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Breast milk and lactation play

Apr 3, 2011

I am HIV+ and was diagnosed 2 years ago. Since then I was put on HAART and have been undetectable ever since.

I have two children and have been lactating ever since they were born, when I was with my positive boyfriend breast milk play was part of our foreplay, since this time though we have split up and I recently started seeing a new man. He doesn't know I'm positive and similarly we played. I never saw it as a prolem until I learned recently that there can be more HIV DNA in breast milk than in the blood.

The thing is he had a legion on his penis which I didn't know about at the time which he says was very sore. It has been 4 weeks since this possible exposure and just recently he has been complaining of night sweats and waves of flushes during the day.

We have always used condoms for penetrive sex and not messed around in any genital to genital contact.

I am beside myself with worry that I may have passed on my HIV, something I swore I would do everything to avoid.

My question is one I can't find any research or information on anywhere else. There is plenty of info on transmission via breast milk from mother to baby, and some very silly stuff about breast milk to adults orally but I can't fnd anything on breast milk to genital transmission.

Can you tell me anything about the risks in reference to my case?

Many Thanks


Response from Dr. Frascino

Hello Suzi,

You haven't found any specific information on the risk of HIV-transmission from breast milk coming into contact with to genital lesions because none exists? Exactly how would one design an ethical clinical trial to study this? HIV-positive breast milk is considered an infectious fluid, so there would be at least a theoretical risk. I would suggest you disclose your HIV status to your new playmate. It's the right thing to do. If, for whatever reason, you don't feel you can, you could consider anonymous notification through the local health department or other anonymous notification modalities. (See below.)

I should also point out that your risk of transmitting the virus is significantly decreased because your antiretrovirals have decreased your HIV plasma viral load to undetectable levels.

Good luck!

Dr. Bob

reinfection (DISCLOSURE, 2010) (INSPOT.ORG, 2011 ) Jan 11, 2011

I have been diagnosed as HIV positive since 8/2009 and have been on Atripla since then. My VL is undetactable and my CD 4 count has gone from 40 to 467 since I started Aripla. A few days ago I had unprotected sex with a guy and ejaculated inside him. I didn't know his HIV status Stupid, I know, but it happened. Do I need to be concerned about reinfection with a new strain of HIV? What should I do?

Response from Dr. Frascino


You were diagnosed HIV positive in August of 2009 and are on Atripla. OK.

You had unprotected insertive anal sex with a guy of unknown HIV status a few days ago. Not OK!

What concerns me most is that you are apparently only concerned about the remote possibility of reinfection. Has the thought even crossed your mind that you might have infected your partner while doing the unsafe dance with no pants? What should you do? You should notify your partner that he has been exposed and needs HIV testing. Had you told him within 72 hours, he could have taken a course of post-exposure prophylaxis (PEP). Disclosure and partner notification is never easy, but it is extremely important in decreasing new infections. If you're reluctant to contact your buddy in person, consider using anonymous partner notification (see below).

Regarding your reinfection concerns, there is nothing to be done at this point other than to learn from your lapse in judgment and not allow this to happen again in the future.

Dr. Bob

I dont want t pass on what I got Jan 10, 2011

Hi doc, this internet is driving me mad everyone seems to be saying differen things. Im hiv positive and a girl gave me a bj, it was unexpected and I wasboth weak and quick and came in her mouth which she swallowed. This girl does not know my situation. Is it necessary for me to put her in the nightmare of getting a test, I dont plan in meeting her again but she can be located as she is a sister of a good friend. I am hoping that she has notthing to worry her and theres no need to panic her. What do you think.

Response from Dr. Frascino


The blow job was "unexpected"? Exactly how did your throbbing tallywhacker get into her mouth unexpectedly? Oh, never mind. Yes, you do need to advise your partner that she has been exposed and needs HIV testing. Partner notification can be difficult, to say the least. If you are reluctant to contact her yourself, you could consider anonymous notification. See below.

Dr. Bob

HIV guilt (DISCLOSURE, INSPOT.ORG, 2010 ) Oct 14, 2010

Dear Dr Frascino

I was diagnosed HIV+ in 2006 at the age of 19. My immediate reaction was to cease being an active participant in sex as I was, at that time, under the false impression that this radically reduced the risk of my infecting someone else.

Regrettably, I had 3 situations where I engaged in unsafe penetrative sex (as the passive partner). While I was always vocal about the fact that I strongly suggested using protection, all 3 of these guys were not interested in using protection (2 were also on drugs).

Since then, the thought that I might have infected them has been weighing heavily on my conscience to the point that I have developed panic attacks and bouts of depression. My therapist has tried to assure me that if they were prepared to take that risk with me, I was most likely not the first and that I should relax.

Truth is, I can't. Even though my viral load has never been below 4000, I find myself in the throes of intense panic. Even now, 3 years since the last such encounter.

I have since begun treatment (due to recurrent enteritis and chronic fatigue) and I am reacting very well. Undetectable viral load and CD4 on the increase. I have enjoyed 2 1/2 years with the most wonderful HIV- partner. However, my life seems to be in the shadow of these encounters. While it angers me that their stupid decisions are causing me such grief, I just cannot be content.

After the public display in Germany recently of criminal HIV transmission, things have just worsened.

I am not entirely sure what I am asking you but I am at my wits end and do not know how to go on.

Any advice?

Yours sincerely


Response from Dr. Frascino

Hello UK24,

You characterized your problem well when you wrote: "I am not entirely sure what I am asking you but I am at my wits end and do not know how to go on" and ". . . I have developed panic attacks and bouts of depression." Clearly anxiety and depression are why you are "at wits end." You link those problems to "HIV guilt related to three bouts of unsafe sex. These lapses in judgment cannot be undone. (If you are still in contact with these guys, you could advise them they have had an HIV exposure and should get checked. This can be done anonymously. See below.) I absolutely agree with your therapist that it takes two to do an unsafe dance with no pants. Your partners share at least equal responsibility. Your focus on these three incidents from your past may not be the real issue here. Anxiety and depression are clinical syndromes in and of themselves. Your anxiety and depression are presently not being adequately managed r adequately treated. I would advise you talk with your HIV specialist to see if a more thorough evaluation and more aggressive treatment are warranted. You may well need to see a psychiatrist (M.D.) rather than a non-M.D. therapist. The psychiatrist can prescribe anti-anxiety and anti-depression medicaments, which may well be extremely beneficial in getting your life out of "the shadow of these encounters." No one can undo the past, but you can take responsibility for today and the future.

Good luck.

Dr. Bob

Witholding the truth? (DISCLOSURE, INSPOT.ORG, 2009 ) Nov 4, 2009 Last weekend, I went to a great Halloween party with a bunch of friends, and we all got pretty drunk. I remember what happened most of the night, but there are some details that I do not remember. One of the things that I do remember was meeting this good looking guy. I recall flirting, dancing, and getting in a cab with him. We went back to his place; we got naked; we started fooling around. The guy asked me if he could fuck me. I said yes. He then asked me if I was healthy. I hesitated for a second, and then said, yes. I thought, well, I AM healthy. I am a healthy HIV positive person-- but deep inside I knew he was really asking me about my HIV status. He took out a condom, and I put it on him. He fucked me pretty hard. The condom broke I learned the next morning. I blacked out a couple of times througout the night.

When I woke up the next morning, it took me a few minutes to adjust and recognize the person next to me and the place I was in. Forget his name. I had to look at the address label on one of his magazines in the bathroom to remember his name.

Finally, it all started to come back. Panic settled. Once sober, I realized I had not beencompletelyhonest with this guy. I was mortified. I had justified my answer with the notion that I was indeed healthy not sickbut I wasnt (not according to his vocabulary) Now he was telling me about the condom breaking.

I felt like such an a**hole. He was being honest and responsible. He told me what happened with the condom; he told me again that he was healthy and that he had recently been tested; He asked me again if I was healthy. This time I mumbled no. My answer was either not heard or was confused with another question I did my best to cross-talk, and was able to change the subject before he could ask again. I thought, ok, one-night stand, get dress, move, leave before he asks more questions. But before I got to the door he asked me if he could see me again. I wanted to say no, but like a moron I said sure. I did like him, but whatever chance I had to get to know this person was now ruined. I wrote my email address on a piece of paper and left. When I got home I was overwhelmed with sadness and guilt. Ive been having a hard time sleeping ever since. I know we tried to protect ourselves I know the chances for infection are very small, but still, who in the hell am I to decide about his (or anybody elses) health? He had the right to know. I feel that I was as reckless as a drunk driver.

Couple of days later, he wrote. He told me he had a great time. He wants to get together again. I know the simplest thing to do is say no or ignore him. My friends tell me to shut my mouth. That it is too late. I would make things worse if I talk now. So this is my dilemma. Should I remain silent and hope that nothing bad happens (to his health)? Or Should I come clean and tell him the truth? Forget about developing any type of friendship with this guy. Ill be lucky if he doesnt punch me in the face.

With this experience, I realize how deeply ashamed I still am of my HIV status. I am still very angry at myself for having been infected. I crave acceptance and fear rejection so much that I put myself in these difficult situations. I thought I was a decent person, but with this experience I feel as if I have lost my morals and sense of decency. Am I being overdramatic? Perhaps. But I am deeply disturbed about my behavior. I dont have the right to decide for others. As for my drinking, well, I guess that doesnt help either.

Any words of wisdow would be truly appreciated.

Response from Dr. Frascino


Disclosure is never easy. You certainly are not alone in fearing rejection and craving acceptance.

I agree that your deception was wrong; however, I do not believe you have lost your morals or sense of decency. Your intense guilt is testament to your basic moral character.

What should you do now? I think you already know the answer. I do not agree with your friends! If the situation were reversed, wouldn't you want to know the truth? I believe you need to come clean, admit your mistake and accept the consequences of your actions. A face-to-face meeting with a sincere apology would be best; however, if you can't muster up the courage for a personal interaction, you should at least notify him anonymously via an anonymous partner-notification program. "Inspot" works well. See below. Leveling with your Halloween trick is not only the best way to deal with your guilt; it's also the right thing to do.

Good luck.

Dr. Bob

How do I anonymously tell a partner I may have exposed him to an STD??? (INSPOT.ORG) May 5, 2009

Dr. Bob,

HELP!!!! I did something stupid and now I've got syphlis!!!! I'm still waiting for my HIV test!!! What really worries me is that I've had sex with several friends and we sort of forgot to use a condom. But I know these guys really well and know they are healthy and usually play safe. I just can't tell them in person that I have syphilis and my health department wants to know my name. I don't trust them to keep the information confidential if I give them these guys names. HELP!!!!!!!!!!!!!!!!

Mr. Too-Embarrassed-To-Tell-Them

Response from Dr. Frascino

Hi Too-Embarrassed-To-Tell-Them Guy,

You sort of forgot to use a condom???????? Hmmmmm.....Early Alzheimer's I presume, right? Otherwise I'm sure you wouldn't take such a risk. (Learning a lesson like this the hard way is indeed painful and I'm not only talking about the walloping dose of penicillin that's going to be injected into your butt, either! I'm hopeful your experience will make others think twice before "sort of forgetting to use a condom", even with friends.)

Actually there is a way to notify your contacts! Check out the Web site called There you can send an anonymous e-mail to your sexual partners advising them they may have been exposed to an STD. Yes, it's truly anonymous and cannot be traced back to you. There are a variety of very simple messages to send. My favorite is "I got screwed while screwing, you might have too." Dr. Bob says, "Check it out!" Don't delay! Your contacts need to be told and treated ASAP!

Dr. Bob

How soon after exposure can you start treatment(hep c)
HepB ;treatment with Pegasys

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