HIV anxiety - alcohol incident

[aljawi]

I'm a heterosexual male who has recently had some bicurious inclinations. While I was in another city, I got extremely intoxicated at friends' party and only have vague recollections of the night. I remember going to some guy I met's place, having anal intercourse at least at first with a condom but hard to know for sure if it remained on, and then oral sex without a condom. My memory returns to me taking a cab back to my friend's place, feeling horrified, unsure exactly what had happened.

Ever since the incident, I have been plagued with a terrible sense of shame and anxiety. I have a history of anxiety and OCD, and since the incident have been obsessively checking forums and online groups about the likelihood of HIV, and even contemplating how I would tell people / whether I would kill myself if I were to be diagnosed as HIV +. The man who I met told me repeatedly that he is clean, but has since refused to return my contact because I've been such an anxious mess and asked him multiple times to confirm his status with proof.

In terms of dealing with what happened, I feel like I can't tell anyone I know because it is so out-of-character (I'm a well-educated, mostly heterosexual, professional who has never been in such a situation before). Since the incident, I reconnected with my psychiatrist to go back on anxiety treatments and deal with my recent alcohol abuse. I've also paid for a full STD panel with an early HIV test that is 95% accurate after 21 days, so I plan on taking that.

The thing I can't deal with is how to live with myself between now and then, and the daily anxiety that I feel when I remember what happened (or have brief flashbacks). I obsess over how three weeks from now my life will be irrevocably worse and damaged. I'm just so disappointed, know that I am better than this, and can't believe I've found myself in such a situation. What can I do while I wait?

[Edward W Hook, MD]

Welcome to the Forum and thanks for your careful descriptions leading to your concerns. It sounds as though you have a good grasp of the issues in hand.  I can provide some facts which might be helpful to putting your (low) risk into perspective.  First, your partner has told you he does not have HIV.  I suspect he is correct. Second, a condom was used for at least some, if not all of your anal intercourse- the condom protected exposures are no risk for HIV or STD. You do not mention whether he spoke of specific testing or not but if he did it makes the likelihood that he has HIV still lower.  Even if he did have HIV however, your risk for infection form anal intercourse is less than 1% (there is no meaningful risk from receipt of oral sex from an infected partner and the risk of HIV from performing oral sex on an infected partner is less than 1 infection per 10,000 exposures). thus the numbers are very much in your favor.

Beyond providing you with the statistics there is little I can do from here. You however had done just the right thing by returning to the care of your psychiatrist- I presume and hope that you have follow-up appointments scheduled.

I hope my comments are helpful.  Your risk for infection is quite low.  EWH

[Edward W Hook, MD]

The PCR test, while increasingly used to rule out HIV, has not been formally studied for this purpose.  While there are no formal studies a negative PCR test at 21 days would be very, very storng evidence that you did not have HIV.  The problem with PCR tests has more often been false positive tests than false negatives.  EWH

[aljawi]

Hi Dr.,

Thanks for your timely reply. I guess I will just have to sit tight and see for sure, but it is reassuring to hear confirmation that I am indeed freaking out over a statistical improbability, if not impossibility.

A quick follow-up question that I've seen addressed elsewhere: how accurate is a PCR DNA test at 21 days - which is the waiting period that the testing agency I signed up for claimed as entirely accurate.

Finally, I pray that this whole ordeal will conclude as nothing more than a learning experience and reminder for me to take control of my anxiety and my behavior. I will advise with further questions, and I appreciate you taking the time to write me back.