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Unprotected sex and PEP plan
May 23, 2010

Hello Dr., Me and my friend are both 38 yr old white HIV- gay men and last weekend we were out of town on a night of heavy drinking and we wound up doing a threesome with a 19-yr old college boy who was up for messing around at our hotel. It started off as oral on him but he asked if he could fuck me. I've only bottomed maybe 4 times in my life and prefer to top all the time. However, I thought he was hot and said yes if I could do him and he agreed. My friend fucked him with a condom on and then passed out. I then fucked him first and then we flipped and did it back and forth for almost 2 hours without a condom. I came in him but didn't allow him to come inside me after he said something like "do you want me to give you a gift." That freaked me out a bit since I've heard that was slang for "gift-givers." It was pretty aggressive sex and I was sore only in my leg muscles for a couple days after. I was fighting a cold over that time as well and got sicker the following 2 days after and went to my doctor as soon as I got back in town. Wonder if this would further increase my risks if immune function was already down. I clocked 57 hours from time of sex with this guy until my doctor gave me the first dose of PEP treatment. He almost talked me out of it since he thinks 48 hours is now the norm for PEP. The first "baseline" test came back negative yesterday but am awaiting the "important one" back on Monday. He told me that if that is negative (which he thinks it will be), I have a 95% success rate for my follow up tests at 3 and 6 months to be negative. He also wants me to continue PEP the full 28 days. That's the hard part. Day 3 I felt nausea, diarrhea, and a speedy feeling. I'm worried I won't be able to stay on the regimen due to side effects and will be less inclined to do so if this next test comes up negative.

Now that I gave you the background, here's my questions: 1. Even though this was considered a foolish high risk behavior, is my doctor right in thinking I'm going to pull through this with a negative result or is he just trying to keep me from going crazy while waiting for these tests?

2. I am not a sexually active gay man. I'm scared of sex and haven't had it in almost 2 years because I found myself in a similar situation before (not with PEP) and it turned out okay in that instance. Do you think talking to a therapist or hotline would really help me get rid of the fantasy of enjoying cumming inside a partner? Is that a fetish and can it really be dismantled over time? I hate condoms since they make me limp everytime. Everytime.

3. 6 months and nasty PEP treatment is like the worst thing I can dream of right now. My career has just taken off and I'm fighting a sinus infection on top of it. During this PEP 28-days, I've got some busy and important work that need my full attention on. How am I ever going to accomplish these things in this state of mind?

Final note: Worst part is that I have my mind made up about me getting HIV. I've played this over in my head and don't believe I could live with this "manageable disease." I think I would choose not to because I have a few friends that spend hundreds of dollars a month (which I don't have), constantly worry or are on anti-depressants to deal with it. At least that would be my first reaction. It would be a shame to end my life over this so I really hope I wouldn't be able to go through with it but don't trust my emotions enough to know for sure.

Signed, Scared and concerned about my future

Response from Dr. Frascino

Hello Scared and Concerned About My Future,

1. Unfortunately none of us can predict the future accurately. Your decision to bareback with Mr. Barely-Legal does place you at risk for STDs, including HIV.

2. Yes, I would strongly encourage behavioral psychotherapy. The fantasy of unprotected sex is fine. Actually acting out on the fantasy is dangerous. It's equivalent to sexual Russian Roulette. Eventually you will lose and the consequences will be catastrophic. You may hate condoms, but I guarantee you'll hate having HIV/AIDS even more. There are methods to get used to condoms. You might even consider a cock ring to help keep the wood in your latex-sheathed woody.

3. Six months of nasty PEP treatment may be the worst thing you can dream of right now; however, I can assure you having HIV/AIDS and taking the equivalent of "nasty PEP" every day forever is a "nightmare" compared to your "dream." I would advise you continue the full course of PEP as prescribed. If it interferes with your normal life, full attention and state of mind, I think that will be a good thing in the long run, as it will act as a deterrent for ever foolishly putting yourself at such risk again.

4. Regarding your final note concerning your suicidal ideation, you should discuss this will a therapist as well. Time to wise up dude!

Dr. Bob



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