HIV: Two Patients Face The Diagnosis

HIV: Two Patients Face The Diagnosis

I frequently meet with patients who have recently been diagnosed with HIV infection. Some of these individuals have been tested for HIV on a regular basis and know that they have just recently been infected, while others had not been previously tested and are unaware of when the infection might have occurred. People who are dealing for the first time with the realization that they are HIV-infected have provided me with a great deal of insight as to how and why HIV is still being transmitted, as well as what the current understanding of HIV disease is in the community. Two patients I recently met very aptly demonstrated some of these issues.

One patient was a 45 year old homosexual man who had been tested approximately every year for the last 7 years and was told that his most recent HIV antibody test was positive. After the test was repeated, he was referred to me for further evaluation. Needless to say, he was upset and confused. As is usually the case, he was perplexed as to how he became infected as his pattern of behavior had not changed during the past 7 years. In fact, he stated that he was sexually active with only 4 men in the last 2 years and always used condoms during intercourse and was unaware of any incidences wherein the condom broke. He did admit to oral sex without condoms but did not believe that this could be how the HIV was transmitted since he had been engaging in this activity for 10 years and had never become infected in the past. --- Misconception #1. I explained to him that while transmission could have occurred from a condom break or leak, it was also possible that it occurred as a result of oral sex. Although this is an activity that is less risky than intercourse, it does represent a potential means of infection.