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a tale of woe, loneliness and guilt. please help...
May 24, 2004

Here is my tale of woe...

5 weeks ago I had an unprotected insertive encounter with a man of (at the time) unknown hiv status. I was the active partner and I was insertive three times. I didnt ejaculate inside, but we didnt use lube. I it lasted 15mins and I am not circumcised. At this point I knew my status to be neg.

I immediately freaked out after the event (guilt etc.) and tried to seek help and information especially as I strongly suspected this guy to be a sex worker. I phoned the only local helpline I could find in the country where I live and was told that there was no access to PEP in this country and that I would have to go to Europe or the States.

I dont live in a place that has a strong support mechanism for HIV related issues. Added to that, if I were to seroconvert and if the authorities here were to find out, my work permit would be revoked and I would be deported.

I went to a hospital here (on the off chance that if I got to see a doctor face to face, they might help) and, despite what the guy from the helpline told me, and without registering (and therefore exposing my identity) I got a 2-day supply of PEP, as I tried to figure out what to do. This was 44hours after exposure.

I then managed to get a more helpful person who works for this same local helpline. He checked with friends and said that despite my reservations about revealing my identity that I should go and register at the local STD clinic and get some more PEP, which I did. I had another baseline test at this point. It was a fingerprick ELISA manufactured by Abbott (if you are familiar with it). It was negative. The health counsellor I spoke with was very helpful and we talked through the risk etc.

So I was prescribed a weeks supply of PEP. Butfor some mad crazy foolish reason I decided that I was being really paranoid and over-reactive about this encounter and decided not to take it the PEP. What a mistake!

Then a week later I started to get suspicious about my health when I noticed that I had some discharge from my penis. As well as this I had fatigue, sore neck, larger than usual lymph nodes etc and a slight temperature. I went back to the clinic and I was diagnosed with NSU and given anti-biotics. The health worker and I talked over all the issues surrounding the exposure my fears about the guy. She gave me two of these Abbott fingerprick strip testing kits to do the follwing.

To put my mind at rest I tracked down the guy and asked him his status. He told me he was neg. so I asked him to take the fingerprick test. He agreed and within minutes both lines showed red a positive result. Also, the line on the patient bar was very strong which apparently indicates a lot of virus (do you have any information on this?). He seemed pretty unconcerned, but then he got scared and asked me not to tell anyone. I have his e-mail address and can get in contact through a mutual acquaintance, and I would be willing to help him out.

So. I have been monumentally stupid: one, for the unforgivable sin of having unprotected sex and two, for having access to PEP and NOT taking it despite my uncertainties about my partner.

So heres the rub: The last 2 weeks have been mental and physical hell. I cant keep food down, my lymph nodes are enlarged and getting a bit bigger, I have had pretty bad dirrorehea, I have had an almost constant fatigue and my joints occasionally hurt, I have had a slight sore throat and a couple of rashes have shown up. But, so far, NO Fever.

I know that it is foolish to try and predict seroconversion / infection from a few ARS symptoms. I know the mind can play tricks. I have read FAR too much about this. Today is the first day I have felt mentally strong enough to pick up the courage to read the internet about this topic again, and to post this question.

I know this: I will have to wait the 3 months for a full and comprehensive test and again at six months. I will have to leave the country to do that test. It is very probable that if I test positive I will have to leave this country for good the PEP that I didnt end up taking is most likely registered in this countries central computer, so I could be pulled over for a random HIV test. If I am +ve - that will be it, my career is effectively over. As you can see the stress is very, very intense.

My questions for the Doctor:

1. Is it possible that I am experiencing mild seroconversion illness? 2. Could the introduction of PEP meds 44 hrs after exposure have had some effect ? 3. Do you think the fingerprick test could have been a false negative ? (These things are supposed to be 99% accurate) 4. Could I test earlier than 3 months, just for interim peace of mind ? 5. What could I do to help the partner ?

This has been a BIG wake up call doc. Whatever the outcome I am going to send a donation.

I wish that there were better information services in the country I live and work in, but I cant do much about that. I am not a citizen. For now I am fairly resigned to some sort of fate. Whatever comes of this will, I am sure in the long run, be positive for me. I have a small support network here but its small and I do feel lonely, isolated and angry with myself a lot of the time. Some words would help doc.

Thanks.

PS This post is written as candidly as possible, but please feel free to edit, or to reply by e-mail only.

Response from Dr. Frascino

Hello,

Your question is lengthy, but I'll try to be brief. Unprotected sex places you at risk for STDs, including HIV. PEP should be started as soon as possible after a potential exposure and no later than 72 hours. PEP, if indicated, should be taken for four weeks. OK, now on to your specific questions:

1. It is possible, but it is also unlikely, based on your exposure and the information you provided.

2. Possibly.

3. False negatives or false positives are a possibility. Any positive screening test should be reconfirmed with a more sensitive assay, such as a Western Blot (WB), before assuming the test is really positive.

4. You can test whenever you like; however, you'll have to wait at least three months for a definitive result.

5. Encourage him to have a repeat test with confirmatory testing (WB), if the initial result is positive.

Although this probably doesn't need to be spelled out, I will mention that a latex condom and some water-based lubricant can easily and effectively prevent "tales of woe."

Thank you for your willingness to make a donation. If you want to include a note with the donation indicating which country you are writing from, we'll earmark your donation to help promote HIV/AIDS awareness and education in that country, so that hopefully, in the future, others in your situation won't feel so alone or isolated.

Good luck on your tests. We've all got our fingers and toes crossed for you!

Dr. Bob



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