Guide to HIV testing in Malaysia

My ELISA results from Gribbles – HIV negative (HIV 1 & 2 antibodies: Not Detected)
This means I don’t have HIV (the virus which causes AIDS)

Warning: This is a very serious post.

It doesn’t seem like there is a wide awareness about HIV and AIDS in
Malaysia, especially in smaller towns. There’s this phrase – “When you
fuck someone, you’re fucking every single person that person has ever
had sex with”. Granted, the chances of infection via a single exposure
is nowhere near 100% but it is still a very serious risk. HIV
tests, which some people incorrectly call “AIDS tests”, checks for HIV
antibodies. HIV is the virus that causes AIDS. Contrary to popular
belief, most HIV infections are transmitted though sexual activity and
NOT (safety conscious) injecting drug users.

The “data” the government publishes is skewed since prison inmates
and drug rehabilitation center admissions are subject to mandatory
testing, while there’s no mandatory HIV testing for people caught
patronizing brothels. There is also no mandatory testing for every
citizen of Malaysia (which I assume would be unconstitutional). The
statistics are further fudged since inmates convicted with a drug
related offence and/or fails a drug test who tests out to be HIV + is
recorded under “injecting drug users”, even though the vector of
transmission could very well be sexual contact. Feel free to question a
prison administrative officer if you doubt the veracity of my claims.

The presence of HIV antibodies (antibodies detected) means you
should start writing your will, while the absence of HIV antibodies
(antibodies not detected) means you can breathe a sigh of relief. Thus,
if your HIV antibody test results come back as “Not Detected”, you’re
HIV negative (meaning you don’t have the virus – a Good Thing (TM)).
Some of the people I know have such a low awareness and an almost
nonchalant attitude towards this very serious condition, which worries
me, as I feel that there may be an epidemic going around on a scale
that can’t be measured, since not many people go for HIV testing.

Let’s digress a little and talk about why this issue concerns me so
much. I’ll be honest here – I’m fucking scared of HIV/AIDS. It started
from my childhood, I guess…I read a lot about HIV since I was born in
1981, and that was the year this disease made the media. I started
reading on an advanced level at a very early age and my mom kept all
these books about STD’s (they used to call it VD for Venereal Disease
then, but Sexually Transmitted Disease is the preferred term now)
around the house.

It scared me to death. I was so afraid of that book I didn’t want it
in the house. It had graphic pictures of end stage AIDS patients and
long lists of potential symptoms. It was definitely not suitable as
childhood reading material. Bear in mind that I was only 9 or 10 around
that time and I had read lots and lots of HIV/AIDS articles and
research papers. It was like a morbid fascination. It scares me to read
it, yet there was this dirty and retch inducing urge to read about it. I spent many hours each day thinking about STDs…

That’s when my phobia about STD’s, and more specifically HIV
started. It was a real phobia – I couldn’t stop thinking about it. I
would accidentally bump into someone in public and worry that somehow
lacerations invisible to the naked eye on both our bodies would
transmit the disease to me, even though I know that’s unlikely. I would
make my parents bring me for HIV testing when I touch a public toilet
door lock and accidentally touch my genitals while taking a piss, even
though I know it doesn’t spread that way and I know how long the HIV
virus would survive outside the body (not very long).

But like I said, it’s a phobia and phobias are irrational by nature.
I was young (primary school age) and I didn’t have a medical counselor
like first year med school students had, so it overwhelmed me. I guess
I’ve never blogged about such a personal issue, though I’ve hinted at
it in my veritas posts. I can’t have sex with people who have not gone
through a HIV test under my supervision. Yup, you can all laugh now,
but it’s no laughing matter for me. It scares me every single day, even
though I don’t engage in high risk behavior. Like I said, phobias are
irrational.

I’m no virgin even according to Bill Clinton’s definition of sex, so
there’s nothing wrong with my equipment. My family jewels are perfectly
fine, thank you very much; it’s just the irrational psychological fear
of being exposed to HIV that manifests in the most efficient way – me
losing my erection. I simply can’t maintain an erection during
penetration unless I’m sure it’s absolutely safe. It’s like my brain
associates sex with HIV, and I just can’t do it (literally, try
stuffing a prune into the slot in a piggy bank) unless the receptive
partner takes a HIV test and it comes out negative.

I usually go for HIV tests every 3 months. That might seem like
irrational behavior since I don’t engage in high risk activities, but
phobias are irrational by nature. I take both the ELISA and Western
Blot, and I’ll go for the RIPA (damn expensive, it should be called RIPA hole in your pocket)
and PCR (Polymerase Chain Reaction – instantly makes your wallet
significantly slimmer) too if I have the money. Here’s a short
explanation about the tests, this is from memory, so please correct me
if I’m mistaken, but I’m pretty sure I’m not since I’ve been following
this issue with morbid fascination (the kind that attracts and revolts
you at the same time) for a long time.

First, here’s two terms you should be familiar with:

False Positive (FP) – Test came out as positive, but you’re really HIV negative.
False Negative (FN) – Test came out negative, but you’re really HIV positive.

The first one means that it’s a false alarm – ELISA (and some
others) is highly sensitive, which has the potential to induce heart
attacks. 😉 The second one is the one you should fear, that’s why
paranoid people like me go to three different pathology laboratories
every time just to make sure no one fucks up and returns a FN when
you’re really HIV +. It’s an expensive phobia to entertain…

Tests:

These are the two common ones available in Malaysia.

Enzyme-linked Immunosorbent Assay (ELISA)
This is the most common and cheapest (around RM 20) test available –
it’s highly sensitive and it’s what most people refer to when they
mention HIV testing. I’ve never gotten a False Positive (FP) before,
thank God, but ELISA has been associated with that, as well as False
Negatives (FN), so beware. It is better to take the Western Blot
together with this. Some laboratories would give you a strange look,
since people usually only take the much more expensive WB for
confirmation if ELISA returns a positive, since ELISA is highly
sensitive. Insist on Western Blot anyway.

Western Blot (WB)
This is a more accurate (precise) test but it’s damn expensive.
Gribbles offer ELISA + Western Blot for RM 250 here. ELISA results come
back quickly (3-5 days max) while Western Blot takes longer (YMMV,
since blood samples in Kuching are sent to KL for WB since there are no
such facilities here). However, be prepared for about 1-2 weeks for
your WB results to come back.

Other tests:

I’ve only seen these in Australia.

RIPA
This is a test that’s much more expensive than ELISA and Western Blot.
I’ve only taken it twice due to the obscene charges, but it’s worth it
if you’re a hypochondriac. The doctor might ask you why you want to
take this, due to the price, but no one would stop you from taking the
test. They’re probably just puzzled about why someone would opt for the
full battery of HIV tests.

Polymerase Chain Reaction (PCR)
This one deals a real blow to the wallet. It’s a highly specialized
test that can detect someone who’s just recently infected. That’s the
good part – it’s able to detect HIV antibodies faster than ELISA and
Western Blot. This is due to the incubation period, which I’ll explain
later. I’ve only taken PCR once since it’s too expensive.

HIV has an “incubation period” and it does take some time (3 months
is usually quoted, though there are cases where 6-12 months are cited)
before HIV antibodies develop. Thus, you will test as HIV negative if
HIV seroconversion hasn’t occurred. Now, this is an important concept
to grasp. HIV seroconversion can happen anywhere from 2 weeks to
several months after the initial infection.

HIV seroconversion comes after the “incubation period” –
seroconversion is the term for the time when HIV antibodies start
replicating. It can be accompanied by fever, malaise (tiredness),
flu-like symptoms, lymph node enlargement (as your body tries to fight
off the invasion unsuccessfully) and other general indicators, though
some people do not experience these symptoms during the seroconversion
period.

This is meant for people who’re not aware of how HIV/AIDS works, so
excuse me for explaining things which may be obvious to people who’re
already aware of it. HIV positive people have “AIDS” to use an
incorrect, but easy to understand statement. Basically, if you’re HIV
positive, it will develop to full blown AIDS (you will have AIDS) after
a dormant and symptom-less period (6-10 years is usually the figure).
It is important that you understand the difference between the terms
“dormant and symptom-less period” and “incubation period”.

It is also very important to know that you will only test as HIV positive AFTER HIV seroconversion occurs, which can take up to a year.

Example:
Dick is HIV positive (HIV +) while Sharon is HIV negative (HIV -). Dick
has unprotected insertive sex (“bareback”, or “fucking without a
condom”, to avoid too much jargon) with Sharon. It is statistically
easier for a male to infect a female with HIV. Thus, in this example, Sharon becomes infected with HIV.

Sharon wakes up the next day with one fuck of a hangover and
remembers the previous night’s shenanigans. Dick has a reputation for
sleeping around so Sharon is worried and goes to a pathology lab the
next day to request for a HIV test. The test results came out a couple
of days after that and Sharon burst into song with joy since the test
shows that she’s HIV negative (HIV antibodies not detected).

She throws a big party for everyone and vowed not to have
unprotected sex ever again. Sharon is under the mistaken impression
that she’s HIV negative. HIV seroconversion has not occurred yet and
thus, the results did not detect any HIV antibodies. She went for the test too soon.

Two weeks after that, Sharon came down with a fever and exhibits
flu-like symptoms. She went to a doctor, who gave her some medication
and she went home, still happy as a bird that she’s HIV negative.
Wrong. She has already been infected with HIV. The first test she took
did not reflect that coz it takes time for HIV seroconversion to occur.

Three months after the Dick affair, Sharon met David and they
started going out. David suggested that both of them take blood tests
for HIV before they initiate any sexual contact. Sharon did not mind at
all, as she did not know about the incubation period and had mistakenly
put the Dick affair behind her after her first test results came back
negative.

David and Sharon went to a pathology lab together and samples of
their blood were collected for HIV antibody testing. Two days later,
the lovebirds went eagerly into the pathology lab in the morning to
collect their results. They had made big plans for the night – dinner,
movies and (finally) their very first sexual rendezvous.

David collected his ELISA results. It says “HIV 1 and 2 antibody:
Not Detected”. Wonderful news! The couple kisses. The nurse however,
had an unreadable expression on her face. She politely asked that
Sharon come with her to see the doctor. “It’s probably a mix up of some
sort”, thought Sharon and trotted with David into the consultation room.

The doctor breaks the news to Sharon. “Please be prepared for what
I’m about to say. Your HIV test results came back positive both times
on the ELISA and we ran the Western Blot on it for confirmation. The
Western Blot result confirms that the blood sample taken from you
tested positive for HIV antibodies.”

Sharon was stunned. David was equally shocked. “I don’t understand…there must be a mistake…”, Sharon managed to squeak out.

“I’m afraid not, the samples are carefully labeled and tested on
site. Please understand that HIV is a chronic but manageable condition
with the advances in modern pharmacology – it is not uncommon to live
for 10 years or more before it develops into AIDS. We have counselors
here if you would like to speak to them. I know this is a big shock to
you, and I hope that this counselor would be of help. She’s very
experienced with people living with HIV and AIDS”, the doctor replied
while scribbling a name and number on his notepad, tearing it out and
handing it to Sharon.

Sharon left the building in a shocked daze. David was surprisingly
uncommunicative and did not offer any words of support or comfort. The
couple drove home in silence. David stayed in his car while Sharon got
out, still in shock and denial about her HIV positive test result.
“Aren’t you coming out?”, Sharon asked in a puzzled tone. “I’m sure it
was just a mistake, I’ll take the test again tomorrow and it’ll be
fine, you’ll see!”, she added cheerily.

David was avoiding eye contact with her. When he finally spoke, it
was in a hushed, flat tone. “I think we should stop seeing each other”,
David said, all the while sordidly looking straight ahead. “I don’t
understand…it was just a mistake, you see! The pathology lab just
mixed my results up with someone else’s that’s all!”, Sharon pleaded.

David remained silent for a minute and said with finality – “HIV is
a death sentence…your health will slowly deteriorate as you reach
critical HIV viral loads. When that happens, your compromised immune
system would be very susceptible to any infectious disease. I don’t
want to die with you. I’m sorry Sharon.”

Sharon watched shell shocked as David drove away from her porch. She
was found three days later lying in a warm bath with both her wrists
slit. Her left hand was still holding the razor blade and the bathtub
was filled with blood. The forensics team found an inscription finger
painted in blood on the wall of the bathroom. It reads:

HIV – It’s the gift that keeps on giving…but mine ends here with me…

Oops…I think I got a little carried away with that story. 🙂 I was
practicing my creative writing skills…the ending is cliche, I’ll be
the first one to admit that, but I reckon it was a nice ending. What do
you think? How’s my fiction writing skills? It’s cheesy but it’s a very
likely scenario. What would you do if your partner in a relationship is
HIV positive? Would you continue to cherish and love them or dump them
like an…er, AIDS infected person?

On a serious note, and back on topic, there is a lot of debate even
amongst medical professionals about the incubation period, latency from
initial infection to HIV seroconvertion, and post-seroconversion life
span. It’s all variable according to the individual’s heath, whether
they’re taking an effective regiment of medication to lower viral loads
and many other affecting factors. Nevertheless, HIV/AIDS is still a
death sentence, in the sense that you will eventually die (but then
again, life is a death sentence as well, but that’s digressing) unless
some breakthroughs occur in this area of research.

Anyway, I’ve seen some doctors who do not even know what HIV
seroconversion is! The ignorance and misinformation surrounding
HIV/AIDS is appalling. You can either choose to listen to those
doctors, or listen to paranoid me. I humbly suggest the latter, even
though I’m not a trained medical professional, since my methods ensures
utter peace of mind.

Let’s get the facts out of the way first. Having unprotected sex
with someone who is HIV + does not necessarily mean that you will catch
the virus, the statistics are admittedly low, but this is one disease
you don’t want, so just don’t take the risk. Bleach won’t kill HIV in a
vacuum type environment (eg a syringe), so NEVER share syringes or ANY
injecting equipment. I can provide sources (understanding pharmacies)
who can supply single use insulin syringes and sterile water in KL,
Kuching and Sibu if you email me. Please title the subject as “Injecting equipment – (either KL, Kuching or Sibu)” since I have a strict spam filter.

There is circumstantial evidence that circumcised males have a lower
risk of infection. Females have a higher risk of getting infected
compared to males due to the nature of the plumbing. That said, it is
still very dangerous to have unprotected sex with an untested
partner. Please don’t ever do it. Oral sex can transmit HIV as well, no
penetration is required. Safer sex (condoms) lowers the risk of
transmission, but it is NOT 100% safe!

Which leads us back to HIV testing…if you’re in a new
relationship, insist on having HIV tests together before any sexual
contact is initiated. IMHO, if the other party refuses, there’s
something very wrong here. Common excuses are:

1. “I’m insulted you even suggested that! Who do you think I am?”
2. “I will not take the test because it’s an invasion of my privacy!”
3. “Are you suggesting that I sleep around?”
4. “I’m outraged! You should trust me!”
5. “I’m afraid of blood/needles…”

In the case of 1-4, you can try telling your partner that doing this
is actually GOOD for the relationship, since there would be peace of
mind when sexual intercourse inevitably occurs. It works both ways.
It’s not about trust or privacy. It’s just a necessity in this society
where your partner probably has one or more sexual partners in the
past. If the partner objects, that might be a sign they have something
to hide, so personally, I’ll pass and move along (quickly).

Excuse #5 should be easy to rectify, if that’s the truth, i.e.
they’re really afraid of needles/blood and not trying to hide anything.
Some gentle assurance that the procedure won’t hurt might be beneficial
and it’s important that you go with him/her and provide emotional
support eg holding their hand, talking soothingly etc while the blood
sample is taken.

Benzodiazepines works wonders in calming people down – I suggest
alprazolam (Xanax) for its fast acting and strong anxiolytic
(anti-anxiety) effects. PLEASE EDUCATE THE SUBJECT ABOUT
BENZODIAZEPINES AND THEIR EXPECTED EFFECTS BEFORE THEY CONSUME IT.
Never force or emotionally coerce someone to take anything. It should
ONLY be taken by a willing adult, fully knowing the effects and what to
expect.

I suggest (Disclaimer: I am not a doctor, just a person experienced
with benzodiazepines) 0.5 mg – 1 mg alprazolam for non-benzodiazepine
tolerant people (PO, SL is a bit hard for new people to handle due to
the bitter taste). 2 mg or more would only be justified in non-reactive
person(s) or people with a severe phobia for syringes and blood. The
point is to slightly sedate, not knock out, the subject. Again, I must
state that this should be agreed to and willingly taken by the subject.

The maximum anti-anxiety effects should kick in at around 10 – 30
minutes after the initial dose, but the time may vary in different
people. Just ask how they feel eg “How are you feeling now?” to
establish the peak plasma concentration time. That would be the optimum
time to walk in for the blood test, and make sure you’re there for
support.

Here’s a totally irresponsible bit of advice on how to get
benzodiazepines if you don’t have access to any – please understand
that I’m only saying this because I would like to create HIV/AIDS
awareness and promote HIV testing:

1. Go for the HIV test yourself first.
2. Come in 2 hours later and act all strung out and scared shitless.
3. Claim you’re REALLY worried about the results and would appreciate anything to help with the anxiety.
4. Mention that you’ve been prescribed alprazolam (Xanax) before for anxiety and it really helped.
5. Leverage the 1-3 days results turnover to get a reasonable amount. It helps if you’re experienced with doctor shopping.

I managed to bum 2 blister packs (strips) of 10 x 0.5 mg alprazolam
(Xanax), 2 blister packs of 10 x 5 mg clorazepate dipotassium (Sanor 5)
and 5 x 2 mg clonazepam (Rivotril) in my latest HIV test (shown above).
That’s 10 mg of Xanax, 100 mg of clorazepate and 10 mg of Rivotril, but
I’m experienced with doctor shopping and can be a good actor if I want
to, so YMMV. Nevertheless, any self-respecting doctor would prescribe
some form of benzodiazepine to you, since its short term and perfectly
indicated for the situation. I strongly suggest alprazolam (Xanax) as
it’s perfect for this situation.

I actually tried to squeeze more out of the doctor – he had a drawer
FULL of benzodiazepines, and I was like a kid in a candy store, going
“Can I have 10 blister packs of that, 10 of these, 50 tablets of that
etc” and he laughed and said “No, I’ll only give you four strips and
you can have a couple of clonazepam tablets if you want”. Smart, this
one. Has a sense of humor too. 🙂

Now that we’ve taken the hard part of the equation out (convincing your partner to take the test), here’s veritas’s guide to HIV testing in Malaysia.

There is only one rule.

Remember it.

Rule #1 – Your name is Bob.

It’s Bob. It’s not (insert your name here). My name is always Bob
when I go for tests. I’m not Poh Huai Bin, my name is Bob. I always use
my real name in Australia as they provide confidential blood tests but
remember this, and listen real carefully:

Don’t ever give out your real name in Malaysia.

Malaysia DOES NOT provide confidential HIV testing. If your results
shows you’re HIV positive, the doctor is OBLIGED to report you and give
your personal details to the Ministry of Health who KEEPS A DATABASE OF
PEOPLE LIVING WITH HIV AND AIDS. They WILL conduct periodic checks on
you if you get into that database.

There’s an addendum to Rule #1 – NEVER donate blood unless you’re sure you’re HIV negative!
This is because the blood bank will contact you if your blood tests out
to be HIV positive. The usual procedure is to ask you to come in for
another test due to “unusual results”. They will do a Western Blot if
you fail the ELISA twice. You are not anonymous when you donate blood.
You WILL get into that database if your Western Blot returns positive.

Please note that I am TOTALLY AGAINST people who are HIV + and
continue spreading the virus. You will die a horrible, miserable death
and burn in hell for all eternity if you continue having sexual contact
after knowing your HIV status. It is also ILLEGAL to knowingly infect
others and I hope you go to jail and die inside there.

The reason I’m for anonymous testing is because I’m against the
unconstitutional database of people living with HIV/AIDS in Malaysia,
which is a major privacy infringement. The way I see it, if you’re HIV
+, you can either do one of two things:

1. Suicide (if your religion does not prohibit that).
2. Live with it and NEVER have sexual contact or other activity which could transmit the virus.

I strongly encourage people to go for HIV tests since I believe
there’s an epidemic waiting to happen with the trend towards
indiscriminate sexual exposure and a general lack of education about
the severity of HIV and AIDS and common vectors of transmission. I’ve
heard shockers like “Using a condom makes sex unexciting” from both
males and females. I’m quite sure the reported HIV/AIDS figures in
Malaysia are totally incorrect due to the lack of mandatory HIV testing
except for Muslim couples in Johor.

Here’s a scenario for you. John Doe seems to be a well educated,
intelligent and HIV aware person. He only has one sexual partner (let’s
call her X) in the past and she seems to be HIV aware and careful as
well. X has 10 sexual partners in the past. Each of X’s partners has an
average of 5 previous sexual partners. Fucking John Doe means you’re
essentially fucking 50 other strangers you don’t know.

This is just the calculations for 3 degrees of removal. In real
life, the number would be much more. Let’s assume that X had a stroke
of bad luck and one of her 10 partners infected her with HIV. X did not
know about this and unwittingly infected John Doe as well. Now, you
come into the picture and fuck John Doe. Oops. You can’t tell if
someone is HIV positive just by looking at them. I’ve heard this
shocker from a DOCTOR who said “I don’t think she’s HIV positive”, just
by LOOKING at the subject. May the Lord save his soul! There is no way to tell if someone is HIV positive without going for tests!

How to take anonymous HIV tests in Malaysia

1. Go to a new (one who doesn’t have your medical records) doctor
who offers this service. Ensure the doctor does not know you because
usually doctor-patient privilege means jack shit in Malaysia. Also,
make sure the pathology lab they outsource tests to is reputable.
2. Tell the nurse you want to see the doctor for a blood test. Here’s where they ask for your IC (Identity Card).
3. Politely refuse to hand it over and decline to reveal any
information and say that you just want to be known as “Bob” due to
personal reasons.

IF the nurse says they need your personal information, ask to speak
to the doctor. Explain to the doctor that you want to take a HIV test
and would like to remain anonymous. Most professional doctors will be
accommodating. If they’re not, go back to #1 and repeat till you find
an understanding one.

1. The doctor may make small talk eg asking where you work, what
your name is etc. You should not answer these questions. Reply with a
polite “I’m truly sorry doctor, please don’t take any offence, but I’ll
prefer not to reveal personal information”.
2. You will probably be given the ELISA test. You can opt for the Western Blot as well, if you have the money.
3. The doctor will swab you and insert a needle with a large gauge
(hole, if you will) after finding your veins with a tourniquet.
4. You will be expected to clench and unclench your fist for blood to drain into the test tube.
5. Once a suitable amount of blood sample is taken, you’ll be given a
reference number (if you’re not given one, please ask for it, since
you’re only “Bob” and you need a unique reference number to collect
your results).

Here’s a couple of photos of the HIV blood test procedure, this subject is “Jane”:

The doctor registers a vein and starts to draw blood.

This is the test tube where the subject’s blood sample is transfered for HIV testing.

Now, listen to me carefully. The doctor is legally obliged to hand
over your particulars to the Ministry of Health if your results test
out positive. There is a stupid way and a smart way to get around this.
The stupid way (which is not recommended, it’s called stupid for a
reason) is to come in, gauge the expression of the nurse or doctor
(they will know your result, they are able to see it) – if you sense
something amiss, grab the results and run out of the clinic before they
have a chance to stop you. No one will stop you anyway, but this is the
stupid way, there is one loophole that allows a more subtle approach.

Now, please listen up, this is the only way to get anonymous test
results in Malaysia. This requires a truly understanding doctor, and I
have a recommendation if you’re in Kuching.

Loophole:
The doctor is obliged to inform the authorities if you’re HIV + and
give them your personal information. The doctor does not have your
personal information, Bob. 🙂
Negotiate with the doctor about test result retrieval. This is the only
way that allows the doctor to maintain his professional integrity and
stay on the right side of the law and yet allows you to remain
anonymous. Most doctors will agree to this, if they went into the
medical profession with an altruistic desire to help people instead of
other reasons.

Here’s the loophole – tell the doctor that you’ll be calling him to ask about your HIV test results.

1. Make an agreement with the doctor that if your test result is
negative, it will be conveyed over the phone eg “Hello, good news, you
tested negative on the ELISA”. If the test result is positive, ask for
the doctor to tell you to come in and collect your results eg “Hello,
your test results are back, please come in to collect it.”
2. Now, call the doctor from a public phone eg “Hello, this is Bob, and
I was wondering if the HIV test results have come in yet”.

If the doctor says “Hello Bob, your results came back – all clear,
negative for HIV” go in and collect the test result. You’re HIV
negative. 🙂

However, if the doctor says “Hello Bob, your results are in, please
come in and collect it”, don’t go in. You already know what your result
is based upon the previously agreed upon phrase. You’re HIV positive.
Sorry.
P/S – Please verify HIV status by taking more HIV tests in other
pathology labs before you jump off that building. It could be a false
positive.

To reiterate, you have to make an agreement with an understanding doctor about the procedure for collecting the test result.

The deal goes this way – if your results are negative, then the
doctor will tell you over the phone. However, if your results turn out
to be positive he’ll ask you to come in and collect it. Notice the
difference?

Do you see how this works now?

The doctor did not breach any ethical code by telling you over the
phone that your results are negative. It’s good news, he’s just
informing you about that to save you from unnecessary anxiety.
On the other hand, he has fulfilled his legal obligation by asking you
to come in to collect your test results if it’s positive, since he’ll
need to record your personal details. He has told you to come in, you
just didn’t go in, and there’s nothing he can do about that, he’s not
responsible for no-shows.

Most doctors will be happy to do this if you ask nicely. There you have it – anonymous and totally private HIV testing in Malaysia!

Please feel free to comment and ask for clarification if you have any questions about how this works.

Jane’s ELISA results – also HIV negative. Remember that you’re “Bob” if you’re male and “Jane” if you’re female. 😉

I’ll be honest here and say that I’ve gone for many, many HIV and
other STD tests. I don’t need it, since I don’t engage in risky
behavior. However, I have an intense fear for HIV, which I blame on the
young exposure to age inappropriate material without a councilor to
talk to. Did you know that I secretly sneaked out to see a doctor when
I was in Primary 4 (10 years old) to test for gonorrhea coz I’ve been
reading about it and I was convinced I have it even though I haven’t
even had sex at that age. I told the doctor not to tell my parents, but
he did. Oh well.

That’s just the way I am…it’s like the first year medical student
syndrome – you start noticing and obsessing about having a disease coz
the symptoms all match (at least in your mind). Unfortunately for me, I
did not have counseling services at that time, so it really affected
me. I spend hours each day worrying about diseases. I’ll be a
hypochondriac for life if I don’t have benzodiazepines.

I’ll do things to make myself forget about imaginary symptoms. One
of my favorites at that time was stuffing my right fist into my mouth.
Try it and see how it feels. 🙂 Your jaws are bent and aching, which
provides a brief respite from the anxiety in your mind. I also scrape
my knee on purpose by falling down intentionally. It helps to get those
nasty, scary thoughts out of your mind if you make a proper wound and
jab it every time you get paranoid.

One particularly bad time required me to swallow this one meter long
plastic toy sword so I can think about choking instead of catching some
disease just coz I accidentally bumped into someone. I didn’t like to
have physical contact with anyone then, I’m afraid they’ll somehow
transmit a disease to me (I have a very vivid and unstoppable
imagination). I still feel uncomfortable about physical contact, though
benzodiazepines help a lot.

I guess you can say that my childhood was a little unusual. OCD used
to play a dominant part as well. I won’t go into that since there’s too
many to mention but one constant manifestation is snapping my fingers
on my right hand, starting from the fore finger till the thumb to
“open” (or start, if you will) the issue. Depending on the intensity of
the anxiety and worry, the repetition can vary from one to 35 times
(for extreme moments of fear).

I would then think about the issue I’m afraid of, going through it
many times, usually an even number so it won’t happen again (coz if
it’s even, it’s settled, divisible by two). This can last from minutes
to several hours and if someone breaks my train of thought by talking
to me, I would have to quickly “close” the issue by snapping the
fingers on my left hand for the equal number of times that I did for my
right hand (so that it will be closed, if it’s not the same, it’s bad
coz it’s still open) and restart again.

This can happen many times a day…I would think “I think I didn’t
snap my fingers on that left hand hard enough that third time, so the
issue is still open” and I’ll have to repeat the process all over
again, using a higher number to “overwrite” the botched one. Well,
since I’m telling you all so much about my psychological history, I’ll
just tell you something that no one knows, except for my immediate
family and doctor.

Retracted penis syndrome…have you ever heard of that? It’s either
known as koru or kuro in Malaysia and it’s a psychosomatic condition
that would be diagnosed as panic attacks now. Now here’s the strange
thing. I’ve never even known that something like that existed until
recently. I’ve experienced it without even knowing about it!

There was this time where I worry constantly about my penis. I would
imagine that my left testicle seems lumpy and I was afraid that it was
cancer of the testicles but didn’t have the means to test (my parents
thought I was crazy anyway – “psycho” was the term my mom used) it
properly then. I did get my parents to bring me to a doctor, and he
pronounced that my testicles are perfectly fine.

But I only felt assured in the doctor’s office. I started worrying
again once I got home. What if that doctor was wrong? He’s just a GP
after all. It kept on worrying me till I was 16, I had always thought I
would die early of testicular cancer, till I finally managed to get a
proper test when I got to New Zealand. No malignancy anywhere, it’s
just natural for some veins to feel larger.

Back to my rather disconcerting experience with RPS, it was when I
was 11 years old or so. I still remember it like yesterday. I was
sitting on the bottom step of my stairs worrying about STD’s as usual.
I would go through the whole day, trying to remember if I touched my
penis after my hands were “dirtied” by touching something in a public
place.

I knew it won’t transmit STD’s…heck, I knew much more about STDs
than many people even at that tender age. Back to retracted penis
syndrome incident, I was sitting on the bottom step of the stairs at
home. It was night and I noticed that my short pants had some kind of
stain on it. In hindsight, it was probably pre-cum, but I thought it
was pus from some STD that I contracted by accidentally touching some
nasty things in the toilet.

I was cracking my fingers in my right hand to start my scary
thoughts when it happened. I felt my penis shrinking. I was alarmed. I
checked and saw that it was shrinking. I screamed for help and my
parents came running and asked what’s wrong. I said my penis was
disappearing into my body and I was panicking and there was this
overwhelming feeling of impending doom – I was going to die if my penis
disappears into my body and I was trying desperately to pull it out.

I was terrified, I’ve never felt so afraid before and I was pleading
for help, it was getting smaller by the second and I’m going to die and
I was pulling as hard as I can and begging and praying to God to just
let my penis come back again. It was not my imagination as I saw my
father’s face when he looked at me desperately tugging at my phallus –
he was shocked and immediately pulled it with me to stop it from
completely disappearing.

It was just a nub at the worst point…and we were holding to it for
a full minute while I was hyperventilating and feeling faint. It felt
like the whole phallus was falling into my body forever and I would
die, I must pull it out. It did stop retracting after a while
and my parents took me to a doctor the next day who said that my
genitalia is perfectly fine. It was my first panic attack. I guess you
could call it that. Psychosomatic panic attacks…damn those mind
fuckers.

My point is, I’ve always had issues with chronic anxiety, which is
debilitating…one of my closest friends told me that he doesn’t
understand why I take drugs, because most people who take drugs are
from broken families and my family is “normal”. I consider him one of
my best friends and I knew he means well. I didn’t think I answered
that question then.

I’ll answer it now. It’s not just people from broken families who
take drugs, that’s a gross generalization. Drugs give me an outlet to
another state of mind, one that isn’t constantly worrying about one
thing or another. It’s an ephemeral escape into another state of mind.
I feel like I can be all that I can be on methamphetamine. I love the
emotional bonding that MDMA induces. I take magic mushrooms and LSD
because of some sadistic desire to induce bad trips. I smoke cannabis
because I’m bored. I drink heavily so that I can sleep. I heavily
self-medicate with benzodiazepines because it makes me sane.

I’m self destructive. I don’t care that my heavy daily drinking is
culling my brain cells and destroying my liver. I don’t care that my
benzodiazepine use is excessive, or that I would probably be on it for
life, because it gives me blessed peace. Everyone is pressuring me to
taper off benzodiazepines. I’ll be honest here and admit that I’ve
never even tried to taper. It was all a farce to make everyone happy.

But I don’t want to make everyone happy. I want to make myself
happy. I want to be free from anxiety and excessive and irrational
thoughts. I once thought I stepped on a syringe while walking. It
turned out to be a rusty nail but I was still irrationally worried
about HIV. I was franticly searching for the nearest hospital to get
zidovudine (ZDV).

I know this nurse (who requested not to be named when I called her
to ask for permission, and I have to honor that since she reads this
blog :p) who had a needle stick injury once. She was giving a patient
an IV injection and in a temporary lapse of judgment, used her right
hand to cap the syringe instead of docking the cap and inserting the
syringe into the dock tray (the safe way to go about it). She was
seriously considering zidovudine therapy while the pathology division
of the hospital she’s attached to ran an emergency HIV blood test on
that patient using a rapid HIV test that can detect newly infected
people (PCR).

There are studies that suggest post exposure use of zidovudine may
reduce the probability of you being infected with HIV. It’s kinda like
a pre-emptive strike – you have to take it immediately after exposure
and finish the course, which would make you as sick as a dog, but may
reduce the chances of you contracting HIV. The efficacy of this has
been argued by many medical professionals, and it’s not easy to obtain,
so you won’t be able to do something like have unprotected sex and go
on ZDV. It just doesn’t work that way.

The rusty nail incident happened several years ago. It was just a
rusty nail but I was frantic…I had already planned to jump over the
counter and resist security while I search for zidovudine if push comes
to shove and they won’t hand it over.

My latest HIV test (March 2004) came back negative, as always, but
I’m already budgeting for the next one. I’ve never talked about this
before, it’s kinda personal and people might think I’m mentally unsound
but yeah, now you know why I have issues with irrational anxiety and
the extent of my hypochondriac thoughts.

This is just one facet of it – my phobia about HIV. This is the
reason I don’t fuck around. I’m just too scared of contracting HIV that
my penis automatically balks and loses its erectile function as a self
defense mechanism before penetration, so you’ll never see me follow
through on sexual prepositions. I just joke around – I have a myriad of
excuses in my excuse bank to avoid actually doing it. My two favorites
are “Benzodiazepines have muscle relaxant properties and my heavy
benzodiazepine therapy makes me unable to maintain an erection, so I
can’t fuck you” and “I’m coming down so hard on methamphetamine, I can
barely stand, much less fuck”. 😉

I will only have sexual intercourse with someone who tested negative
consistently over at least a six month period with the whole battery of
available HIV antibody detection tests who isn’t sexually active with
anyone other than me. I’m not saying that I’m “holier than thou”, au
contraire, I’m just fucked up inside my head. I don’t engage in
behavior that would put me at risk for HIV infection, so a rational
person would not shell out this kind of money for regular and
unnecessary (for me) HIV blood tests. But as I’ve mentioned many times,
phobias are irrational by nature. 🙂 I make light of things, but I
really do have many issues with chronic anxiety and I have serious
hypochondriac tendencies that can only be kept in check (somewhat) by
benzodiazepines.

I don’t know how much I’ve spent on doctors and medical tests…

Update:

The doctor’s Gribbles envelope which he gave me. I also managed to bum
some benzos off him in the process. Heh. He also gave me a book about
Christianity. *shrugs*

My Western Blot (WB) test results – all clear! =D

WB results for “Jane” – clean slate.

Doctors are always quick to try and get me to taper off benzodiazepines. I don’t want to return to all that craziness.

I know that a lot of doctors will sprout that the chances of HIV
transmission via sexual intercourse is relatively low, but do you
honestly want to take the chance?

Be safe. Be responsible. Go for HIV testing.

This is the first community service article brought to you by sixthseal.com 🙂

We like to provide quality content for all audiences, so here’s a new post at veritas’s domain:
Methamphetamine in Kuching, Sarawak [castitas.com]

P/S – The subject matter which my dear guest author* goes into is
not for everyone. Please don’t click the link unless you like reading
veritas’s posts.

* The terms “guest author”, “alter ego” and “pseudonym” means the same thing in my dictionary and is used interchangeably. 😉