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Gay Pride '05 in Toronto--Oops!
Jun 29, 2005

Hey Dr. Bob,

We just wrapped up Gay Pride '05 (25th year here in T.O.) and it was great! Weather was in the high 80's, sunny, beautful men and a LOT of fun. You should come up and check it out some time. Toronto loves you.

Unfortunately, I didn't have as much fun as I had hoped this weekend due to an incident on Thursday (June 23rd). Here's the scoop ...

I was receiving oral through a gloryhole at one of the many "establishments" here in Toronto (the Bijou) -- I could not see the other guy (he was behind a wall). He stopped giving oral for a few seconds and came back -- this time his mouth felt different -- warm, tight, I couldn't get my penis all the way in -- it just felt kinda weird -- but I thought he was doing something with his mouth. Anyway, after 20-30 seconds, I realized something felt wrong and I looked down and I saw his ass! I FREAKED OUT! I have always played safe and I couldn't believe how stupid I was not to know the guy had replaced his mouth with his ass. God, I'm a stupid Canadian! Anyway, it was 20-30 seconds of unprotected insertive anal with no ejaculation. Obviously, I have to assume this guy was poz -- god only knows how many strangers have been inside him! I don't know his status for sure -- I got outta there as quickly as I could.

Nonetheless, I went to my doc the next morning and he put me on PEP. He said the risk was not overly significant -- but taking PEP for this would be my decision. I decided to be safe -- and go with the PEP.

My question(s)?:

1) In your professional opinion, what is my risk level? I value your opinion and would love to get your expert point of view. I know you couldn't say for sure -- but have you ever heard of a guy getting HIV from giving unprotected anal for 30 seconds?

2) I'm on Nelfinavir, Lamivudine, Stavudine for 30 days (started 12 hours after the incident). Side effects have been minimal so far. Is that a good combination of meds? ... and ... do I have to stay on for a full 30 days?

3) What is the success rate of PEP? Can I still have sex while I'm on PEP?

4) I took an HIV test at the doctor's office (prior to starting the meds). But this whole experience has scared the crap outta me! Now I'm 2nd guessing my previous encounters. I'm a total bottom (at least until this incident) and have had about 11 guys -- all safe within the last 4 months. No condom breakage, etc. Odds that the result will be neg are in my favour ... right?

Sorry to burden you with this stuff. I've been beating myself up for the last 3 days about how stupid I was to have this happen.

I'm trying to put this in perspective and be logical -- and my logic tells me ... unprotected insertive anal for 30 seconds (taking PEP) and protected receptive anal with 11 different men in 4 months (no condom breakage) -- the odds are in my favour ... right?

Sorry for the long e-mail. Any insight you can offer would be greatly appreciated.

Hope to see you at the next Pride Parade in T.O.

Signed, Stupid Canadian ;)

Response from Dr. Frascino

Hey Canuck,

I love Toronto, too!

As for your questions:

1. The estimated per episode risk for HIV acquisition from insertive anal sex with a partner confirmed to be HIV positive is 6.5 per 10,000. Your exposure is very brief and we do not know the HIV status of that "bait and switch" dude on the other side of the wall. So your estimated risk would be even less. As for ever hearing of a guy getting HIV form 30 seconds of poking, no, not personally. But then again, how many dudes would admit they only lasted 30 seconds, right?

2. A full course of PEP is 28 days. I would encourage you to take the full course. Nelfinavir, lamivudine and stavudina is a potent PEP regimen. The biggest potential side effect would be diarrhea from the Nelfinavir.

3. The success of PEP is difficult to quantify, because everyone's experience is so different. Suffice it to say there is adequate evidence now that it is an effective intervention. Although even when Pep is appropriately prescribed and taken, there are still PEP failures. Can you have sex while on PEP? Sure! But, as always, make sure it's safe sex.

4. Protected sex is indeed protected if the latex condom was used properly and did not fail. Yes, the odds are very much in your favor.

To sum up, I believe your total perspective is correct (and logical!). Unprotected anal at the Bijou for 30 seconds followed by PEP plus 11 episodes of protected receptive anal would indeed place the odds in your favor.

I miss Toronto, and it's been far too long since my last visit. Hug all the boys on Church and Young Streets for me, OK? (Yes, I do mean all the boys).

Good luck with your PEP and follow-up tests. I'm sending you my very best good-luck karma!

Dr. Bob



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