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Slowly Climbing Out of the Well
Aug 21, 2007

Dr. Bob:

I posted a few days ago - "In the Worry Well," if you remember, about my year-ago experience and the personal hell I've been putting myself through since then. I wanted to let you know I got tested, did one of those rapid tests at Planned Parenthood, and it came back negative. I asked while I was there about the accuracy of the test, and the nurse said 99%. The anxiety pit I've dug myself into over the last year is causing me to worry, yet again, about the 1%, but I do have an upcoming appointment with my shrink.

It was a finger-prick test and then the tester put my blood on some plastic thing where it shows two stripes for pos, one for negative or something along those lines. It only took ten minutes between dropping the blood and getting the results, which makes me skeptical. I guess I want to know what your opinion is on the accuracy of these tests, and what the chances are of getting a false negative.

Should I get a follow-up, or save the money because this is definitive? (I think I might need it more to pay for all the shrink appointments I'm going to have, anyway.)

Also, your readers should know firsthand, from me, that waiting to get tested isn't worth it. I felt a lot better just being there to get tested, with everyone around me being incredibly reassuring. If I could take back the entire year I've spent fretting about this, I would, but of course I can't. The worry, though, does make you take stock of life, and realize that, negative or positive, we could all go at any minute for any reason. I wish I'd spent the last year living like I thought I should, and hopefully, with some reassurance from Dr. Bob and the psych I'm going to see, I'll be able to from now on.

Keep up the excellent work, Dr. Bob, and as soon as I'm done paying for psychology, you can expect some money from me. Your foundation now tops my list of organizations I donate to when I can. If I was wherever you are, I'd hug you, but since I can't I'll just hug you in spirit.

And as a sidenote, whichever conservative ass gets the nomination early next year, we're going to take that bastard to the cleaners.

Sincerely,

Anon

Response from Dr. Frascino

Hello Anon,

Actually, the accuracy of rapid tests is well above 99%! Depending on which rapid test is used, sensitivity and specificity are more in the range of 99.6% to 99.9%! False-negatives are nearly nonexistent! I'm glad you are following up with your shrink, as HIV is definitely not your problem. No way. No how!

Thanks for the cyber-hug (and tweak of my left nipple, you naughty boy you!).

Finally, yes, I too am primed for some significant ass-kickery in the upcoming elections!

Dr. Bob

In the Worry Well Aug 17, 2007

Dr. Bob:

I'm a gay guy who, about a year ago, hooked up with a guy from work (he was 24, me 20, if it matters). He performed oral sex (mouth-to-penis only) on me. I never came, but as I was about to go down on him he stopped me to confess he was pos. In retrospect I feel what I did next was the result of a severe lapse in judgment, but I didn't want to be a jerk or throw him out of my place or anything, so I told him I was fine with it, only I wouldn't give him oral; and I'd still have anal sex with him using a condom (I was insertive). He said, "You probably won't get it from sucking me off," but I wouldn't budge on that one; come to find out it's true that I probably wouldn't, but I still think I made the right decision in that regard.

Despite my relative inexperience, I knew for a fact that there were pos/neg couples who had sex all the time without one infecting the other. From what I can tell, having read through many of these posts, I was mostly safe. He ended up having to jerk me off to finish anyway, so I never even came inside the condom while I was inside him.

The next morning he thanked me for being understanding, but that was little consolation for the concern I woke up with, and the fear and self-diagnoses began. I started asking him questions about how he got it, which he said was from having a lot of unprotected receptive anal sex; and how he was dealing with it, to which he responded he wasn't being recommended for medication yet or anytime soon (which I assume to mean his viral load was low at the time). I sort of blew him off once he left, figuratively speaking, never wanting to knowingly put myself at such a risk again. I liked him, though, and I partially regret that - but that seems unrelated to this.

I've since moved away from him (certainly not because of him, though), and we rarely speak anymore. Over the last year I've always had a small fear in the back of my mind that seems to grow every day. I never exhibited any of the symptoms I've read about, and there's none now that would logically point to HIV. But having knowingly exposed myself, I know there's some, if only minimal, risk. I've read enough here to know now that guilt, shame, and anxiety are playing a big role in my mind right now.

The worry is getting bad enough to take over important parts of my life - school, a new job; all that stuff that everyone deals with is getting trumped by my obsession over whether or not I'm infected, or whether or not I should get tested. The typical what-ifs I read about on this forum are all going through my head, too. I've got a few questions.

1) I've had sex (unprotected oral receptive and insertive, protected anal insertive) with other people in the last year that I know for a fact have been sunsequently tested as negative. Should that be any kind of indicator to me about my possible infection?

2) I think I need to see someone about the mental issues I'm dealing with. There's a family friend who's a psychologist who I've gone to in the past for unrelated issues, and I trust him implicitly. But I've seen you recommend psychiatrists as opposed to psychologists in a few of instances because of the ability to prescribe drugs. Should I go to the guy I trust, or are my psychological issues such that they warrant medication?

3) I'm not at all saying I know I have it; just worried I might. I've been dealing with the mental strain of that risk, though, since the day I realized I was gay, and sometimes wonder that this all might be an extension of that fear. There's probably still some shame about being gay in there that I've never dealt with, too. That is to say that if it turned out I was infected, I just know I'd end up telling myself I was being somehow punished. Is a test the only thing that will truly put me to rest? Or do you think this is purely a psychological thing?

Sometimes I want to believe it'd just be better to go on not knowing, so that even if I have it I don't have to feel like I'm fighting an uphill battle all the time. And then I realize that not knowing and worrying isn't safe - not for me, and not for anyone I might end up having sex with. I feel like I can't confide in anyone, and that I'm just going to keep driving myself in crazy, painful, wasteful circles until someone outright tells me what to do. I'm tired of rationalizing to myself, of feeling like shit all the time, of being on this computer reading all sorts of info instead of truly living my life. I need your advice. However repetitive or easy-to-find-yourself the advice might be, it'd just be nice to hear from someone what I should've figured out myself a long time ago. Thanks, Dr., for taking the time to do what you do.

Sincerely,

Anon

Response from Dr. Frascino

Hello Anon,

I'll be brief.

1. No. You cannot use other peoples' HIV status as a surrogate marker for your HIV status.

2. A psychologist would be fine for this type of problem.

3. A single rapid HIV test would indeed give you an accurate answer in as few as 20 minutes. However, in addition to this, I would encourage you to seek psychological counseling to confront your conflicts about being gay.

Your HIV risk would be essentially negligible, assuming the latex condom was used properly and did not fail. Your worries are unwarranted. Psychological counseling, on the other hand, is definitely warranted!

Dr. Bob



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