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very high risk encounter, donation forth coming
Nov 10, 2005

Dr Bob:

First of all I want to congratulate you on the wonderful job you do helping people cope with this horrible disease, very few people I know have the sensibility, warmth and sense of humor you have.

I hope you will have the time to answer be back, I know its very hard since it is physically impossible to answer every question on the forum, but a couple of words from you at this point would really help me.

This is my story, Im a 29 year old men, married with a beautiful 3 month baby, and about 4 days ago I went on a business trip, after work I decided to go for some drinks with a couple of friends, so to make the story short I got completely wasted and had sex with a man that night, I had never been with another man before so you can probably think how I feel, and I dont mean this in a disrespectful way, its just a new experience that didnt happen under the right circumstances, I feel totally depress not because I had sex with another man but because I had to be completely wasted to do it.

Any way my risk exposure was the following, unprotected insertive oral sex with no ejaculation and receptive anal sex.

The anal sex was protected until the condom broke, he changed it immediately for a new one, and we proceeded to have sex until the second condom broke again, and again he changed it immediately, he ejaculated but was protected with a condom.

I know he was inside of be when both condoms broke since I heard them pop, so I was expose for a couple of seconds each time.

He was a high risk person since I had to pay for sex.

I know that a 3 month test is warranted, and I know that assessing some kind of risk for this encounter is not easy, but my questions are as follow:

Considering my exposure does my encounter qualify as unprotected receptive anal sex?

How many people actually get infected from exposures similar to mine?

Do I have to test past 3 months?

Dr Bob I feel horrible and depress and I know that in a couple of weeks I will start having every symptom in the book either because I really got infected or because stress and anxiety.

I love my wife and daughter more than anything in the world and just the taught of been HIV positive is killing me, I dont have the strength nor the heart to confront her if I turn out positive, so I dont know what I will do. I know I need help and I will seek it but right this moment I needed to get my story out because its killing me.

I hope you have the time and patience to answer be back,

Sincerely,

Peter

Response from Dr. Frascino

Hello Peter,

1. Does your exposure qualify? Yes, your encounter does qualify for unprotected receptive anal sex, albeit very brief and with the ejaculation "protected". The estimated per-act risk of acquiring HIV from unprotected receptive anal sex is 50 per 10,000 exposures to an infected source. Your risk estimate would be less due to the minimal "unprotected" time you were exposed, the fact we do not know the HIV status of your midnight cowboy and the fact he was wearing a condom when he came.

2. How many folks get infected from exposures similar to your? The best I can offer is the statistic I posted above.

3. Should you test past three months? If we knew your partner was HIV positive, the CDC would recommend a test at both three and six months. A three-month test is absolutely recommended. If you want the extra reassurance of a six-month confirmatory test, that potion remains open to you, although it's not an absolute necessity in my opinion.

Peter, I would strongly encourage you to seek counseling now. Not only to help you cope with the stress of the window period, but also to confront your guilt associated with this event. Equally important will be the need to address your sexual-orientation issues. Ultimately, I would suggest you level with your wife. Counseling may help in this regard as well.

Good luck, Peter.

Dr. Bob



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