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Unprotected Sex
Oct 28, 2001

My boyfriend is hiv+ and we have unprotected sex (anal) for about 1,5 years, with interruped coitus. By accident he ejactulated in me, and i imeddiatly washed my self. There were no woonds or blood involved, either his or mine. How much of a risk is this, and what can i do to rapidly know if i'm infected. Please note that i check my self regurarly for hiv, and i've always tested negativly. (please excuse my english, but i'm portuguese)

Response from Mr. Kull

The episode you describe puts you at significant risk for infection. Being the receptive (bottom) partner in anal sex with an HIV infected person without a condom is one of the most efficient ways to transmit HIV. While ejaculation greatly increases the risk for infection, exposure to pre-cum alone poses a real risk for infection. Having your partner pull out before he ejaculates decreases the odds of infection, but it is not recommended that you rely on that technique, especially since it doesn't always work (as you experienced). It is really important that you try to use condoms for anal sex.

Since you are at significant risk for infection, you may want to consider beginning medication treatment right away (called post-exposure prophylaxis, or PEP). PEP--the use of anitviral medications shortly after a high-risk exposure to PREVENT infection--was initially used among healthcare workers who accidental needlestick injuries. Researchers found that PEP reduced the rate of infection by 79%, but some who took PEP still became infected. Research on PEP for sexual exposures is currently being conducted to see if treatments for the general public are feasible and effective.

Post-exposure prophylaxis probably needs to be started within 24-36 hours of exposure (some guidelines extend the window to 72 hours). Since the procedure is still not widely practiced, is expensive (and not covered by health insurance), and can cause troubling side-effects for people, PEP is only recommended for individuals who have a significant exposure to HIV (like yourself). Criteria vary, but PEP is generally warranted when someone has unprotected vaginal or anal intercourse with an infected person or a person from a high-risk group, or for a victim of sexual assault. Programs that provide PEP are developing (mostly in urban areas) and hospitals sometimes have protocols for administering non-occupational PEP. You could talk with a medical provider, visit an emergency room, or contact an AIDS service organization if you would like to pursue PEP. These venues should be able to provide the necessary testing recommendations to determine if infection occurred.

RMK



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