Another Lost Condom--Response
Jan 17, 2007
Hello again, Dr. Frascino,
Thank you for your answer. I want to elaborate a bit more in order to correct some misconceptions you may have about my situation.
As someone who came out in 1981, the very year the first AIDS cases were reported, I have grown up as a gay man with the epidemic. I have always paid close attention to news about HIV and AIDS, I have practiced safe sex consistently for twenty years, and I am very aware of this Web site, AIDS organizations, and the latest news about efforts to fight the epidemic. I have lost friends to AIDS, and I have friends now who have received an AIDS diagnosis. Even with this history, however, I was startled when I found myself in a situation where safe sex efforts failed and I then had to scramble to find information and resources.
I have never seen postexposure prophylaxis (PEP) recommendations in a newspaper, brochure, or bar; I found very few testing sites in Los Angeles that offered the rapid HIV test or were even open for testing; and the counselor, educator, and nurse that I spoke with (all from different organizations) said I needed to act fast but couldnt offer any services from their organizations. It was only when I located a CDC report on nonoccupational exposure that I found a chart that clearly set forth the exposure risk, the number of hours since exposure that PEP could begin, the information necessary to prescribe PEP, etc. If I, with education, computer access, a sexual partner willing to be tested, the ability to take time off from work, the shamelessness to disclose intimate and embarrassing sexual details, and the strong desire to protect myself, had trouble figuring out what I should do (get tested with my sexual partner, which the counselor advised; get tested with my sexual partner, or make a strong case to my private doctor, as the educator advised; or get tested with my sexual partner, or go to an emergency room, as the nurse advised), then what does the person without these things do, especially with the clock ticking?
Basically, the safe sex information generally available advises what to do to be safe, but it doesnt say what to do in case the sex happens to be unsafe. If, as the information often says, condoms can come off or break, what does someone do in that circumstance? Why arent organizations set up to deal with emergency cases? I understand that even safe sex has its risks, but I was accustomed to everything going well and felt unprepared to deal with the shock when things didnt go well.
So, I am not unaware, just asking for clearer information, like the CDC chart, that spells out, in an easy-to-understand way, what to do and when. And you can bet that I will pass details about this experience on to friends! It was a friend, not a Web site or AIDS organization, who first brought PEP to my attention.
Thanks for your work.
Response from Dr. Frascino
Gosh, if you had that much trouble in L.A., just imagine the dudes in all those square red states in the middle of the country. All emergency rooms, urgent care centers and STD clinics are supposed to be well versed in PEP. It is my hope that more and more primary care physicians will also incorporate these services into their practices as well. PEP is readily available here in San Francisco and apparently much better publicized than in L.A., if your experience is any indication. I would encourage you not only to pass the information you learned on to friends, but also encourage your local AIDS service organization to get the word out to both gay and straight establishments, sex clubs dance bars and local publications. As the saying goes, "pay it forward." Also take a look at the PEP information on this site. I just did a quick "search" and turned up over 4,400 references!
Another Lost Condom Jan 12, 2007
I am a 47-year-old gay man. After twenty years of practicing safe sex, I had an unfortunate accident recently that really frightened me. After having very physical anal intercourse with the man I have been dating for the past five months (him as a top, me as a bottom), I found after his ejaculation that the condom I had put on him had come off during sex and was lying on the sheets. This threw me into a panic, as we had not been tested together, and I had to trust his assurances that he was HIV negative. After a flurry of phone calls, Internet research into postexposure prophylaxis (PEP), and a visit to an HIV counselor, we ended up getting a rapid HIV test, where we both tested negative. The whole experience has made me wonder about the likelihood of HIV transmission in such accidental cases, the recommendations for PEP, the window period when HIV antibodies don't show up in rapid tests, and the whole question of why there isn't more specific and readily available information about what to do in such cases. I still cringe when I remember discovering that I had been screwed without a condom, and I feel scared about the possibility that I could have contracted HIV through an accident. Any advice or information you care to offer?
Response from Dr. Frascino
You wonder ". . . why there isn't more specific and readily available information about what to do in such cases." WOWZA!!!! I've been typing my little fingers to the bone spewing out this information over and over again for years. I feel like the Department of Redundancy Department!!! You've been getting plowed (safely) for over 20 years. Could it be you just haven't been all the receptive to the information that has indeed been very readily available, particularly in our gay community? Pick up any local gay rag or stop by almost any gay establishment and you should find information and pamphlets about safer sex and PEP. Browse through the copious resources on this site or gay-specific sites, like gay.com, etc., and you should quickly come to the realization that the information is indeed out there and readily available.
I do agree as a country we are sex-phobic and puritanical and this leads to a dangerous information vacuum. Our current administration has made that much worse. Remember John Ashcroft (Dubya's first Attorney General)? He wasted $8,000 just to cover up the bare breasts on a statue of Lady Justice!!! He reminds me of a modern day Pope Pious VII. That pope ordered all the weenies chiseled off the statues at the Vatican! But I digress . . . . No doubt we should have condom ads on TV, like every other civilized developed nation and a science-based sex-education program in our schools. This would include STD/HIV prevention education. But alas . . . Dubya is still in office and so we are forced to spend our tax dollars (and young lives) on a bungled war instead of embryonic stem-cell research or HIV/AIDS awareness and prevention.
As for advice related to your situation, you both tested negative; consequently, your chance of even being exposed to HIV is remote at best. (Your partner would have to be in his window period, the period of time in which he had contracted the virus, but not yet developed detectable levels of anti-HIV antibodies.) PEP would not be recommended in your situation. To be absolutely certain of your HIV-negative status, you could get one confirmatory rapid test at the three-month mark.
After you've had a chance to peruse the information in the archives of this forum and on related links, if you still have any questions, don't hesitate to write back. And now that you are becoming informed (albeit belatedly) about this information, I urge you to "pay it forward," which means discuss what you learned with friends, family and anyone who will listen, OK?
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