PreP Top, Bottom Not...risk?

Question

Hello,

Approx 5 weeks ago I had unprotected insertive anal sex with a friend. I did not ejaculate inside. He claims to be neg but not on prep and said he was tested a month prior. I have been on PreP since Aug 18 and have not missed a single dosage.

I got a small case of strep I think 2 weeks after the event (sore throat, white spots on tonsils, no discernible fever, swollen glands on neck) and took antibiotics after a day and all was well, but I cant shake the feeling I could be seroconverting?

What is the risk my encounter...could he have been in accute HIV stage and tested neg? How much does that increase the risk?

Answer

Hello,

Thank you for writing in. The wonderful scientific thing about PrEP is that it works even if your partner is HIV positive and detectable. It puts you in full control of your sexual health, independent of what others do or don't do with their own bodies.

Based on the circumstances you described, I can't see any HIV risks at all. You've been on PrEP for more than 7 months now, so that would bring your risk of acquiring HIV to nearly zero even if exposed. But add to the fact that you topped in this encounter, and that significantly decreases any risks further. Even without PrEP, acquiring HIV from one exposure as a top is exceedingly rare, less than 1% (https://www.poz.com/article/HIV-risk-25382-5829). Add the fact that your risk on PrEP is decreased by more than 99%, and we're talking less than .01% - nearly impossible.

You are more likely to get struck by lightning then get HIV under these circumstances. Now I do agree that you can't take someone's word as their actual HIV status, there are many valid reasons why someone may not know or share their HIV+ status. I would hope your friend would also consider getting PrEP for himself in order to protect himself and by extension preventing any HIV transmissions to his non-PrEP'd partners.

So what's with the side effects? Only a healthcare worker who has met you in person can tell you for sure. But I can tell you that I used to get similar symptoms all the time when I worried about HIV. I spent two decades psycho-somatically creating physical distress for myself, thinking I had gotten HIV, when in fact there had been no exposure. Getting on PrEP changed that fear for me, and I hope in time it will change that for you too.

In this process of changing fear it can help to be medically accurate about the terms we use. You wrote you had "unprotected" anal sex with your friend. But if you've been taking PrEP consistently since August then you did not have unprotected sex, you actually had some of the MOST protected sex an HIV negative person can choose to have. Using PrEP for protection is far more efficacious than using condoms by themselves.

So I hope you continue to talk with your providers about your medical symptoms, and consider ways to change your fears around HIV transmission on PrEP. Sometimes time makes a difference, sometimes talking to a qualified PrEP-informed therapist can help. Either way, I hope you're soon able to experience the joy and pleasure than sex and intimacy can bring.