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I'm asking again, sorry/
Sep 22, 2006

Hi Dr. Bob,

I am reposting a question regarding recent exposure. I can't remember what I asked exactly in my last question, so I'm going to be more specific this time around. Also, after reading through many of the archives I have a better idea of risks, ratios and determinants in contracting HIV. Please forgive me if I sound too neurotic.

I had three+ exposures over the course of 6 weeks with a man I was dating. The first was brief unprotected sex with no ejaculation in which I was the recpetive. The second was unprotected sex in which I was the receptive; ejaculation was outside the body and then he inserted his penis into me for about a minute. The third was a mutual masturbation session in which he came and after a few minutes post ejaculation we both used our saliva as lubricant and he inserted his penis into me for a minute or two. I also was the insertive in unprotected sex on three occassions. We also engaged in oral sex, gave and receieved, without ejaculation. I sound so trashy. I've been obsessed with thebody the past few days and I feel most comfortable with your advice because you seem the most understanding and real.

It is a very hard situation for me right now, as it is for everyone when concerning HIV. I'm 23 and my mother - who was the greatest person in my life - died at the end of August and this man found out not three weeks later he is HIV positive. Two days before I tested negative. I'm very active, maintin a good diet, hardly get sick. The fact that I always practice safe sex makes me more upset with myself. I don't blame the guy - he had no idea and we trusted each other, but it's a lesson learned that you can't just take someone's word for it and to always play safe. Anyway, I'm reading risks per act being 1 in 50-200 for unprotected anal receptive sex. Truth be told I guess I can be considered a power bottom in that anal sex is not usually hard for me nor does it cause visible damage. However, I understand that that doesn't negate me contracting the virus. I guess what I want to ask is, given my descriptions, what are we looking at? The man gets his labs back in the next week. He had his last unprotected session in January, tested negative in February, got flu-like sick in March. If he conracted the virus in February, can viral loads be low come months later? I know tat viral loads can change daily, but post infection is the viral load usually high or low?

I don't know if I'm being clear. I'm very scared and sad. I can't think of anything else. My mother died a month ago and I can't even mourn her because I'm too consumed with whether or not I have HIV. I'm a realistic person and understand that this virus is tricky, I am at high risk and that I have to wait three months to test since my last exposure and then again at six months. I guess I just need to talk to someone and in my city it's not very easy to just walk in and get some counseling, but I'm working on it. Ok, I'll just hope that the odds are in my favor and maybe my mom is looking out for me. I believe in and practice good karma, so please just send some my way. I hope that I can be a rare case and be negative, but I have to wait. I just want to say that you are very inspiring for those who are fearful. You're very optimistic and prove that life doesn't have to stop. Thanks for listening, even though I'm not very clear. Take care, all my best and a donation is on it's way.

Response from Dr. Frascino

Hello Power Bottom,

It's probably not quite accurate to claim "I always practice safe sex . . ." and then go on to describe six unsafe episodes of unprotected mattress mamboing. But we won't hold that against you.

Following your review of the information in the archives, you seem to have an accurate assessment of your HIV risk and what you need to do about it. Your risk: unprotected insertive and receptive anal and oral sex with a partner who subsequently learned he was HIV positive. Certainly your risk is significant, but there is still a decent chance you did not acquire the virus. I won't bother reiterating the statistical risk estimates, as you've already reviewed those.

Regarding your viral load question, the HIV plasma viral load is generally quite high for several months after primary infection until the body's immune system can kick in and begin fighting the infection.

As for what to do, you are correct: you'll need an HIV-antibody test three months after your last potential exposure. If negative, an additional test at six months is recommended, because you had a confirmed significant HIV exposure. We'll keep all fingers and toes crossed for you!

If the anxiety of waiting through the window period is difficult for you, I agree counseling may significantly help. I'd also suggest you continue to read through the extensive archives of this forum. The testimonials can be very encouraging and should help you keep your fears in check.

Thanks for your donation (www.concertedeffort.org). In return, I'll send my best good-luck karma that your HIV tests are negative. But whatever the outcome, please know that I'm here if you need me, OK?

Good luck.

Dr. Bob



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