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internet dating
Aug 17, 2011

dear dr. Bob

I have read through many of your post as well as the earlier post from Ryan from 2001-2003. I'm a bit confused and will briefly explain my situation to you.

I am male top and hiv- 30 and uncut and DDF and met a male bottom on a dating site. The guy listed himself as negative.We met up at a bar and then he came home with me. I used condoms during the anal sex. Me top, him bottom. However somewhere along the way the condom slipped off either when i was gonna remove myself from him or maybe it slipped off a 1-2 minutes prior. I checked the condom a few times while i was inside and it rolled up and i kept rolling it back down. When i removed myself at last I saw the condom was missing i informed him i was negative and then he comes clean and say he is positive. This happen Sunday morning around 2am which means im still within the 72 hour window.

The information Ryan posted years ago stated that the CDC suggest that the majority cases of condom slippage or breakage do not result in HIV transmission and rather unprotected safe from start to finish was the main reason of transmission. He never recommended PEP. Your post however almost state each time that one should get PEP if within the window period.

The guy informed me he's been positive for 10 years and undetectable. Today I cringed thinking about this situation because i was recently tested neg and that was suppose to be a new start of sorts but i'm trying not to be to upset about this as i know i was too responsible and i was being responsible by using condoms up until the slippage.

Do you think i should get PEP? I do not have health insurance and i'm not sure how my body will take to this medication (i have a heart condition) and frankly i'm scared. the guy told me he chooses not to put his information online but insist on safe sex. he said he would be around if i needed to talk about it. He also said he understands my anxiety but feel i will be ok given this brief encounter. however, he's not a doctor.

what do you think? Please advise. I don't want to PEP if this is not considered significant.

thanks so much. LES, NY

Response from Dr. Frascino

Hello, Les.

There is a big difference between the condom slipping off as you were slipping out of your bottom boy's backdoor and having the condom slip off for "1-2 minutes" while you were jackhammering your way to heaven. If you were in the love canal unprotected, PEP would be indicated. If you slipped out while slipping out, so to speak, PEP would not be indicated.

That your buddy is presumably on antiretroviral medicaments that have driven his plasma HIV viral load to undetectable levels would significantly decrease, but not totally eliminate, your HIV-acquisition risk.

The decisions whether or not to take PEP is yours and should be based on the degree of your actual risk of an unprotected HIV exposure.

Good luck!

Dr. Bob



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