Friends in low places
May 12, 2009 12:50 AM   Subscribe

A friend of mine, recently married, went to Africa and slept with 3 prostitutes. He came back about 3 months ago, and over the last 3 weeks he has had an insistent cough and flu like symptoms. He went to the doctor, and the doctor did a lung and throat check-up and everything was fine there. So the doctor ordered a HIV test. Results are coming on Friday.

He said he slept with the girls and wore a condom. Since the doctor ordered the test he has obviously not slept with his wife anymore.

Now, in my opinion, it's possible that this guy has HIV. I don't know how, but everything pretty much points in that direction.

The question is : how do I prepare myself to be his friend when he gets the results? He may not even want to tell me, he could freak out and do something stupid, he may get depressed, he may find religion - I really don't know. But this is a very good friend of mine and he helped me massively at low points in my life, and I want to do the maximum I can do.

Obviously, I'm there for him to talk to, but is there more I can do? I feel a bit helpless, like even if the diagnosis is positive, there is almost nothing I can do.

Any ideas?
posted by ChabonJabon to Health & Fitness (31 answers total) 4 users marked this as a favorite
Have they checked for malaria?
posted by 5_13_23_42_69_666 at 12:56 AM on May 12, 2009 [1 favorite]

how do I prepare myself to be his friend when he gets the results? ...this is a very good friend of mine... and I want to do the maximum I can do.

Well, should he turn out to have contracted HIV, your choice is pretty clear, I think.

You treat him EXACTLY the same as you always have. Exactly.
posted by rokusan at 12:56 AM on May 12, 2009 [8 favorites]

Well, you don't know for sure that he has HIV yet, but if he does he'll probably need a good divorce lawyer. You could also start looking for HIV support groups and have some information ready for him so he can talk to others with the same affliction.
posted by benzenedream at 12:59 AM on May 12, 2009

"In the majority of the infected population, HIV remains asymptomatic for years. The only way to know if you have HIV is to be tested. It is important to know, however, that it may take up to six months after exposure to the HIV virus before you will test positive on an HIV antibody test, although most infected people will test positive within 3 months."

I don't know his timeframe, but maybe unlikely his current symptoms are HIV-related?

posted by martens at 1:04 AM on May 12, 2009 [1 favorite]

Martens: this could be acute HIV syndrome (also known as Primary HIV). Nonspecific symptoms plus sexual/travel history would make me suspicious if there was no other obvious cause.

If he is HIV positive? Supportive, don't go all weird on him, make sure he takes his antiretrovirals. And yeah, agreeing with the above - help him through the almost-inevitable divorce...
posted by Coobeastie at 1:18 AM on May 12, 2009

Response by poster: Another problem I should mention: He will not want a divorce because he can only stay in the country I am living in because he is married. He did not marry for love, he married to get a Visa. So if this diagnosis turns out to be true, he may want to not tell anybody for exactly this reason. He will likely also not tell me in this case, so I may have to deal with a situation where he has the disease but does not tell me about it.
posted by ChabonJabon at 1:24 AM on May 12, 2009

Another problem I should mention: He will not want a divorce because he can only stay in the country I am living in because he is married.

I'm not sure it would really be up to him.

Anyway, what you described doesn't sound like HIV to me although I'm not a doctor. People don't usually get HIV and then get AIDS right away. Being HIV positive usually means just having the virus, whereas AIDS means having the disease. If he really did wear a condom then the chances of him getting the disease aren't really all that high.

Also, what countries did he go to? Not every country in Africa has a high HIV infection rate.
posted by delmoi at 1:51 AM on May 12, 2009 [1 favorite]

I hope that your friend's visa marriage was entered into with the full knowledge and co-operation of his spouse and that it doesn't include any kind of sexual contact. Because if she married him for love, and/or if he is putting her at risk of whatever diseases he may have picked up from those prostitutes, that makes him a pretty vile human being. And if it is a love marriage on her part, and he does turn out to have HIV and you find out about it you need to insist that he tells her immediately or do so yourself. We're not talking about a case of crabs here.

Anyway, statistically, the risk of female-to-male transmission is fairly small compared to the risks of male-to-female and male-to-male contact. There are some who believe that the chances are even lower than what the statistics suggest, because there are many men who will insist that they could have only been infected by a woman rather than admit that they had sex with another man. These statistics rely on self-reporting to record transmission method, and that is an extremely unreliable method, especially when something like sexuality is involved.

Basically, it's not impossible, but it's highly unlikely that your friend caught HIV from his little adventure. Lots of things can cause long-lasting cold and flu-like symptoms. Two that spring to mind are Mononucleosis and Cat Scratch Disease.
posted by Wroksie at 2:27 AM on May 12, 2009

Sorry, I just re-read the part of your question where you say that since he ordered the test, he has stopped sleeping with his wife. So... correct my timeline here if it's wrong, but he slept with three prostitutes on a continent with a notoriously high incidence of HIV infection and then proceeded to have sex with the wife that he doesn't love, and is just using for a visa, and then only decided to get tested for HIV when he got the sniffles? At what point between the prostitutes and sleeping with his wife did he get complete battery of tests for all the other possible STD's out there? And if he's scared that he might have contracted HIV, why in fucking hell has he not immediately told his wife so that she can get tested, too?

You need to insist that he comes clean with her immediately so she can get a full battery of STD tests, or you need to tell her yourself. Someone in your question needs support and someone to talk to, and it sure ain't your friend.
posted by Wroksie at 2:42 AM on May 12, 2009 [50 favorites]

Whatever the results of the test, I think your role as a friend who knows all the details is to remind him that he needs to get back in touch with his humanity and stop acting like such a colossal, Jerry Springer-worthy asshole. Sounds like he needs some really tough love and if you care about him at this point maybe you are the one to give it to him.
posted by No-sword at 3:09 AM on May 12, 2009 [7 favorites]

You have a moral obligation to be there for your friend but a greater moral obligation to inform the wife that she may have been exposed to HIV. If you want to do what's right, you have to have your friend tell her or do so yourself.

If you don't care morally, and just want to be his friend, then everyone is right--maintain the status quo in the relationship.

This is a real prick-ish thing for him to do, and to me, cancels out whatever supportive role he may have played earlier in your life, so I think I would re-evaluate where the emotional emphasis should be in this story.
posted by A Terrible Llama at 3:54 AM on May 12, 2009 [4 favorites]

Now, in my opinion, it's possible that this guy has HIV. I don't know how, but everything pretty much points in that direction.

The symptoms you've described, on the timeline you've described, are unlikely to be the result of acute HIV. The symptoms might have been the same, but he likely would have had the symptoms closer to the date of his trip. In addition, if he actually used a condom he's not at huge risk for having contracted HIV. It's possible he's HIV positive, but if he is, it's also possible that the timing of this trip is just coincident with his trip to Africa.

You support him by supporting him. If he's positive it's more important to help him develop a healthy attitude about his disease than it is to deal with the OMG AAAIIIDDSSSS! If managed properly HIV is much much closer to a chronic disease than to a terminal one, a very serious chronic disease, but something that is treatable nonetheless. People live with diseases that threaten to kill them more quickly, and mess up their lives much more dramatically, than does HIV.

I guess the point I'm trying to make is that the best support to offer is the support you would offer a close friend with any chronic disease. Help him make good decisions about care, help him remember to take his medication, help him to find a good doctor, help him to remember his appointments. The more you treat the particular diagnosis as incidental, the more likely it is to be incidental.
posted by OmieWise at 4:50 AM on May 12, 2009

About marital sex, he may be truthful, he may not. His wife should get tested, too.
posted by Carol Anne at 5:31 AM on May 12, 2009 [1 favorite]

Since the doctor ordered the test he has obviously not slept with his wife anymore.

I wouldn't believe that until I talked to her myself. The most important obligation you have here is to an innocent person who should know about her husband's infidelity and possible infection - fake marriage or not.
posted by Optimus Chyme at 5:43 AM on May 12, 2009 [1 favorite]

For future reference, they make HIV tests that return results in ten minutes so you don't have to go through this kind of waiting game. If you contact your local GLBTQ community center they'll tell you where to get one for free, and he could know by the end of the day.
posted by The Straightener at 5:47 AM on May 12, 2009

What is missing from the timeline is when he actually slept with the prostitutes. It says he came back 3 months ago, but does not mention when he left, or when he slept with them (it could have been last year). This is useful data.... but it is all speculation until friday anyway so just sit tight with them.

If you can, reach out to and support his wife at the same time, it may remind him to do so.

What an awful situation.

Good Luck to them.
posted by Studiogeek at 5:57 AM on May 12, 2009

there is almost nothing I can do.

I understand how terrible this sense of powerlessness is, but the best way you can be a good friend to him here is to mind your own business and deal with the details as they arrive.

And if he doesn't want to tell you the results of the test, you need to honor this. Though I'd probably reconsider my friendship with anyone who trusted me enough to tell me he was getting tested with an incurable, potentially fatal illness, but not enough to tell me what the results of that test were.

As someone mentioned upthread, there's no real need to wait so long, there are faster tests. But if you must wait, then try to occupy your time and mind with other things in the meantime, worrying won't help anything.
posted by hermitosis at 6:39 AM on May 12, 2009

Aside from the question of HIV:

Is "the doctor" in question a travel specialist? It is very common for people from temperate climates to travel to the tropics and return with diseases that mystify their local GP. He could have low-level malaria, he could have some sort of parasite. He should find a travel clinic or travel specialist. These exist in large cities in the US. I'm not sure where your friend is, but he should be able to find someone.

Back to the question of HIV:

Someone close to me contracted HIV a couple of years ago through unsafe sex. It was very hard for me to comprehend his stupidity. How could he let this happen in 2007? Eventually I got over it. He's on good meds now (including antidepressants for the underlying depression that in part explained his behavior). Some aspects of his life, e.g. potential for marriage etc, have become more complicated. But it has not signaled the end of his life, as it might have ten or twenty years ago.
posted by alms at 7:11 AM on May 12, 2009

Apart from the HIV/ethical issues, you might ask whether his doctor checked specifically for TB.
posted by lakeroon at 8:37 AM on May 12, 2009

Response by poster: His trip was about 3 weeks long, and I don't know when exactly within the 3 weeks that he did the act. According to my research you exhibit flu-like symptoms for a while following a HIV infection, but these then go away for many years till you actually get aids.
posted by ChabonJabon at 8:39 AM on May 12, 2009

ChabonJabon, it sounds like your friend was concerned that his symptoms were caused by seroconversion/Acute Viral Syndrome. This affects about 30% (IIRC) of people infected with HIV--the symptoms are a result of the immune system attempting to fight off the virus in the early stages of infection.

So my thought is that if someone came back from Africa with the symptoms you describe, seroconversion wouldn't be the first thing most doctors would think of--there are many other diseases that produce the same symptoms in their early stages, most notably malaria, as others have said, but there are others, including tuberculosis. I would encourage you to encourage your friend to see another doctor with more expertise in infectious disease.

That said, your friend sounds like an ass. On the one hand, you say that his marriage is a marriage of convenience; on the other hand, you say he's sleeping with his wife. Does the wife know that this is a marriage of convenience?
posted by Sidhedevil at 8:54 AM on May 12, 2009

Actually, it's not that likely that he has HIV. It's likely he has a cold, seasonal flu, or some bug that he picked up because he was traveling and exposed to lots of new germs.

You help him by educating yourself about HIV, encouraging him to not do anything stupid, and helping him deal with the results, HIV+/HIV- or whatever else.
posted by theora55 at 9:03 AM on May 12, 2009

Actually, it's not that likely that he has HIV. It's likely he has a cold, seasonal flu, or some bug that he picked up because he was traveling and exposed to lots of new germs.

This. A teensy-weensy small percentage (1.14%, according to the WHO) of people do get infected with HIV even when using condoms; only a small percentage (I looked it up and it's actually 34%) of people infected with HIV experience seroconversion. So the chance that this is seroconversion is one-third of one percent, even assuming that the sex workers were HIV-positive.

Now, of course the doc is going to test for HIV, because that's a routine test. And, yeah, your friend had sexual contact with sex workers in Africa, so that enhances his risk factors.

But still, it seems like you're assuming that it's more likely than not that he got AIDS, when the odds are actually against it.
posted by Sidhedevil at 9:18 AM on May 12, 2009

If the tests come back as negative, he should get re-tested in a few months, since it can six months for HIV to show up on a test, depending on the test.

Knowing the country would be helpful. Regardless, his symptoms could be from many other things.

And if he does have HIV... well, many HIV+ people consider it a chronic, long-term illness these days. Life expectancy for children with HIV is similar to those without. It can be managed.

Does your friend have insurance?
posted by bluedaisy at 9:19 AM on May 12, 2009

Your friend sounds like quite the f@#$ing asshole. Sleeps with three hookers in Africa and then comes home, sleeps with his visa wife, and then thinks that he needs tested. At what point did the "I might have something" thought process come into mind? Was it the I'm having sex in Africa part or was in the 3 African hooker part? I doubt he has HIV or AIDS these things take time to show up.
posted by Mastercheddaar at 9:58 AM on May 12, 2009 [1 favorite]

How to "prepare yourself to be his friend" after he gets the results? When it turns out he has the flu, counsel him not to sleep with prostitutes anymore, especially in Africa. (I'm sure there are local alternatives.) If it turns out to be the AIDS, ask him why he lied to you about using condoms. In either case, this guy is a mess and needs a real friend to set him straight. (Unless you approve of his behavior, in which case good luck to you both.)
posted by turducken at 10:40 AM on May 12, 2009

Any specialists in tropical medicine around your area? He might want to consult one if his HIV test comes back negative as there are many diseases and parasites that NA doctors would not be familiar with. As for your friend's morals, well, I think that's been pretty well covered. Sounds like you should watch your back around him if he's willing to treat his wife in such a shabby fashion.
posted by x46 at 11:26 AM on May 12, 2009

only a small percentage (I looked it up and it's actually 34%) of people infected with HIV experience seroconversion

This is incorrect. (It's a typo, but still incorrect.) A percentage of people infected with HIV experience seroconversion syndrome, which seems like the flu. Seroconversion is developing antibodies to a virus or pathogen, and ~100% of people infected with HIV "experience seroconversion." One begs the other.
posted by OmieWise at 11:58 AM on May 12, 2009

So if he doesn't have HIV then there's no dilemma? If my close friend did anything half as ghastly I'd never go near them. This is sociopathic. If you want to be a friend you could start by remembering that another person's life is in jeopardy and there are things that supercede friendship.
posted by docpops at 2:16 PM on May 13, 2009 [3 favorites]

Any update?
I Don't know you, but i think of this pretty often. Hope it worked out OK.
posted by Studiogeek at 3:48 PM on May 17, 2009 [1 favorite]

Response by poster: Update: He did not have HIV. He's still married, but now he's sleeping with a lot of local girls. His wife is happy, and never complains about him going out all the time.
posted by ChabonJabon at 11:46 PM on October 4, 2009

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