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hiv, pre-cum and / or undetectable
May 1, 2014

i am a gay male. 2 weeks ago i was with a guy who did tell me he was positive and he also said he was undetectable. i know enough not to trust or risk it given undetectable, but in the heat of the moment i may have had exposure. I am trying to understand. It is too late for PEP but wondered if i should have

1. he fingered me with his saliva (i have heard no risk) 2. he rubbed his penis on my anus (i have heard no risk) 3. he then stuck it in slightly while the frontage...i would say, in about 1/2 inch for less than 5 seconds. i have a fissure that does often bleed. he didn't have any precum from what i saw and he said he doesn't precut much at all. he also reassured me again that he was undetectable (but who really knows, best to be safe). I really don't know the risk.

the bigger question on #3.... i know HIV transmission needs to happen when someone is actually inside you..but how far? i.e. - it is possible that the fissure area does get some exposure to air - it is almost external, slightly internal.

i am starting to freak out, and also getting sick... no symptoms of ARS, but worried it will turn out this way for me.

how much risk am i in? i know i shouldn't have even let #3 happen. But... i did.

oh - we also did oral - and i am not concerned there. he gave me a blow job, and i gave one very briefly.

help?

finally - THANK YOU of what you do. this education is important.

Response from Ms. Southall

Hi A couple things here, first you are correct with oral and fingering there is low to no risk there. HIV transmission can only occur when there is a direct and prolonged exposure to body fluids, semen, vaginal fluid, blood or mother to child through breast feeding. This most commonly occurs through unprotected vaginal or anal sex and sharing of needles. Casual contact, sharing utensils, drinking after someone, etc are not way for HIV transmission to occur. If you go to this link HIV101 it will take you to our page that talks about the ways in which HIV is and is not transmitted.

As for the short exposure through anal sex, it was unprotected and so there is a risk there but again very low. We also know that someone who does have HIV and has an undetectable viral load the risk of transmission dramatically decreases.In the research conducted so far, there have been no recorded HIV transmissions among heterosexual couples where the HIV-positive partner is on treatment and their blood viral load is undetectable. However, this does not mean the risk through condomless sex is zero. All of the couples studied to date have also reported using condoms often. This makes it difficult to determine the risk of HIV transmission when no condom is used.

Although there have been no studies among gay men and other MSM, there has been one report of HIV transmission occurring between two men when the HIV-positive partner had an undetectable viral load.

Also, the risk of HIV transmission when the viral load is undetectable may not be the same for all types of sex. This risk may be higher for anal sex than for vaginal sex, particularly if the HIV-negative partner is the receptive partner (bottom) during anal sex. This is because receptive anal sex generally carries a higher baseline HIV risk than other types of sex.

There are ongoing studies following serodiscordant heterosexual and same-sex couples who are taking HIV treatment, have an undetectable viral load, and do not always use condoms. These studies will provide a better understanding of the risk of HIV transmission when the viral load is undetectable.

Your overall risk is very low.

The testing guidelines for HIV are to be initially tested at 3 weeks post exposure and then again at 90 days. As long as there are no other exposures happened during this time frame than the results are conclusive.

Be well and stay safe, Shannon



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