On prep for the last year fisted a guy without glove and had a cut on hand
Nov 22, 2017
Hi Damon i have been on prep for the last year. Went out on Saturday night. Had some recreational drugs and ended up fisting a guy without a glove. Had a blister on my finger that popped a couple of days ago. looks like it had a healed layer of skin over it. Just want to check if i am at risk or if i need to add more meds to my prep regimen. Did not know the persons status.
Response from Mr. Jacobs
Based on the events you describe, you would be at no risk of contracting HIV from this scenario. Here's why:
(1) Consistent use of PrEP offers more than 99% protection from any exposure to detectable levels of HIV (http://www.natap.org/2016/ICAAC/ICAAC_02.htm). If you're using PrEP as prescribed, your chances of acquiring are nearly zero.
(2) In 36 years there is only one reported case of someone acquiring HIV through fisting. That person had frequent ulcers on his hand, and was not using PrEP (https://www.aidsmap.com/Fingering-and-fisting/page/1323538/).
(3) Your own blister had a healed layer of skin on top of it. Even without PrEP, your skin on your finger is the best protector from detectable HIV entering into your mucous membranes.
(4) You don't know this person's status. And although that in of itself does not protect you, it is equally as possible that he is also HIV negative and on PrEP, and/or undetectable and untransmittable (https://www.preventionaccess.org/).
Even if we knew for certain that you had mucous membranes that had been exposed to detectable levels of HIV, the medical recommendations would not advise you to take more medications. These are exactly the scenarios under which PrEP was tested, and the circumstances under which many of us use PrEP today. It is taken by people who are HIV negative in case they are repeatedly exposed to blood, semen, or vaginal fluids of people living with HIV and carrying a detectable viral load.
Or, it the words of the researchers, "When taken daily or near daily, PrEP is highly effective for HIV prevention in persons with repeated HIV exposures; therefore, initiating a PEP regimen is not indicated in people who are adherent to their PrEP regimen." (https://academic.oup.com/ofid/article/2/4/ofv126/2460270).
Although you didn't ask, I just wanted to add in here as well that recreational drugs do nothing medically to compromise the efficacy of PrEP. Many of the original efficacy trials, especially the UK "Proud" study looked at how well PrEP worked in people engaging in chemsex. 62% of the participants in "Proud" reported using crystal meth with sexual contacts. Even under those circumstances there were still zero acquisitions of HIV when PrEP was taken as prescribed (https://www.poz.com/article/PROUD-Lancet-27761-8114).
I'd encourage you to continue using PrEP as prescribed, get tested regularly (every 3 months is recommended in the U.S.) and let yourself enjoy pleasure and play as you see fit. I hope this helps!
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