HIV Fears Two Years After Unprotected Receptive Anal Sex: What If HIV Tests Were Wrong?

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Question

Two years ago, I had unprotected receptive anal sex with someone whose HIV status I don't know. I was tested at three weeks (with a fourth-generation test), and it was negative. A little over a year after the possible exposure, I got pneumonia. While it did respond to antibiotics at home, it seemed more serious than what people my age (26) usually have. So, naturally, I Googled it and freaked out.

I found a web page that said bacterial pneumonia can be the first clinical manifestation of HIV. So I got tested again (with a fourth-generation test) a year and nine months after the possible exposure, and it was negative. The problem is, I am terrified every time I get a cold that it will be pneumonia (because I've read recurrent pneumonia is indicative of HIV), and I'm wondering: Should I do another test? Or a viral load test to be sure?

I'm worried that for some reason I'm not producing antibodies, but that I do have HIV and it's not being picked up by a test. Could I be one of those people who has HIV but never seroconverts? I'm going out of my mind, and I don't know what to do. Please give me your opinion!

Answer

I'm going to start with the short answer here: You did not acquire HIV from this encounter. The fourth-generation test given at three weeks confirmed that. The fourth-generation test taken one year and nine months after this exposure confirmed what was already proven.

I don't know if you are a seronegative person who will never seroconvert. What I can tell you is that it is very unlikely you would seroconvert after only one exposure to HIV. Even if your partner was living with HIV, and even if your partner had a detectable viral load -- and those are two big ifs -- your chances of acquiring HIV from one exposure through receptive anal sex are approximately 1 in 72 (1.43%). That's not zero, but it is fairly low. HIV seroconversions typically occur after multiple exposures.

Your sentence, "So, naturally, I Googled it and freaked out," speaks volumes about what is really happening here, and it is indicative of the blessing and curse of our information age. In general, I think it is an advantage that we live in a time when information on early signs of HIV seroconversions is available to anyone with a WiFi connection. On the downside, it can create a dynamic where people read about HIV symptoms and then mentally manifest those symptoms. It is a tricky game our minds can play when we're anxious, afraid, and scanning the Internet at all hours.

Now here's a little story: In 2011, one of my favorite singers, Stevie Nicks, was embarking on an unusually small tour in major U.S. cities. She was healthy, strong, sober, energetic, and wanting to play intimate venues where she could feel connected to her audience. It just so happened that her first new solo album in 10 years was going to be released at the same time as my birthday, and she was going to appear in a very small theater close to where I lived. I was going to turn 40, buy her new album, and see her live and up close, all in the same week! A lifetime dream come true!

But Stevie never made it to New York City. And why not? Because she, like over 400,000 Americans, was hit by pneumonia that year, causing her to cancel all her tour dates. Pneumonia is a very common and brutal infection that kills over 900,000 children worldwide each year. It is not synonymous with HIV at all, and it is easily spread from casual contact with saliva or mucous.

I know that some people may associate pneumonia with AIDS, since many people with AIDS died from pneumonia when exposed before we had effective HIV treatment. But that doesn't mean that having pneumonia now is a sign of having AIDS, or of being HIV positive. Stevie Nicks sure isn't, and neither are most of the children who are gravely afflicted with pneumonia each year.

Although "AIDS phobia" is not an official clinical diagnosis, it is often used to describe people who believe they have HIV even though they have had no exposure, and who don't believe medical tests that come back with an HIV-negative result. Often, therapy and medications can help. My opinion is that you should consider talking to a therapist in your area. I hope this helps you begin the process of prioritizing rationality over terror and placing facts over fears.