Unprotected sex in Africa

[9997]

Dear Doctor:

I am young American woman working in urban South Africa.  I have had sex with 7 different male partners here in the last 3.5 months, and have been with each of these partners from one to three times each.  Of these partners, 4 were from South Africa, 1 from Zimbabwe, 1 from France, and one is from Ghana, though all are staying in SA.  Many of these men I believe to have frequent safe sex but do not have steady partners.  Most encounters included some combination of digital penetration, oral sex, or protected vaginal intercourse.

There is one incident of particular concern:  In an idiotic drunken moment, I had unprotected vaginal sex with a 25 yr old Ghanaian man, who came inside of me.  While he claims to have been tested (though I do not know how recently) and to not have other partners, of course one cannot be sure.  As far as I know, there were no abrasions or other compromised genital tissues at the time of the incident.

I went for a rapid HIV test today, exactly 29 days after unprotected sex, and the result was negative.  I plan on going for a test at 7 weeks (instead of at 6 due to traveling), 3 months, and 6 months.  I would like to assess my risk factor relative to the prevalence of HIV/AIDS in this region of the world and the potential of a remaining window period.  Also, am I being absolutely excessive in testing?

Regards,
9997

[H. Hunter Handsfield, M.D.]

First, you can be very sure you don't (yet) have HIV; a negative test (whether rapid or laboratory based) at 1 month is over 90% reliable.  You should be tested again, but a single additional test at 3 months would be fine.  The additional test at ~7-8 weeks is not unreasonable, but it isn't necessary to go beyond 3 months.

However, your overall risk of catching HIV someday is high if your lifestyle continues as it has been.  From a statitical perspective, you can assume that one or more of your partners to date has been HIV positive; something like 20% of South African and Zimbabwean men are infected.  If you stick with the safe sex practices you describe -- in particular with absolute consistency in condom use for vaginal or anal sex -- your actual risk will remain low.  But you describe one alcohol-related lapse in judgment, and condoms do fail from time to time.  All things considered, you are playing with fire.  Please be very careful.

Best wishes--  HHH, Md

[9997]

Dr. Handsfield,

Thank you for your comments.  I will likely test at 7/8 weeks in addition to the 3 month mark, and will update if my status changes.

Furthermore, I appreciate your concern.  I am aware that I have been participating in a high-risk lifestyle, and while I won't boast immensely more conservative habits, I will state that this period has been excessive and gratuitous relative to my normal practices.   I have never made an alcohol-related poor judgment prior to this, and you can bet that after the stress of these last few weeks, I will not ever do it again.  

Thanks for all that you do with this forum -- this is an invaluable service to many, and you have provided helpful reassurance to me.

Regards,
9997

[H. Hunter Handsfield, M.D.]

The risk of transmission from male to female is higher than 1 in 2,000, probably closer to 1 in 1,000 in North America and Europe.  It likely is quite a bit higher than that in southern Africa, where more HIV infected people are likely to have higher viral loads, to have other STDs, and to be uncircumcised.  In addition, Dr. Hook's and my recommendations on timing of HIV testing depend in part on the level of risk; in a high risk situation like this one, testing out to 3 months makes sense.

[NCR1]

I am no doctor, but I am sure he is going to give you an all clear, however i know the anxiety and exactly how it feels, I am going throught the exact same thing now.

Some useful comments on here, that you may want to remember is that apparently the 2 great doctors on here have never heard of a situation where someone has been tested Neg at six weks and pos after that. so that should keep you a little rest assure. Also in Aus they are using 4th generation technology which in most cases can pick it up within a week to a week and half that is why they say 6 weeks -  3 months to be safe, but also keep in mind it was a single exposure and that there is a 1 in 2000 chance even if he was so with the 30 days testing you have had and the 1 in 2000 chance you can be sure you have nothing to worry about. But im a hypocrite based off australian standards I have been told I am 1 in a million and am terrified still. but i just thought i would pass on some of the facts i have been given. But again the brilliant docs here will tell you all.