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Known Sex With a HIV Man
Jul 25, 2002

I was at a party and ended up having unprotected anal sex with a man that is known HIV positive. I was the top and came in him quickly. I don't think I was in him more than three mins. I realize I am at high risk. Just can't believe I did something so stupid. I was of course intoxicated. I have never done such a thing. I have read so many odds and possibilities of transmission hearing 1 in 500 chance, and 1 in 300. Should I just expect that I will be positive? Does urinating after sex help at all? I have heard that it might. Is there any hope? Sincerely, Scared

Response from Mr. Kull

Having unprotected insertive anal sex (being the "top") with an HIV infected person puts you at risk for infection. While one exposure does not guarantee infection, the fact that you know you were exposed suggests that you take important steps. First of all, if you continue to engage in sex with others before you know your status, it is extremely important that you use condoms. Secondly, talk to your doctor, or find one who you are comfortable talking with about HIV and sex. It's vital that you have a plan to determine your status and discuss treatment options if necessary.

That being said, there are certain things that are important to understand about your risk. We know that the bottom is at much greater risk for HIV infection than the top in anal sex. The specific data on HIV transmission from a bottom to a top during unprotected anal sex are somewhat controversial; statistics about transmission per episode of unprotected anal sex don't differentiate between receptive and insertive. The bottom is at greater risk because the lining of the rectum is more likely to come into contact with more HIV infected fluids and is more vulnerable to infection than the urethra. Insertive partners in vaginal sex have about a 1 in 1,000 risk of infection per episode.

The actual degree of risk will vary in each situation depending on numerous variables (viral load, presence of blood, sexually transmitted infections, duration and frequency of exposures, and immunologic factors). Unprotected anal sex is risky to the top because the rectum is prone to microscopic tearing that could expose the top to blood, which is highly infectious.

None of this means that you should throw away condoms because you are a top. Tops do get infected with HIV, and taking a risk like that is probably not worth it. The odds are actually higher that you will be infected with another sexually transmitted infection if you have unprotected anal sex, as the prevalence of STIs among men who have sex with men is high.

It sounds like you understand a key factor that contributed to your situation: you were drunk. While drinking alcohol doesn't necessarily make people have unprotected sex, being intoxicated can impair your judgement and lead to impulsive behavior. Take a closer look at your Substance Use as it may be causing other problems in your life as well.

RMK



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