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Risk When Condom Breaks With Guy On PrEP ?

Sep 25, 2017

Last night I was having sex with a guy that I regularly hook up with where I was the top. During the sex, I realized the condom had broken so probably was only inside him bare for 30 sec to a minute. Although we have regularly hooked up, he has had other partners in the recent past. He tested negative back in April and is currently on PrEP, and has only had protected sex since his last testing. That being said, what are your thoughts on my risk?

Response from Mr. Jacobs

I'd say you are at higher risk getting hit by a car crossing the street to his house than you are of getting HIV from the encounter you described.

I do understand that as gay/bisexual men we have been indoctrinated to believe that all sexual activity and pleasure must inevitably result in some sort of punishment. But fortunately medicine doesn't follow such moralistic perspectives. So let's look at the facts to see what your risk factors truly are at this point:

(1) You say you topped a guy you regularly hang out with. Let's just say for the sake or argument that you fucked him vigorously condomless for 30 minutes instead of 30 seconds. And let's say for further argument that he wasn't on PrEP at all. Even IF he had a detectable level of HIV, and you were inside him, your risk of acquiring HIV from this one exposure would still have been less that one percent (https://www.poz.com/article/HIV-risk-25382-5829).

(2) Now the reality: You were inside him for an estimated 30 seconds. I've never heard of anyone acquiring HIV from just 30 seconds of insertive sex.

(3) The other reality: He's on PrEP. He is absolutely correct in telling you he has only had protected sex since then, because PrEP IS considered "protected sex" whether condoms are used or not. Daily use of PrEP provides far more protection from HIV than condoms alone given condoms break (as you well know) and are prone to human error. PrEP, when taken as prescribed, is not compromised by these variables and is more than 99% efficacious at preventing HIV (http://www.natap.org/2016/ICAAC/ICAAC_02.htm).

Meanwhile in the U.S. alone, at least 192 pedestrians are hit by a car every day. I know which of these scenarios I would be more aware of in your position right now (http://www.pedbikeinfo.org/data/factsheet_crash.cfm).

I hope this does not come off as minimizing your concerns. You are very wise to explore your risk, and ask for information that can help you accurately assess your dangers. At the same time, I do look forward to living in a world where all men and women are able to enjoy sexual intimacy and decide how to experience consensual pleasure with accurate data about their actual risk. Perhaps after this you might be the one who can help your friends get this information.



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