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Unprotected receptive anal sex
Jan 26, 2010

Dear Dr.

Thank you for this brilliant resource it is really helping me to deal with what I'm going through. 5 days ago I experimented sexually, for the first time I was with a guy. Just to clarify I am a guy! Basically I was a complete idiot and didn't consider any risks until afterwards and am now very scared. I had unprotected receptive anal sex. My memory of the night is hazy to say the least - I thought the person may have ejaculated in me once but I didn't feel anything, there was also no blood present surprisingly. I asked the guy in the morning what happened and he assured me he is clean, he told me we had anal sex 3 times and when he was about to cum he pulled out and shot in the towel. This is the first and ONLY time I have engaged in unprotected risky sexual behaviour. I don't feel I can trust this guy at all being honest - I do believe him about not ejaculating in me because I didn't feel anything and I remember him having a towel. I have a full STD check booked for 3 weeks post incident and plan on another one 3 months post and finally 6 months post. I don't know how I am going to carry on in the meantime it's really affecting me.

My basic question relates to the odd's that I have acquired HIV? I have read that there is a 5 in 1000 chance HIV can be transmitted through unprotected receptive anal sex with a HIV pos person per act. What defines an act - is it a few minutes of anal with ejacultion? Also I'm wondering how the virus can be so rampant when there is a 5 in 1000 chance of transmitting the virus at the highest risk behaviour.

Thank you for your wonderful resource - I have learned a valuable lesson from my mistake and I hope I don't have to pay for it - what are my odd's of contracting HIV?

Response from Dr. Frascino

Hello,

Unprotected receptive anal sex does indeed carry the greatest risk for HIV transmission when considering the risk associated with various sexual activities. The CDC estimated-risk statistic that you quote is a population statistic. It basically helps in establishing relative risk. For instance, unprotected insertive penile-vaginal sex is riskier than receptive oral sex, but not as risky as insertive anal sex. These population statistics cannot be strictly applied to an individual sexual experience, as there are many potential complicating factors (viral load, viral strain, medications, concurrent infections, local trauma, immune integrity, etc.) Consequently, the bottom line for you is that you had a high risk sexual encounter and will need HIV screening.

As for your Brokeback Mountain top guy, I, too, would be concerned, because he readily and repeatedly barebacked you. If you're still in touch with Mr. Three-Times-In-One-Night Top-Guy, you could ask him to get a rapid test. If he is indeed HIV negative, you'll be able to relax considerably. The only potential risk if he tests negative now would involve his being in his window period (very recently infected and not yet producing detectable levels of anti-HIV antibodies in his blood). The chances of this would be remote.

As for your not knowing how to carry on while waiting for your definitive HIV test results, I suggest you spend the time learning more about HIV, HIV prevention and HIV transmission. This Web site has a wealth of information on these and other related topics. In addition you might consider counseling to explore sexual orientation issues. This was your first man-on-man action and unfortunately it's left you feeling guilty and scared. Your future health and happiness depends on your being honest with yourself about your sexual orientation and being better informed on safer sex techniques to prevent STDs, including HIV.

Good luck.

Dr. Bob



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