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What is the "likelihood" of my being infected?
Oct 12, 2007

I know what you're gut instinct will tell you to say immediately upon viewing this question--that there's no way to properly guess the risk that I am infected, and getting a test is the only way to rule out HIV infection 100%. However, my mind needs a break. I've been dodging friends and classes for the past 2-3 weeks because I've been so scared, and if I don't get some sort of response soon (aside from waiting six months for the conclusive HIV tests) I fear that I may fall into a deep, deep state of depression. So here goes...

I've been dating a guy for just over two years, and we decided about 2-3 months ago (somewhat foolishly) to do away with condoms. Neither of us had been tested, but as I had only been with one other person ever and had gotten a test six months after that which came back negative, the only problem was with the possibility of him being infected, and we stupidly decided that the chance of his having it was negligible. We were wrong... so very wrong. A few weeks ago he got tested, and found out he was positive.

I immediately went to get tested myself, and my results came back negative. This was of course comforting, but my fear was that the test would tell nothing conclusive about the couple of months prior to taking it, the time during which our behavior was the most risky. During this time we likely had anal intercourse ~10x, each of which with him topping me, and in none of the cases did he get off (that is, he "pulled out").

I know that the "statistics" state that there is something like a 6.5 in 10,000 chance of becoming infected from a single act of insertive anal intercourse with a positive partner, but what of the opposite? (receptive anal intercourse). Also, if his viral load is 100,000+ (they couldn't measure it beyond this threshold), does this mean that it's even more likely than the average that I become infected from a single exposure? Finally, would you say it's possible that I am still negative, if I have experienced no symptoms except perhaps a persistent crick in the neck (swollen lymph nodes, perhaps?) and aches/pains in my joints that just won't go away?

Not that the symptoms determine anything... but considering my sexual history with him, if you had to guess... which way would you go: positive or negative? We're both in fairly good health with no other known STDs, his viral load is 100,000+, I have been the receptive partner in anal intercourse ~10x, he does not often pre-ejaculate and when he does the amount present is very, very slim, and he has pulled out during every instance in which we had sex.

This may seem out of line, but I'd prefer if you gave me an honest answer. No, "well I couldn't say without a test" or false reassurance--based on what you've seen and heard in the past, do you think it's more likely that I am negative or positive?

Response from Dr. Frascino

Hello Kmic,

Let me set the record straight.

1. All my answers are honest.

2. I do not give false reassurance.

3. I do not "guess" HIV status.

I absolutely agree your personal decision to have unprotected sex was a significant lapse in judgment that put you at considerable risk for STDs, including HIV. Furthermore, I absolutely agree symptoms are notoriously unreliable in determining who is and is not HIV infected. In addition, it is indeed true the receptive partner is always at greater risk than the insertive partner for any type of sex. As for viral load, it is true that higher HIV plasma viral loads are associated with higher risk and rates of HIV transmission.

Your next steps are clear:

1. Get HIV tested at the three-month mark and if negative, retest at the six-month mark.

2. Review the safer sex guidelines. Stock up on latex condoms and water-based lube.

3. Learn from this serious lapse in judgment.

4. Realize your assumption about my honesty, false reassurance and willingness to "guess" is clearly wrong.

Good luck.

Dr. Bob



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