http://www.thebostonchannel.com/news...84/detail.html

"They're not hearing the messages that we heard 10 years
ago. They're not seeing people dying from the disease in the same
way. In some ways it feels like, 'there's a cure for that -- I can
just take drugs,' and they have no idea of the impact the drug
regime and what it will do to their lives," said Rebecca Haag of
the AIDS Action Committee.
http://www.thebostonchannel.com/news...84/detail.html




Collaborative weblog
The strategy. Get tested together before you have sex.
http://NotB4WeKnow.blog-city.com

If so called safer sex practices and condoms really worked we would have
seen the news headlines Epidemic Peaks and is Now Going Down.
There have been no such news headlines.

For so called safer sex practices and condoms to work they have to be
used every single time from beginning to end never ever failing to use
them. People are not that diligent.




Collaborative weblog
The Strategy. Get Tested Together Before You Have Sex.
http://NotB4WeKnow.blog-city.com

Compare te efficacy of the strategy with so called safer sex practices and
condoms. There's plenty of evidence for lack of efficacy of so called safer
sex practices and condoms. There's no evidence of any lack of efficacy for
the strategy get tested together before you have sex.


Collaborative weblog
http://NotB4WeKnow.blog-city.com

On 28 Jun 2003 13:04:42 -0400, Don Saklad <dsaklad@nestle.ai.mit.edu>
wrote:

The window period is not a myth. See below. The good news is that
from time of exposure to seroconversion can be picked up within a
couple of weeks of exposure for most cases.

Third abstract notes a potential limitation of using PCR for viral
load testing prior to seroconversion.

Testing is an excellent idea. As a rationale for abandoning condoms
(which you appear to suggest), it is weak for the other reasons I
delineated, however may work for some few who restrict their activity
to just one other person.

George M. Carter

****
Lindback S, Thorstensson R, Karlsson AC, von Sydow M, Flamholc L,
Blaxhult A, Sonnerborg A, Biberfeld G, Gaines H. Diagnosis of primary
HIV-1 infection and duration of follow-up after HIV exposure.
Karolinska Institute Primary HIV Infection Study Group. AIDS. 2000 Oct
20;14(15):2333-9.

Swedish Institute for Infectious Disease Control/Karolinska Institute,
Stockholm.

OBJECTIVE: To determine the sensitivity of 33 currently available and
seven earlier tests for the detection of HIV or HIV antibody in
primary HIV-1 infection, to estimate the duration of the 'window
period' and the influence of early initiated antiretroviral treatment
(ART). DESIGN: A prospective cohort study of 38 patients with primary
HIV-1 infection. ART was initiated at a median time of 13 (range 0-23)
days after the onset of symptoms in 10 patients. MAIN OUTCOME
MEASURES: The time from infection to onset of symptoms and from onset
of symptoms to the appearance of HIV antibody as measured by 36
different tests, and the start and duration of viraemia, as detected
by four different tests. RESULTS: The illness appeared 13-15 days
after infection in 12 of 15 determinable cases, and seroconversion was
detected within 1-2 weeks after the onset of illness by 27 of 30
currently available tests for HIV antibody, in contrast to the 2-7
weeks or more needed by the old tests. HIV RNA appeared during the
week preceding the onset of illness and was detected in all subsequent
samples, except when ART had been initiated, which also induced a
delay of the antibody response. CONCLUSION: Many tests for HIV or HIV
antibody can now be employed for an early confirmation of primary HIV
infection (PHI). Currently available screening tests proved much more
sensitive than older tests, and seroconversion was usually detected
within one month after infection. Consequently, in Sweden we now
recommend only 3 months of follow-up after most cases of HIV exposure.

****
Miceli M, Giuliani M, Gallo A, Mercurio G, Crescimbeni E, Iudicone P.
Residual risk of HIV-1 transmission: the case of a seroconverter. Clin
Lab. 2002;48(5-6):283-6.

National Blood Transfusion Centre, Italian Red Cross, Rome.
mi.miceli@tiscalinet.it

In the present report we describe the case of a repeat blood donor
infected with HIV-1. In January 2000 the donor was found to be
repeatedly reactive to HIV1/2 antibodies and HIV-1 RNA screening
tests. The donation was confirmed to be HIV-1 positive by Western
blot. During the post-test counselling session, the donor reported a
risk sexual behaviour denied during the pre-donation interview, and he
recalled that in May 1998 he had undergone a check-up including the
test for the detection of HIV1/2 antibodies, which was negative. This
check-up was dated four months the next to the donor's previous
donation in January 1998, which had been found HIV1/2 antibody
negative, too. Serum and plasma specimens, properly stored at -80
degrees C, were available at the hospital where the donor had
undergone the HIV antibody test in May 1998. Thus, the specimens dated
May 1998 and the specimen of the last donation in January 2000 were
investigated again by using the most sensitive tests currently
available in the setting of donation screening. On the whole, the
results suggest that in May 1998 the donor was in the
pre-seroconversion period for HIV-1 infection. The case reported here
stresses that a residual risk for HIV transmission through blood
products still relies on the possibility that an individual may be
accepted as blood donor during the asymptomatic pre-seroconversion
window period of HIV-1 infection. Actually, this phase of the
infection cannot be detected by the routine antibody/antigen-based
HIV1/2 screening tests but only by using more sensitive techniques
such as genomic screening.


****
Aprili G, Gandini G, Piccoli P, Bressan F, Gironcoli MD, Mazzi R,
Parisi SG, Gessoni G, Marchiori G, Franchini M. Detection of an early
HIV-1 infection by HIV RNA testing in an Italian blood donor during
the preseroconversion window period. Transfusion. 2003
Jul;43(7):848-52.

Transfusion Service, Verona Hospital, Verona; Division of Infectious
Diseases, Verona University; Transfusion Service, Mestre Hospital,
Venice; and Transfusion Service, Chioggia Hospital, Venice, Italy.

BACKGROUND: The implementation of NAT technologies for HIV screening
has further reduced the diagnostic window in recent HIV infection.
There is still a debate regarding the cost effectiveness of genomic
screening of blood donations for transfusion-transmitted viruses (HBV,
HCV, HIV). STUDY DESIGN AND METHODS: Since October 2001, at the
Transfusion Service of Verona, single-donation NAT testing for HCV and
HIV-1 (Procleix TMA HIV-1/HCV Assay) of all blood donations has been
performed. CASE REPORT: A case of acute HIV-1 infection detected by
HIV NAT in a repeat blood donor who donated during the
preseroconversion window period is reported. All blood components
donated were discarded, and the donor started antiretroviral therapy 2
weeks after blood donation. HIV-1 p24 antigen was still negative 10
days after the HIV-1 RNA-positive blood donation. Seroconversion was
documented by Day 41 after donation. CONCLUSION: This case report
testifies that HIV NAT screening of blood donation is effective in
preventing the transmission of HIV infection through blood components.

Thank you for your interest in these collaborative exchanges!

Testing oneself is not the strategy. The strategy is get tested together before you have sex.
There is no test for mutual fidelity. Mutual fidelity is more often the exception.
It is a powerful biological force. It is always a good idea to use so called safer sex
practices and condoms even after getting tested together. So called safer sex practices
and condoms work when used every single time from beginning to end, a diligence
that is not possible. Lack of efficacy for so called safer sex practices and condoms
have not worked to stem the increasing rate of new infections since the 1980's.

Testing includes the standard sexually transmitted infections,
1. acquired immune deficiency syndrome human immunodeficiency virus
2. oral pharyngeal, urethral, anal canal sexually transmitted infections
3. tuberculosis
4. hepatitis B, hepatitis A, hepatitis C and get vaccinated for hepB and hepA.

The window or latency period is a myth of denial used as an
excuse for not getting tested or avoid not getting tested today.
There are all the years of sexual activity, much longer than any conceivable window,
that test results will provide useful information that would not be know without
getting tested together.

Vulnerable people who got infected died. Pharmaceutical regimens
have made for many more people living with infections that are passed along.
There been no random samples of the general population in
universal testing studies. For every other disease we do universal testing
of random sampling. Politically correct attitudes have prevailed so far.




Collaborative weblog
The Strategy. Get Tested Together Before You Have Sex.
http://NotB4WeKnow.blog-city.com

In order to know the rate of new infections we need a random sample of
the general population getting tested regularly. We could find what
kind of people might resist exposures to infections.

So called politically correct attitudes have prevailed hampering
universal testing even for a random sample of the general
population. Just like so called politically correct attitudes have
hampered acknowledging that most people are not mutually
faithful. Without knowing the rate of new infections, that is a
statistic different from the death rate, there can be no claims about
the epidemic peaking and going down.

The most vulnerable people may have died off and people living with
infections pass them along.

More likely the rate of new infections is increasing at an increasing
rate. With regimens of pharmaceuticals more people living with
infections pass them along.

For so called safer sex practices to work they have to be used every
single time from beginning to end, a diligence that is not humanly
possible. One test at the beginning does more. Infections can be
detected and treated before exposing another person. Would you have
sex with somebody you meet who tells you they have an infection and
that if you get it you could die a painful death?... A politically
correct answer is not what would really happen when most people
encounter that predicament.





Collaborative weblog
The strategy. Get tested together first before you have sex.
http://NotB4WeKnow.blog-city.com

....nope, mandatory testing doesn't work. Only potential sex partners know
they are potential sex partners. The state does not know who are potential
sex partners.

Univeral testing would provide statistical information about the rate of new
infections.

It does not matter that most people would not do the strategy get tested
together before you have sex. For the potential sex partners it will work
regardless of what anybody else does not do.

There is no claim about it being foolproof. It can detect infections that
would not have been known. The infections can be attended to before having
sex. People who want that kind of life can even choose to go ahead and have
sex anyway knowing of the infections. The difference is having information
not known and being able make a choice not to have sex when infection can be
passed along. There is no choice without information. The health of a
relationship includes and some might say begins with the health of the
potential sex partners.




Collaborative weblog
The strategy. Get tested together before you have sex.
http://NotB4WeKnow.blog-city.com

Having more multiple sex partners is not considered to be a safer sex
practice.

Sex partners do not always agree on what are considered to be so called
safer sex practices and diligence is not possible.




Collaborative weblog
The strategy. Get tested together before you have sex.
http://NotB4WeKnow.blog-city.com

Imagine the disease of the future, both parasitic and cannibalistic and
if you don't have sex you die.

So A calls B and says,
"You've got to come over!"

B says,
"I can't. I'm going over to C's"

A cries,
"You've got to come over now! It's beginning to gnaw at me!"




Collaborative weblog
The strategy. Get tested together before you have sex.
http://NotB4WeKnow.blog-city.com

Don Saklad wrote:
Depends.

I remember a cartoon in the late lamented "Diseased Pariah News."
Raunchy Rabbit was bedding everything in sight, but safely. Timid
Turtle had only sexual partner, but unsafely... and guess who was in the
last panel hooked up to IVs?

Seems you're quite sex-negative, Don. Unless the two people involved
are willing to be tested, and then turn themselves into an institution
where they can be watched for the next three months and get tested
again, getting tested is useless.

The test cannot confirm seronegativity. It can indicate it by lack of
seropositivity, and it only indicates that for the three to six months
prior to test. The test can only be used to confirm a positive state.

But I expect that nothing anyone can say will change your mind.

B/

Don Saklad wrote:

The test results are always ambiguous, unless it's positive.

B/

On Mon, 30 Jun 2003 09:40:03 -0700, Brian Mailman
<bmailman@sfo.invalid> wrote:

Eh! Your both rong!!

(well...kinda...and LOL...grammar queen check: I'd written "your
welcome." Sigh. And one of my pet peeves, too!)

Testing provides a snapshot of a current condition. Any test is
limited intrinsically. The chances you are truly negative are the
test's specificity. The measure of the likelihood of being truly
positive is its sensitivity. The HIV tests for antibody have been
measured and are >99% I believe on both measures.

However, one limitation, as noted, is the window period.

The other limitation is subsequent exposure to infection.

George M. Carter

On 30 Jun 2003 10:54:28 -0400, Don Saklad <dsaklad@nestle.ai.mit.edu>
wrote:

Increasing numbers of partners increases risk. But these risks can be
minimized by using a condom, particularly for penetrative sex
(vaginal, anal). Not eliminated, but substantially reduced.


So best to never have sex. Most adults (and even a lot of children)
don't choose that option, no matter how much the preachers squeal, the
imams holler and the rabbis yell. Nor the shitheads like Bush that
push "abstinence only" with that "Got Coke" smile on his shifty face.

George M. Carter

I don't disagree with most of what you are saying and glad you are not
a mandatory testing proponent. I think general sampling OCCURS
already--many states have "names reporting" that ostensibly enhance
epimiologic capturing of HIV incidence. However, it probably scares a
lot of people away. By contrast, unique identifiers could achieve the
epi need without the extant fear, stigma and discrimination that still
accompanies HIV.

But that is distinct from your rather peculiar persistence that this
testing is somehow going to replace consistent use of condoms. It IS
humanly possible. It's not that hard to do, really. For some, it is.
They could use some alternative ideas like this, and to that extent
it's great. But to get so restricted into this mode of thinking seems
short-sighted and narrow-minded.

George M. Carter



On 30 Jun 2003 10:29:59 -0400, Don Saklad <dsaklad@nestle.ai.mit.edu>
wrote:

I had no idea people were basing their sexual strategies on cartoons!

And as to your attitude about me being absolutely uninfluenced by what
you have to say, how about you being influced by anything I had to say?

Golly, I hope you pass on this information that it is a totally
worthless thing to do, and health care consumers can save billions of
dolloars a year by not geting tested for anything.

And finally, what other worthless tests will you be giving up?
tuberculosis
severe acute respiratory syndrome
anthrax
cancer
and so on...

Sombebody might be asymptomatic for something like syphillis, if they
don't get tested for it their brain is slowly going to rot.


Of course you could say the test results are always ambiguous, unless
it's positive about any test but that doesn't stop people from getting
tested for things like cancer so why make an exception for sexually
transmitted infections, acquired immune deficiency syndrome human
immmunodeficiency virus?




Collaborative weblog
The strategy. Get tested together before you have sex.
http://NotB4WeKnow.blog-city.com

Self selecting groups of people like the military do have universal
testing. People who know they are positive are unlikely to try
entering the military. Newborns are tested universally.

Have you a link or reference to any specific program?... that does names reporting.




Collaborative weblog
The strategy. Get tested together before you have sex.
http://NotB4WeKnow.blog-city.com

Don Saklad wrote:
Neener-neener.

B/

GMCarter wrote:
(bobbitage)

Which is exactly what I'm talking about. The test doesn't really test
_current_ conditions but is a snapshot of the previous 3 months.

B/

Testing detects sexually transmitted infections for all the years, all the time before
any conceivable window or latency period. A recent sexual contact can raise fears.
Most likely exposure to infections would be from sexual contacts over previous years of
sexual activity.

Getting tested today, now, right away can detect infections earlier.
Getting tested today, now, right away can determine when the infection
began. Getting tested today, now, right away provides a benchmark
useful for determining possible treatment.




Collaborative weblog
The strategy. Get tested together before you have sex.
http://NotB4WeKnow.blog-city.com