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My life has become hell, please answer!
Jun 28, 2001

Dear Dr. Ryan,

Please accept my warmest congratulations on the excellent task you carry out, providing all these valuable information on such a burning issue of our era. I am a 26 year old student in Athens, Greece and I wrote you for the first time two days ago. I have had encounters with female sex workers in whorehouses here in Athens in the past. They were always protected (I always wore a condom during the vaginal sex with them). Nevertheless, during my last encounter two months ago, as I was withdrawing from the vagina of the prostitute,without having ejaculated, the condom I wore slip off. She placed it again on my penis and masturbated me till I came. Since that incident I have been worried sick. I can't eat, sleep, attend my classes and participate in my exams. My life in general has become hell. I am afraid to touch my family or my fiancee from fear not to infect them. Please, please help me, I am desperate! Am I at great risk of having been infected from that contact I described? Should I get tested and if yes, when? Once again, I am waiting anxiously for your advice. Please help me!

Response from Mr. Kull

You are not at "great risk" for HIV infection in the encounter you describe. If the condom you were using "slipped off" only while you were withdrawing your penis from your partner's vagina, it seems that the contact your penis would have with vaginal fluids would be minimal. Situations like yours do not generally result in HIV infection.

That being said, you are not at zero risk for infection (STD/HIV), which is probably not enough of a guarantee for you, or anyone, to feel completely at ease. For many people, testing at least three months following exposure is the only way to put the matter to rest.

Your situation becomes complicated because of your finacee. In the unlikely scenario that you were HIV infected in the incident you describe, you will not infect your fiancee or family members by "touching" them, but you may put your fiancee at risk for HIV and other STD's if you have sexual contact with her (especially unprotected). I assume that this adds to the psychological stress you are experiencing. It will be important for you to make some decisions as to how you will proceed with this dilemma.

Many people write to this forum with concerns similar to yours; people filled with guilt and anxiety about having extramarital/relationship sex. Being monogamous is not easy for many people, and for some it may be an unrealistic expectation. The pressures to be monogamous and the need to hide sexual encounters outside of the primary relationship can lead to deep emotional discomfort. Bringing an STD or HIV into the relationship can be even more devastating. Many infections in the world can be attributed to secrecy about certain behaviors that a spouse or partner may not be aware of, in order to preserve the relationship and the idea of monogamy (be it sex or needle-sharing). People often become trapped in a cycle of secrecy and denial that can be destructive to the self and the relationship.

If you continue to have sex outside of your relationship it will be critical that you make some decisions since you will always be at risk for certain infections. Since this is not an easy task, I often recommend that people seek out the help of skilled professionals: marriage counselors, social workers, psychotherapists, religious/spiritual advisors, etc. And, of course, it you feel comfortable talking with your partner about your concerns, that could be beneficial as well.

RMK



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