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Slim chance?-please help
May 15, 2001

I am a male who had unprotected vaginal intercourse with a woman of unknown status (several times in one night). There was no blood and I had no visible cuts. I am worried. I have never had unprotected sex before. I have seen her a couple of times since and we always use a condom now. I talked with her about it and questioned her sexual history. She said she tested negative for HIV and other diseases about a month before our unprotected encounter and that she had always used a condom except with her boyfriend (from out of town) who she sees monthly. Her and her boyfriend both tested negative 2yrs ago when they started dating and she believes he is faithful to her even though she is obviously not so faithful to him. She had protected sex many times with 2 guys other than myself and her boyfriend in the last 5 months but the condom broke on a couple of occasions. Anyway, I have a couple of questions: I know I am at some risk, but should I be worrying? I read in your response to another question that the odds of infection for 1 instance of unprotected insertive vaginal sex with an HIV positive woman were less than 1, which is somewhat reassuring (especially since it doesn't even seem all that likely that she is positive in the first place). How was that percentage calculated and is it accurate? Also, she said that in recent months she had a condom break in a couple of instances and that upon realizing this she washed herself with some kind of disinfectant bodily cleansing fluid, does this work as a preventive measure? Lastly, I know I need to wait until 3 months after our unprotected encounter to have an HIV antibody test result with very high reliability, but I read that the average time needed turns out to be only 25 days. What exactly does this mean? What is the percentage effectiveness/accuracy of the test at 25 days? What about at 90 days? 180 days? Please respond. Thanks for your help.

Response from Mr. Kull

Let me answer your question point-by-point:

1) No, you should not be worrying, but the fact is, you are worrying. Experiencing feelings of anxiety, worry, or fear are common reactions to having unprotected sex and thinking about HIV. Based on this one encounter, you are not at significant risk for infection.

2) The recent figures on per contact risk (see The Body's coverage of the conference report http://thebody.com/confs/retro2001/pavia10.html) are based on a study in Uganda of 174 serodiscordant (mixed HIV status) couples. The risk for infection per episode of vaginal intercourse was about .17%, or 1 in 500. The study's findings are similar to other studies of this nature.

3) Cleaning out the vagina or rectum with douches, enemas, soaps, disinfectants, etc., after sexual contact probably does not decrease the risk for infection. In some cases, irritation or trauma to the region during cleansing may actually increase the risk for infection.

4) Information on HIV testing generally states that "most" people will develop a detectable level of antibodies in 25 days. This is based on different studies of different groups of people. Many sources say that the antibody test has greater than 99% accuracy after 3 months. Getting tested three months after exposure is the best way to determine your HIV status.

RMK



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