 2 days into our dating process. I would prefer to wait a bit longer, even when I'm deeply interested in a girl. But how could I possibly say no? I gladly accepted.
She took me to meet her mother, who was a jovial and friendly woman, in order to psychologically seal the deal by introducing me to the family.
The first night we met, we had sex in my hotel room. Same on the second night, only a bit more kinky. On the third night, she had a stomach ache and couldn't handle dinner. So I stayed with her while she lay in bed at the hotel, as I tried to give her something to ease the discomfort. Finally, after more than an hour, her stomach settled down. Appreciating the attention, she started making advances on me. (She is sexually agressive, like few men I have known, and often locates attractive women in public before I do.) However, this time, she made it clear that she found condoms to cause unacceptable discomfort. I tried to reason with her for a bit, but reasoning with a horny woman doesn't get you very far. So finally, I agreed, on the condition that she would join me for a trip to a reliable testing clinic thereafter. She said that would be fine, so we did our little thing, unprotected.
The next morning, she needed to run to her place of business, which she had neglected for a few days at this point. I let her know that I understood, and was just happy to have met such an attractive girl who was also quite independent for her age, although she was not yet making enough money to support herself and her mother. (She was unashamed to ask for money, but I saw how frugally she spent it, and considering the lifestyle she was offering, I didn't have much problem giving her THB5K to help out, just after she had asked me to be her boyfriend. Yes, that's an enormous sum to pay a bar girl for a night, which should be THB1K-3K. But she wasn't a bar girl, and she didn't insist on payment, either. This was just me, doing an experiment, to see what would happen.)
On account of the need for her to catch up on missed work, we agreed that I should return to Bangkok. We would meet again soon at a suitable HIV testing clinic or hospital.
When I got home, I called her and asked what day would make the most sense for testing. I explained that I would pay everything. She became increasingly agitated, because apparently this implied that she was "dirty", even though she had only had 3 boyfriends previously (and had sex with 4 different men, one of whom was a rapist, after which she said that she had been tested twice for HIV). I let her know, in no uncertain terms, that HIV doesn't imply anything about personal character. It can happen to virtually anyone. For whatever reason, she ignored this explanation and became increasingly hostile. With a final expletive remark, she cut the line, and SMSed me back to let me know that we had now officially broken up. It was shocking to me how little this woman valued her own life, let alone her boyfriend's. I tried to call her back, but she refused to answer. I decided not to attempt to contact her again, as this moral defect on her part rendered us incompatible, to say the least. It's a shame, given her other, more attractive personal qualities. But that's life.
It's hard to imagine a girl such as herself being HIV positive, particularly since most of her partners have been women. (Lesbian transmission is quite rare compared to heterosexual or gay.) However, she either doesn't want to face up to the effects of her wild adventures, or perhaps she knows that she's HIV positive and just hopes the problem won't exist as long as she ignores it. Either way, I knew that I needed a test.
So the first thing I did was look at the American Centers for Disease Control
(CDC) website. In particular, the absolute and relative risk of various sexual behaviors:
http://www. cdc. gov/mmwr/preview/mmwrhtml/figures/r402a1t1. gif http://www. cdc. gov/hiv/topics/treatment/pic/pdf/chart. pdf
As you can see, the overall risk of insert penile vaginal intercourse is about 5 infections per 10K acts, where the male is HIV negative and the female is positive. While this would be a dangerous longterm habit, a single instance is not much to worry about. I returned to my work, and paid little further attention to the whole issue.
The next day, as I was changing clothes, I noticed a pair of scabs near the top of my penis shaft. They had the characteristic reddish brown hue of a recently healed cut. Granted, it might have been dried blood from her, but she was long off her period, so I doubt that. I peeled them off to find what appeared to be damaged skin beneath. Apparently, in our foreplay, she had injured me. Suddenly we were playing a very different game, as most penile-vaginal sex does not involve a bleeding penis. Now, the statistics were rather more like receptive anal sex, which often involves bleeding. That risk is about 10X higher, or 50 per 10K acts. Still small, but high enough that I needed to take more drastic measures because the small chance of infection would lead, in effect, to the loss of my life as I knew it.
It was now 41 hours since we had had unprotected sex. There's something that you need to know, which can save your life if initiated within 72 hours of known or suspected HIV exposure (much better, as few hours as possible). It's post exposure prophylaxis (PEP) for HIV:
http://www. cdc. gov/mmwr/preview/mmwrhtml/rr5402a1.htm
In Thailand, what this amounts to is a trip to the nearest hospital to get antiretroviral drugs. You need to take them for 28 days. If you read various authoritative websites, different drug cocktails are suggested. If you use more drugs, the odds of contracting HIV become smaller, but the side effects may be so bad that you can't finish the required 28 days, and if you get HIV anyway, it may end up being resistant to multiple drugs. I highly suggest Bumrungrad Hospital in Bangkok (http://bumrungrad. com), but if you can't go there, then go anywhere that you trust to have real drugs. By the way, New York City considers 36 hours to be the limit for receiving PEP. So don't waste time. Every hour counts.
Lucky for me, as a precaution, I had stopped by the hospital on the way back from her city, and collected a 28-day supply of antiretroviral drugs as a precaution. Initially, I had decided not to take them, as the side effects aren't justified by such a seemingly small risk. But when the risk level proved to be about 10X as high, it was time to pull out the heavy weapons. As I write this, I'm still on the drugs. Sometimes I forget what I was just thinking about, or get tinges of nausea. I see weird images of things blending together when I close my eyes, although my vision is normal. At least, I've heard that the side effects get milder with time.
So at 41 hours, at 15:00, I took my first dose. My odds of contracting HIV are small, and have probably been cut in half, assuming that I can tolerate this crap for 28 days.
That night, I noticed that I was starting to get a fever. This was hardly surprising, as I'd had a sore throat all week, and hadn't slept well because I had a bombshell girl in my bed. But all the fun was catching up with me. I needed rest.
It was then, lying there in my bed, that I remembered something that had happened 2 months ago, in 4/2012. I had met Nan online, my only sex partner before Lina. She was a lovely office girl. She was attractive enough, but not a stunner, although she had a wonderful personality. We had agreed to meet near her office, which was a bus ride from Bangkok.
She helped me to find a hotel. We chatted a bit, and went out for a walk. When we returned to the hotel, the forces of nature took over, so to speak, and sex ensued. In part, I was just having sex because I liked her. She had her physical strong points, to be sure, but I wasn't all that hard (literally) for her. This actually turned out to be a serious problem, because it allowed the condom to shift and move in ways that would not ordinarily occur.
In particular, she had almost, but not completely, finished her period. After the fact, I discovered that her blood had penetrated the condom, and had run all the way to the top, where the reservoir is located. In that location, it's highly probable that her blood had come into direct contact with my urethra. I immediately realized that I needed PEP. However, it did not occur to me at the time that it might be available, and only a brief bus ride away. I figured that the odds of penile-vaginal transmission were very low, and therefore simply ignored the event, apart from urinating as much as possible in order to reduce infection risk. I washed up and went to sleep next to her.
Fast forward 8 weeks, back to the first night on HIV drugs. The fever was kicking in. This was not good news, when one considers the typical time delay between initial HIV infection and manifestion of symptoms (if they occur at all):
http://upload. wikimedia. org/wikipedia/commons/a/a4/Hiv-timecourse. png
The fever coincides roughly with a peak in viral load, which is somewhere between 2 weeks and 2 months after the fact, more often sooner than later.
(Some people show no symptoms at all, but 80% get a fever.) Granted, it was probably just the flu. I had no "HIV rash" or other signatures which occur in some patients. I did, however, have a sore throat, which is one symptom.
This fever was also odd. In my entire life, I don't recall having a fever without any respiratory or nasal problems whatsoever, apart from a sore throat which produced very little phlegm.
The next day, I resolved to get blood tests. I took an HIV antigen test, an HIV antibody test, and an HIV PCR DNA test. You can Google these if you want to know the various pros and cons. The bottom line is that taking all 3 would give me a virtually indisputable answer as to what, if anything, had occurred back in April with respect to HIV.
By the way, while Nan wasn't particularly sexually active, she did have a tattoo. Tattoo parlors in Thailand sometimes don't know how to properly sterilize their equipment. (Another of Stick's contributors mentioned that they microwave the needles, which does not sterilize them.) If you get a tattoo, bring a cigarette lighter and burn the needle yourself. It's possible that she acquired HIV through the tattooing process.
While awaiting the test results, I observed another curious fact. First of all, understand that HIV drugs are longterm therapies. Specifically, they exist in order to reduce your viral load (the number of HIV virusses per milliliter) over weeks or months. No one should expect to notice anything an hour after taking them. At least, that's what I thought. But unexpectedly, I noticed that, 2 days in a row, about an hour after taking the medication, my fever dropped perceptibly. The effect was certainly not placebo, because my expectation was merely to feel even sicker due to the drugs on top of the fever. But there it was. I could perveice it unmistakably. At night, the fever would come back in hot flashes, which some people call "night sweats". Night sweats are another signature of early HIV infection.
At this point, I largely accepted the fact that I was HIV positive. None of the evidence was particularly compelling alone, but when you pieced everything together, it constituted strong evidence of HIV. Only definitive evidence was lacking, for which I had given blood.
The results were to be made available at 9 the next morning. I had requested an email. However, no email had yet appeared in my inbox by 11:30. <Shabby email management in one thing but in this case it is damned unforgivable on the part of the testing facility – Stick> Knowing that Thai culture makes many Thais unwilling to be the bearer of bad news, I was resigned at that point to what had been discovered in my blood. Weak as I was, I briskly made my way to the hospital for final confirmation. In the taxi, I was rehearsing how I would explain all this to family and friends.
The hospital staff is friendly in the typical Thai way. They are courteous and at least attempt to be helpful. After I gave my name to the nurse at the counter, she looked me up in the computer. Suddenly, she frowned for no apparent reason, and told me to wait. She went in the back of the office and started rifling through papers, then conferred with a colleague for a moment, apparently distressed about something. I just wanted this to be over. Come what may, so be it. But I hate uncertainty.
Finally, she produced a slip of paper, scrawled with the doctor's handwriting. Negative on all 3 tests! For this outcome, I was completely unprepared. I broke down and cried. They had the courtesy to move me to a chair, then to an empty office. I must have cried for several minutes. Crying with tears of joy. I am a very level guy, not given to emotional outbursts. But I could not contain my joy at receiving such a blessing. It was as though I had acquired HIV, and been allowed to go back in time, and undo it. This was the happiest day of my life!
I am not out of the woods yet. The unprotected sex with Lina, with the possibility of a skin tear, still haunts me. I believe that I am now over the vast majority of the risk, but perhaps I still have a 1% chance of contracting HIV. I will finish out my course of antiretroviral drugs, despite the fact that I feel a bit like vomitting as I write this. My odds are good. I will take every advantage that I can get. I won't know definitively for about 3 months, when I take another HIV PCR DNA test.
All this has changed my life. If I can save one of you people reading this, then it was worth all the horrible stress. What I learned:
If you're a male, don't have sex if you're not very hard. Otherwise, the condom can move too much, allowing fluids to leak in and out at the bottom.
Understand that sexual behavior statistics are just overall averages. Not using condoms, or exchanging blood as opposed to sexual fluids, causes the risk to explode.
Risks compound. If it's 99% certain that something won't happen, then after about 69 times, it's only 50% certain that it still won't have happened. (0.99 to the 69th power is about 0.5.)
Speaking of risks, understand population risk as well. The overall HIV rate in Thailand is estimated at roughly 3%. High, but not exessively so. However, as recently as 2007, 19% of the bar girls in Bangkok involved in an HIV survey tested positive. <I ABSOLUTELY DO NOT BELIEVE THIS FIGURE and I back this up by saying that yes some bar owners test girls and of those i know, the number who test positive is VERY low i.e. less than 1% – Stick> What's the risk that you can have sex with 10 of them and not encounter HIV? (1-0.19)^10, or about 12%. Put another way, if you have sex with 10 of them, there's an 88% chance that you will have had sex with an HIV positive partner. That might be OK under certain risk management scenarios, but know the risk first. Few people test. Instead, they show up at the doctor when they have full blown AIDS. Remember, the symptoms of infection are few or none until the disease has progressed to the point of medical emergency.
Use PEP. PEP isn't a substitute for safer sex. The side effects range from discomfort to outright intolerance. But when exposed to bodily fluids through an opening in your skin, you should seriously consider doing it, depending on the suspected HIV status of you partner. If started rapidly, it may save your life. If you miss the 72-hour window, talk to your doctor. At that point, it may be safer to simply allow your body to fight the virus until, probably years later, it needs help from a drug.
Many people have the perception that HIV is a manageable illness. In some sense, they're correct. But how many pills do you want to take, and how much money do you want to spend? Recent experiments suggest that it will be cured in 10 or 20 years using stem cells. So what. Will you last that long? Will your liver last that long against the onslaught of powerful drugs? Do you want your immune system torn apart by a virus, then rebuilt in a lab? Yes, there are longterm nonprogressors. But we don't know why some people progress faster than others. Thailand also happens to have a vigorous variant of HIV, which no doubt is more resistant to certain drugs, than the "naive" variants that existed back in the 1990s.
Test! The stress is lower if you test with your partner before you have sex. If your partner refuses to do so, find a new partner. Seriously. This is a matter of life and death. If they don't care that much about you, then you should probably move on anyway. Beware of the time windows involved. Different tests have wildly different nondetection windows, and of course different prices. Talk to your doctor about the pros and cons of each.
You might think that, having lived inside the silent hell experienced by a recent infectee, that I would be against anything but monogamous sex. I'm not. I think some risky behavior is worth the obvious rewards. It just depends on the relative quantities on both sides of the equation. Above all, make sure that you're using the most accurate possible data to evaluate risk, and account for compounding, if you intend to repeat the act many times in your life. Pull up your calculator. Use it to assess the real risk level of longterm behavior.
Want to read more about HIV encounters in Thailand? Try Googling "hiv site: stickmanbangkok.com". It's a sobering must-read for anyone attracted to the good life here.
This experience has profoundly influenced my life, above and beyond the issue of sex. It has reminded me that every second of my life is a blessing, which is not to be wasted. Enjoy your intimate encounters, but please learn from my negligence before it's too late..
First of all, it's great to hear that it's very, very unlikely you contracted HIV. I hope the next test proves this once and for all!
I think one major problem with HIV education is that there is so much misinformation out there that people really don't know what to believe. When you're given information which is later shown to be highly exaggerated or perhaps even factually incorrect, or statistics that may be cooked, it makes it hard to really know what is going on.
I do know people personally who contracted HIV in Thailand but here's the thing. I cannot be sure *how* they contracted it! I suspect that some people have secrets they would rather not reveal and these are material as they would probably explain how they caught it.
I know a lot of people – and have read reports from MANY more – who have had years of unprotected sex – and in many cases with dozens and dozens of high-risk partners – and they have yet to contract HIV. When you hears stories like this, it makes you wonder about some of the info out there.
No, I don't recommend anyone indulge in unprotected sex with high risk partners. I do however wish that there was a bit more honesty about transmission of HIV, what the real HIV rate is and just how high the risk of contracting it sexually really is.