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AFRO-NETS> Condom breakage & failure (7)

Condom breakage & failure (7)
(and HIV transmission)

Hi all in AFRO-NETS!

I wanted to comment the discussion on condom breakage and HIV trans-
mission. According to very reliable research, the transmission rate 
of HIV in one UNPROTECTED intercourse is a lot less than 1% (in the 
absence of other sexually transmitted infections). In his calcula-
tions of commercial sex workers etc. Ron calculated days, months and 
years as if the risk of HIV-infection would be about 100% in one in-
tercourse (unprotected or when the condom breaks) with an HIV-
infected one. The risk of HIV transmission in a needle stick injury 
is around 0.1-0.4%. If the risk is not big, it does not mean that we 
shouldn't take precautions. I think it is very good that we have uni-
versal precautions and somewhere also possibility to post exposure 
prophylaxis. And also possibility to use condoms. 

But as Cordula wrote, "STATISTICALLY it needs several hundreds unpro-
tected intercourses or condom breakages to transmit HIV". The role of 
other STDs is of course crucial and I really think that one of the 
major reasons to the disastrous HIV-situation in Africa is poor diag-
nosing and managing of other STDs.

This brings us to a very interesting question. Should people know 
about this "not 100%" transmission rate? Ron wrote in his first let-
ter about "truth" and the importance of it. Is this the kind of truth 
he meant as well?

I have been working with HIV-question in Africa for more than 10 
years. It seems to me that most people think that the likelihood of 
getting HIV from an infected person in one unprotected intercourse is 
about 100%, anyhow a lot more than 50. I also have started to think 
that the ones who know better, do not seem to feel that it is impor-
tant for people to know that this is not true. They want to "protect 
the secret".

I am a gynecologist and worked for three years in a rural hospital in 
Namibia 10 years ago. That time we had many married couples of whom 
one was infected (and even falling sick with AIDS) and the other one 
not infected even when they had had regular, unprotected intercourses 
for years.

There are many people who find it unnecessary to get tested when they 
find out that their previous boy/girlfriend is falling sick with 
AIDS. I think that not knowing that it still is possible to be HIV-
negative after having (even regularly) sex with an infected one is 
eating up or annihilating hope of millions of Africans and discourag-
ing them to get tested. I truly think that there are hundreds of 
thousands of people around us suffering in vain and being depressed 
and not seeing any reason to change their life style and thus going 
on taking risks only because they think that having had sex once or 
twice with an HIV-infected person means that they for sure are in-
fected also.

Quite many people seem also to use each other's tests to test them-
selves. If I get a new boyfriend and have unprotected sex with him a 
couple of times and after that still get tested negative, I would 
conclude that he is negative also... what a mistake! If I have had 
sex several times with somebody and then see that his test is nega-
tive (or positive) then I would think the same applies to me.

Knowing that HIV is not transmitted in every intercourse with an in-
fected person could also alleviate at least a bit of the fright and 
horror the raped persons feel in the absence of post exposure prophy-
laxis and waiting for the window period to pass to get tested.

My opinion is that trying to "keep the secret" and not letting the 
people to know about the facts and truth about HIV transmission is 
actually helping HIV to spread. Knowing the truth could encourage 
them to get tested and to stop taking risks. What do you think?

Maija Palander
Medical Doctor, Project Coordinator

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