Sunday, November 23, 2008

.
    > This is a really good idea. The trick is to somehow get this to be
    > a social norm so that people aren't scared and embarrassed about
    > asking for this. As things are now, asking your significant other
    > to get tested before having sex would probably come across as
    > offensive to many people, therefor most people probably won't
    > ask. Hmm maybe a Planned Parenthood public service
    > announcement or something?

Until there is a cure-for-certain vaccine, or enough people die, testing is not likely to be the norm.
.
            >> Sounds like it would work well for some folks, not so well for a hookup.

    Gosh, I'm just thinkin out loud here, but could "hookups" have anything to do with the AIDS epidemic?

    > I was pointing out that there are common situations in the real world where the strategy you're touting wouldn't be especially helpful.

Not washing hands before operating was also once a very common strategy--even a standard practice.


    > Do hookups have something to do with the AIDS endemic? I suppose you could look at it that way.

I'm going out on a limb here, but will guess yes.


    > The broader question I'm asking is whether it is helpful to look at AIDS as the sum of behaviors and biologic test results (as current epidemiology & public health practice tend to do), or whether it might make sense to back off a bit and ask whether we might make more of a difference by laying off the moralism inherent in behavioral approaches

I'm going out on a limb here, but will guess that things like clean water, sterilized instruments, and washed hands have little to do with moralism.


    > and focusing on some of the structural forces, such as homophobia, gender hierarchies, racist ideologies, and poverty production that also obviously have huge impacts on the AIDS endemics across the world.

I'm guessing that some of the stanard practices mentioned above would work for homophobes, non-homophobes, racists, non-rascits, poor or rich people, etc, all over the world.


            >> I guess what I'm trying to figure out is how people react to the concept of risk,

Irrationally is the word I think you're looking for.


            >> and whether 'public health' might not better be focused on some of its more traditional success strategies that involve systemic changes, rather than individual coaching.

I'm thinking that people become infected one at a time.


    With something like tuberculosis the FIRST step is to get tested. Workin out pretty good so far...

            >> ...Traditionally, public health has had its greatest success{es} with things like water, sewage, & poverty remediation.

    and testing...

Individuals have to take care of the testing part.


    > Tuberculosis is a great example of how structural changes far outstripped the ability of medicine and individualized behavioral messages to curtail the spread.

Today everybody deals with it, first, by testing.


    > Arguably, the first successful steps in curtailing the spread of tuberculosis included addressing slum dwellings where people lived in extremely close quarters, pasteurization of milk, and various other public health approaches. (e.g. AJPH 1998 88(7):1105-1117)

Its still time for individuals to get tested...


A L Fairchild and G M Oppenheimer
Public health nihilism vs pragmatism: history, politics, and the control of tuberculosis
http://www.ajph.org/
cgi/content/abstract/88/7/1105

http://www.ajph.org/cgi/reprint/88/7/1105

    > Testing in NYC began in the late 1880's, well after tuberculosis incidence had started declining rapidly. It probably helped somewhat after that point, but we have tended to overlook the relatively larger impacts of structural interventions that preceeded testing and continued to affect the incidence of tuberculosis afterwards as well.

Once all the reading is finished you still need to go get tested.

Saturday, November 22, 2008

        > I don't know how common that
        > strategy is. Sounds like it would work
        > well for some folks, not so well for a
        > hookup.

Gosh, I'm just thinkin out loud here, but could "hookups" have anything to do with the AIDS epidemic?


        > I guess what I'm trying to figure out is
        > how people react to the concept of
        > risk, and whether 'public health' might
        > not better be focused on some of its
        > more traditional success strategies that
        > involve systemic changes, rather than
        > individual coaching.

With something like tuberculosis the FIRST step is to get tested. Workin out pretty good so far...


        > I don't know if there are home tests for
        > chlamydia. By systemic changes I mean
        > addressing homophobia, sexism,
        > racism, wealth extraction
        > (redistribution to the rich), etc.
        > Traditionally, public health has had its
        > greatest success with things like
        > water, sewage, & poverty
        > remediation.

and testing...

Thursday, November 20, 2008

.
        > Because I think it's always good to
        > be prepared for sex.

A thought experiment
http://en.wikipedia.org/
wiki/Thought_experiment


How widespread is the phenomenon?... The strategy of
"Let's get tested TOGETHER
  BEFORE we have sex, for A VARIETY of STDs."

Sexual health checkups reduce ambiguity/risks and can be like anything else POTENTIAL sex partners might do together.


_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
> And also that brings up a very important thing.
>
> This is good that we're having this conversation.
>
> Because I think it's always good to be prepared for sex.
>
> Okay, you want to have all the tools you need by your bedside or potentially in a carryall, allright, in your purse, allright, so you're prepared for sex.
>
> And that's why we're having this conversation.
>
> Because if we don't talk about it first right we're very un likely to be unprepared when it comes time for sex.
>
> That's why communication's really important with your partner.
>
> And also the boy scout motto of "Be prepared" is essential which includes condoms and water based lube.
>
> That's what's recommended.

Tuesday, November 18, 2008

Please note that in my remarks I made no reference as to which test or tests, the individuals using this approach should take.

Please note that by making reference to the blood supply I have indicated a personal knowledge about how blood is tested differently from the standard clinic test for "HIV".

          > Hi. You are obviously free to make
          > whatever decisions you want regarding
          > your safety and your body. But we did
          > want to point out a serious
          > misunderstanding that you might have.
          >
          > You wrote that it is not necessary to
          > worry about the three month window
          > period, because the blood supply is
          > safe and they don't wait three months.
          > The problem with that thinking is that
          > you are confusing two different types
          > of tests.
          >
          > The blood supply is screened for HIV
          > using a variation of a viral load test
          > (p24 antigen test), and the blood
          > samples collected are *pooled* in order
          > to test them for HIV. This is a very
          > different test, and pooling blood
          > samples changes the accuracy results.
          > This is *not* the test that someone is
          > given when they go for an HIV test.
          > Those tests are HIV anti-body tests,
          > and anti-bodies can take up to three
          > months to show up accurately on the
          > test, so that's the reason people are
          > told they should wait as close to three
          > months as possible.
          >
          > Individuals are not given the same type
          > of tests that the blood supply
          > undergoes because that test has not
          > been approved by the FDA for diagnostic
          > purposes, and individual samples cannot
          > be pooled due to the timing of each
          > person requesting a test.
          >
          > So please understand that if you merely
          > get an HIV test and a negative result,
          > and then discontinue practicing
          > safer-sex (which we believe is what you
          > are implying) you are putting yourself
          > at a higher risk than necessary for two
          > reasons. One is what we've already
          > discussed -- due to the three month
          > window period, it is possible that
          > someone was recently infected but it is
          > too soon to register on the test, and
          > so you will receive a false negative
          > result. The other reason is that if
          > someone should expose themselves to HIV
          > any time after the test, and the two of
          > you are not playing safely, then one
          > person can infect the other. Sadly, we
          > have had many calls from people who got
          > infected because of that reason.
          >
          > So our goal is not to get into a debate
          > with you, but rather to make sure you
          > understand our perspective, so that you
          > can make an informed decision about
          > what you want to do. We hope this
          > additional information is helpful for
          > you and we send you our best wishes.

Monday, November 17, 2008

.
          > We can't really tell you how widespread
          > that particular strategy is, because
          > with so many gay and lesbian people,
          > it's difficult to know what everyone is
          > choosing to do.
         
          > But getting tested is certainly
          > important. However, we would stress the
          > importance of not using negative test
          > results as a reason to start putting
          > yourself at risk.
         
          > If you and a partner decide to get
          > tested together and both have negative
          > HIV results, for instance, that's great
          > news. But because it can take up to
          > three months before HIV infection shows
          > up on an HIV test, the test results you
          > are getting are always three months
          > out-of-date. There really is no way to
          > know for sure what someone's HIV status
          > is at the moment you may have sex with
          > them.

If this three month rule were the case then why
is the testing of blood donations so effective?
Look here:

http://www.google.com/search?
q=%22how+long+can+blood+be+stored%22


It seems that testing is extremely
reliable--which accounts for so few cases of HIV
via blood transfusions.

There is some risk of infection from any
encounter even if both partners turn out
negative. However, you are more likely to die in
an automobile accident driving to an encounter
than you are to die from HIV from a
just-tested-negative individual.

Again, its not RISK FREE! But many other things
in life are far more risky


          > That's why we encourage people to
          > always assume it's possible that the
          > person they are with might have been
          > exposed to HIV either within the last
          > three months (and before it could show
          > up on a test) or at any time after they
          > were tested. So if you always play
          > safe, then you are taking
          > responsibility yourself for your own
          > body, and not relying on sometimes
          > outdate test results to keep you
          > healthy.

Always "playing it safe" is far more risky than
sex with a just tested negative person. There is
only safer sex--not risk free sex.

Sunday, November 02, 2008

The only way you can be sure you haven't killed anyone with
HIV (assuming you are positive) is to test every one of your
sexual contacts over the course of their life. If they get sick
or die, then it is still possible, with the best of current technology,
to determine if they died from a strain of the virus they got from
you. So, unless you've done this level and intensity of testing,
then you can't say for certain if anyone has died or gotten
sick after having sex with you.

What probably happens, in reality, is that uninfected people
have sex with a number of infected people and get the virus
from one or more of them. So it then becomes possible for
any one HIV+ person to say, with some belief, that they did
not pass HIV on to a given person--so responsibility is lost
in the crowd. There is the possibility for each infected person
to say some other person didn't get the virus from them. This
is nature's way of saying that having sex is more important
than being responsible.

Unless a complete fix is found for HIV, then you can look
forward to the epidemic continuing largely unabated.
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