Safe Sex

[QUOTE]Originally posted by sabio
[i]3. If you focus on an infection, say HIV, the number we are after is the probability of getting infected in a single encounter. I would say that if this number is one in a million, the vast majority will consider it acceptable. If it is one in ten, the vast majority will consider it unacceptable. This number is affected by the percentage of providers that are infected, the probability of getting infected from a single covered/
uncovered encounter with an infected girl, and the probability that an infected girl will pass your prescreening (if you do the test). If the resulting probability under
a given scenario is within YOUR acceptable range, you are in business.[/i][/QUOTE]

This is basic probability (bayes formula). But, you need to have the individual probabilities first.

BTW, I wouldn't be too sure about the vast majority feeling like 1 in a million is a small enough probablility to play it safe. The chances of winning a typical 65 number lottery are something like 60 mil to 1 (maybe even higher). Still, it's not a 'vast' majority that abstains from buying a ticket every week.

purplengold

You are right. The probability is straightforward to compute once you have the components. The one in a million is clearly a guess on my part. My reasoning goes as follows. One in a million per encounter means less than 1% probability of infection after 10,000 lifetime encounters with providers, which I would guess covers the vast majority of hobbyists.

Given that the probability of eventually getting cancer / stroke / heart attack / fatal accident
is much higher than 1%, it is arguable that the 1% increment in risk is justified by the "fun."

Of course, this is just an opinion. Whether it is one in a million or one in a billion, what matters is that it is not zero, and the question becomes: does scenario X achieve that risk.

hooky wrote (in another section):

>hey sabio
>
>still looking for those numbers. it was something i heard on public radio
>i think about 6 months ago. no luck so far finding it on the net.
>obviously any numbers like those are going to be someone's ballpark
>guesstimates, still they were very interesting for me to hear. included
>were giving and receiving oral and all other types of sex for both
>women and men.
>
>hooky

Sabio,

I have read stats on HIV transmission, but I can't seem to find what I'm looking for on the net. I can assure you the chances are much greater than one in a million - if the person you are having sex with is positive, the odds for vaginal sex are around one in 1000-10,000 depending on whether you're male or female. But stats will usually only describe what would happen in a 'control group' anyway - for example, where a healthy male has one session of unprotected sex with an infected female. Things don't work like that in real life though.

What if she has her last client's semen inside her, and you have a cut on your penis? What if she wipes you down with alcohol swabs and it causes an irritation? What if she's been using Nonoxynol-9 and has an irritation of her own? What if you or her have another existing STD (which greatly increases your chances of transmission)? What if you have unprotected sex a second time, and your penis has already been rubbed raw the first time?

I think you would be taking a huge risk relying on a DIY testing kit. HIV has a window period of up to 6 months - she may test negative today, but test positive next week. You would also be putting the sex worker's health at risk for the same reason - you could test negative in front of her, but actually have been infected the month before. The only way of being sure that someone doesn't have HIV, is to have them tested and then wait six months - ensuring that she does not have any sort of sexual contact in that time.

As for the HIV tests serving the secondary purpose of scaring girls off if they have other STDs - I do not have any diseases at all, but I would not do your test if you asked me to. It's an invasion of my privacy, it's unecessary and ineffective, and to top it all off - it would leave me with a cut on my finger, which would put me at greater risk of contracting HIV!

PS. Here's a good site for HIV info...
http://www.avert.org/trans.htm

RN:

Many thanks for your well-informed post. Please understand that I have not reached
a conclusion yet. It would be great if we continued the discussion at the intelligent
level of your post, so that meaningful conclusions can be reached. I will address here
some of the points you raised

[i]
>I can assure you the chances are much greater than one in a million
[/i]

I agree with you. Just to clarify, the one in a million number that I mentioned in my
previous post is only a target, only after either the covering or testing scenario is
adopted, and only describes the probability of getting infected in one encounter in
general, not one encounter with a known HIV+ person.

[i]
>if the person you are having sex with is positive, the odds for vaginal sex are around
>one in 1000-10,000 depending on whether you're male or female.
[/i]

This is consistent with the numbers I could find so far.

[i]
>What if she has her last client's semen inside her, and you have a cut on your penis?
>What if she wipes you down with alcohol swabs and it causes an irritation? What if
>she's been using Nonoxynol-9 and has an irritation of her own? What if you or her have
>another existing STD (which greatly increases your chances of transmission)? What if
>you have unprotected sex a second time, and your penis has already been rubbed raw the
>first time?
[/i]

Indeed, a lot of factors affect the probability of transmission. The final numbers are
meant to incorporate the different factors according to their likelihood. If you know
a risk factor is present (say you have another STD), your numbers will be worse. If you
know a risk factor is absent (say you do not have another STD), your numbers will be
better. By the way, circumcision, among all things, is reported to reduce the
probability of female-to-male transmission significantly.

[i]
>I think you would be taking a huge risk relying on a DIY testing kit. HIV has
>a window period of up to 6 months - she may test negative today, but test positive
>next week.
[/i]

This is the most important point in my opinion. Indeed, without it, the 250-to-one
performance of OraQuick would be decisive. The question is what is the percentage of
infected providers that are in the so-called seronegative window: have the virus but
still not enough antibodies. If this is 5%, then we are comparing having covered sex
with 20 infected providers, versus having uncovered sex with one infected provider.
By the way, I looked into the seronegative window a bit. According to what I read, the
time it takes antibodies to develop to a detectable level is less than one month for
most people, and it is rare to take more than three months. This does not contradict
that for some it may take 6 months. What matters is the PROBABILITY that this is the
case, since this is what will affect the ultimate probability. If someone has reliable
data on this, please post them, and do correct me if I am wrong.

[i]
>You would also be putting the sex worker's health at risk for the same reason - you
>could test negative in front of her, but actually have been infected the month before.
[/i]

Not at all. As I said in my original post, I assume the hobbyist knows that he is not
infected (to moral certainty, say through DNA testing).

[i]
>As for the HIV tests serving the secondary purpose of scaring girls off if they have
>other STDs - I do not have any diseases at all, but I would not do your test if you
>asked me to. It's an invasion of my privacy,
[/i]

I can perfectly understand your position. This is a sensitive point, so please bear
with me here. I will take No for an answer. I plan to explain the health purpose of this
exercise to the provider. I may even offer to compensate her for her trouble. Given
that, I feel it is OK to ask, pretty much like it is OK to ask for specific services.
If an unifected provider refuses as a matter of principle, I will just miss out on her
and try someone else. The bottom line is that, if I am convinced of the health benefit
(and I am not convinced yet), I will simply do it.

[i]
>it's unnecessary and ineffective,
[/i]

Please allow me to argue that this is yet to be determined.

[i]
>and to top it all off - it would leave me with a cut on my finger, which would put me
>at greater risk of contracting HIV!
[/i]

Point well taken. The finger prick is necessary for PocKit, but OraQuick can be used
with oral secretions.

Again, thank you RN for starting an intelligent discussion.

NIH study says it is [b]one in seven[/b]

The US National Institutes of Health conducted a study on the effectiveness of condoms in preventing HIV transmission during vaginal intercourse. The results showed an 85 percent decrease in risk of HIV transmission among consistent condom users versus non-users.

One in seven is nothing to sneeze at when it comes to saving lives, and it does show that condoms are effective as a public health measure. However, I must say that the number is lower than I thought it would be when it comes to comparing the two scenarios
in my previous posts (covered sex versus fast test kits).

Summary found in:
[url=http://usinfo.state.gov/topical/global/hiv/01072004.htm]
http://usinfo.state.gov/topical/global/hiv/01072004.htm[/url]

Full report found in:
[url=http://www.niaid.nih.gov/dmid/stds/condomreport.pdf ]
http://www.niaid.nih.gov/dmid/stds/condomreport.pdf [/url]

Performance numbers for PocKit

This is the herpes 10-minute home test kit that I am exploring for checking providers
for herpes-2 (even when they don't have outbreaks). The performance looks better than
I initially thought:

False Negatives (infected person testing negative): one in [b]25[/b]

False Positives (uninfected person testing positive): one in [b]33[/b]

Seronegative window (time after infection for test to work): [b]13 days[/b] (median)

Notice that we are comparing these numbers to the condom protection (one in [b]7[/b] for
HIV per my previous post, presumably even worse for herpes since it can be transmitted
through the skin outside the condom).

Details are found in:
[url=http://www.pockit.com/pockitpro/herpes_prod_pubs.htm]
http://www.pockit.com/pockitpro/herpes_prod_pubs.htm[/url]

Although this is PocKit's web site, the numbers come from quoted studies that are
published in the open research literature.

Condoms are 85% effective? I'm willing to bet 99%+ for latex condoms provided they don't break. If used correctly and with a little caution condoms break maybe 1 in 100? So the 85% seems bogus to me and probably covers people who don't know how to use condoms as well as people who SAY they always use them but mean that they usually use them.

Meanwhile, good luck on having the women allow your medical testing. Not too likely . . .

[quote]Originally posted by Prokofiev
Condoms are 85% effective? I am willing to bet 99%+
[/quote]
The 85% is not my number. The US Congress commissioned the NIH to determine what
that number is, and NIH had a panel of experts consider a multitude of scientific studies
and concluded that it is 85% (see the links below). This was a surprise for me too, but, with all due respect, I would take a conclusion by the NIH to be more credible than a bet
by you (I really don't mean any offense here, I am just stating a fact).

As for practical issues (acceptance by girls or lack thereof, what to do in case of a positive, etc.), I am not addressing them yet since they would be irrelevant if the
safety of the testing scenario is not up to par. I don't know yet if it is up to par.
This is what I have been trying to gather credible information on.

Let me address the 85% from a public health point of view. Even if it were only 50%, it would make sense for health officials to advocate condoms in strong terms. A person who catches HIV not only does a great harm to him/herself, but also poses a great risk to others, and eventually costs society enormous medical expenses. If the percentage of HIV cases can be cut even by a mere half using a simple, economic, and universally
recognized tool such as condoms, this would be rightfully advocated by any responsible public health entity.

However, for an individual, the 85% is indeed psychologically discouraging in two ways. It makes you feel uneasy even when you use condoms, and it may affect your resolve to use them (knowing that the HIV risk of one bareback encounter is like the risk of seven
covered encounters). Like it or not, [b]it is 85%[/b]. I prefer to deal with reality and plan accordingly, rather than ignore the facts and have a false sense of safety.
This is why I am trying to objectively compare the covering and testing scenarios.

Finally, for someone who has as much fun using condoms as not using them, this is a no brainer. Use condoms. If you think testing adds to the safety enough to justify the hassle, use testing on top of it. If not, forget about testing. However, if you do not
have as much fun using condoms, then it makes sense to look into alternatives. If the safety of the alternative is up to par, take it. If it is not, you need to put up with
condoms. Just think of how many posters admitted going bareback in the heat of the moment every now and then. If testing was done (which happens BEFORE the heat of the moment), these very high risk situations would not have arisen in the first place.

Re: condom breakage.
A few months ago, I estimated that I've had sex with over 4000 men. Add the repeat customers, etc and...well, lord knows how many times I've had sex! As I've said on this board before, I only had a condom break ONCE in the time that I was working. (And that guy was particularly large).

The risks of a condom breaking with a sex worker are much lower than with 'regular' girls. (There is actually a study that proved this...Perkins, I think?) You can't help but get good at putting one on, when you're doing it so many times a day! Also sex workers (here at least) use condoms of different sizes to ensure a better fit, and they use lube - which is something that 'regular' couples rarely use.

That NIH study was a study of other studies from around the world. Not only does it include breakage but undoubtedly some lying as well. How can you possibly make sure that the participants always used condoms? Never were IV drug users? Can't. These are usually interview studies where you ask questions but can never be sure of the truth. Couldn't even confirm that condoms had any effect on other STD's. Not enough reliable data. Since HIV transmission is almost completely blood and semen related, how well does latex protect against viral infections passing thru the membrane? Close to 100%. A broken rubber? 0%. Pulling a soft dick out and making a mess? A problem.
Plain old lying? The biggest problem of all . . .

-P

I confess I've also always been curious on the whole condom breakage thing. I've never had one break on me, so maybe guys could pipe up here -- how common is it, really?

Yes, I've had them break at least 5 or 6 times out of perhaps 500. And during critical times of the month . . . but I've always dodged that bullet. But never with a pro where we are both very careful. The problem is that you can lose the slack at the tip , especially with an undersized condom. Then if you thrust too hard and deep, looking for more pressure /tightness you can shread the rubber. You can usually feel it . . . not the actual breakage but a pleasant warm/wet feeling (!) Each time I was thinking, "Man this feels good tonight!" without thinking why that might be so.
Of course a couple of drinks can cloud the mind.

And this has never happened in missionary or woman on top position. Only when I'm entering from the side or some strange angle.

RN: 4000 Huh. Are you bragging or complaining? I don't think I'll ever reach that level (a new woman each day for 11 years . . .) but I'm sure some of these guys have you beat (but NOT if they are 29!). . .

And do you use lube INSIDE the condom as well? Or only outside? I read a tip somewhere that lube inside is very pleasurable. AND IT IS. If the condom is large enough you can slide in and out of it a little and it has a different feeling. But I don't do that often . . . maybe I should.

Zero breakages here. Seldom use lube although sometimes on the inside. BUT you gotta throw 'em out if they've been in the sun/glove compartment/wallet/whatever too long AND I don't buy "off brands." Oh, and also I always bring American condoms when travelling to Third World countries. I am down on my country at the moment but we do lead the world in two things for sure: condoms and toilet paper. That is good since Bush can both suck my dick AND kiss my ass.

Dickhead, waving your flag instead of your dick. Japanese condoms are the worlds best (small is beautiful). And Skinless is the best brand (though I do like to go skinless) Superior technology. We don't have a dickhead brand. Japanese toilet paper is also the best. When I got bj'ed here on the street, the lady used a tissue to wipe me and the condom (Japanese) up. Japanese manners are best. But Thai hos give the best lays.

Also, anyone putitng lube into a tube ain't thiking of safe sex. They are thinking with their dickhead.