Possible exposure risk??

Question

Hi Dr. Bob!

I am 23 year-old male diagnosed 7 months ago as HIV+. I've been on medication ever since and am happy to say my CD4 count is great and my viral load has been undetectable since August.

I've recently let myself have feelings for a boy for the first time since being diagnosed, and it's been a bit of an emotional roller coaster. It being my first time, I was not sure WHEN was the appropriate time to tell him about my status and I fear I may have waited too long.

In the last few weeks, we have been making out, mutually masturbating to completion, and we have performed oral with no cum shot in the mouth. Last night, we were both intoxicated and wanted to have sex but knew we shouldn't take it that far yet. However, somehow I ended up letting him put it in my ass unprotected for two thrusts before stopping.

I told him today that I was HIV+ considering what happened last night, and he is freaking out. As he should. He was worried about cuts on his hand and getting my semen in there, also a cut on his chin area and wisdom teeth coming in.

Is he at enough risk that we should look into PEP? I emailed my doctore and told him the details and he said that there shouldn't be any concern. But I care for this boy and want to make it right between us. HELP!

Answer

Hi

Finding exactly the right time to disclose one's HIV status is never easy. However, if you waited until after your potential Mr. Happily-Ever-After has his unprotected throbbing tallywhacker firmly planted in your backdoor, it's a pretty safe guess that you've procrastinated a bit too long.

Regarding post-exposure prophylaxis (PEP), this only has a chance of aborting HIV infection if it is started as soon as possible (and no later than 72 hours) after exposure. Unprotected anal sex, even only two thrusts, is risky business for which I would offer a course of PEP. That you are on effective antiretroviral therapy (ART) that has driven your plasma HIV viral load to undetectable levels significantly decreases, but does not completely eliminate, HIV-transmission risk.

As for making things right with your potential Mr. Right, well, you may have difficulty regaining his trust -- and for very good reason. For future reference, I'd suggest you read through the chapter in the archives of this forum devoted to HIV disclosure.

Good luck.

Dr. Bob