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What are my real risks? I'm too terrified to take HIV test.
Jan 14, 2002

I've been online now for days, extremely anxious and depressed, trawling HIV/AIDS websites in a miserable search to assess my 'risk' factor before gathering the courage to take a HIV test. I am a 25-year old healthy woman who has never been promiscuous or injected drugs. I have never had any STDs. In June 2001 I received my second clean PAP smear. Then, just 4 weeks after my clean bill of health from my gynacologist, I had unprotected sex (without ejaculation) with a guy whom a discovered afterwards to be promiscuous and also bisexual. I probably had sex around 20 times with him in this way. I never experienced any symptoms and could not see any obvious signs of STDs in him (eg genital warts for example) or in me afterwards. Of course I realise this means nothing at all! After he told me abot his promiscuous lifestyle I freaked out, yelling at him "You've probably given me AIDS!" He was astounded, arguing in his defence that he has never had receptive anal sex (only insertive) and that, besides, he gets his blood checked regularly as he has titanium plates in his spine (he had broken his neck 5 years ago in an accident). Here is my first question: Assuming he's telling the truth, does having his blood checked (due to the presence of titanium) necessarily mean he will be tested regularly for HIV? The only thing that gives me any shred of hope is the fact that he always came outside me - I am certain as I can be of this. I know there have been many questions similar to this, but I really need to know what is my REAL chance of getting a HIV positive result. Really, I am asking how many cases have there been where a woman has contracted HIV in this way alone? I also read that not all men actually have pre-cum - is this true? I say this because the guy in question stands out in my memory for having practically no 'pre-cum' (in comparison with other men I've slept with who all shared a 'normal' tendency to be quite 'drippy' and 'damp' before ejaculation.) If my risk is moderate I am more likely to go for the test. I don't 'expect' a negative result but if I felt statistics were on my side I would take that gamble. It could be the best or worst news ever and up until now I have adopted a strategy: "If I have HIV I would prefer to find out a few years later after living a few more years of a normal life". This attitude is stopping me from taking the test while my friends are urging me to take it, saying "You probably don't have it! It will stop you worrying and put your mind at ease!" But how accurate is their prediction? I've read on some websites that receptive vaginal sex (with ejaculation) with a HIV positive person carries a '0.006 risk' - What does that mean? That if 10000 HIV positive men have sex with 10000 HIV negative women, only 6 will contract the virus?! - From a very worried reader (Western Europe)

Response from Mr. Kull

First things first: the way you find out your HIV status is by having an HIV antibody test. No one should assume what their status is based on any other methods (CBC, blood donation).

It sounds like you are quite anxious about your situation. I cannot tell you whether or not you are infected with HIV. Let's review some of your concerns:

1) The fact that your partner was "promiscuous" is probably not as meaningful as what he does with whom. If he uses condoms all of the time for insertive anal sex, it is unlikely that he is infected with HIV, regardless of how many partners he has. A man who has unprotected anal sex with another man is considered to be in a "high-risk" category. Most females in the United States who have unprotected sex with men who do not inject drugs or do not have sex with other men are at "low-risk" for infection. However, unprotected, heterosexual sex in sub-Saharan Africa poses a significant risk for infection (the prevalence of HIV infection is much, much higher in that region than anywhere else in the world).

2) The fact that your partner did not ejaculate inside of you does decrease, but does not eliminate, your risk for infection (that is, if your partner was infected). We can't guess if there was pre-cum or not, and pulling out is not a foolproof method; but better than not pulling out at all. People are infected this way, but we do not have numbers.

Try not to play the number game. The odds of being infected in ONE episode of unprotected sex with an HIV positive man are low, but the odds increase every time you have unprotected sex with an HIV infected person. Determining the actual odds for you being infected is not only fruitless, but probably anxiety-provoking (even though doing this type of investigation is terribly alluring and addictive).

3) The fact that you had unprotected sex with a man who has sex with men is a good reason to get tested. Wait at least three months since your last exposure to him and get an antibody test.

4) If your anxiety feels overwhelming or unmanageable, think about talking with someone in the mental health profession (for instance, an HIV counselor, a psychotherapist, or a psychiatrist) to try to get some relief.

RMK



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