HIV risk concern

hi, i am 23, and female. i have never told anyone this because i am too scared. i had unprotected sex with a boyfriend maybe twice about 8 years ago. since then, i have had many boyfriends, all of whom have tested negative. one of my boyfriends i dated for over 2 years and we had sex all of the time without a condom (but he never finished in me). after we broke up, a couple of years later he tested negative for hiv. i have extreme anxiety disorder, and i have lost a few pounds over worrying. i dont know why i am suddenly so concerned. anyway, my question is: since my ex-boyfriend and i had frequent sexual encounters, probably hundreds, if my boyfriend before him had given me hiv, wouldnt my other boyfriend had tested positive? help, i'm freaking out.

[H. Hunter Handsfield, M.D.]

I'll try to help.  Your risk for having probably is low, but that depends on information you don't provide:  any boyfriends or other partners who also have sex with men? any injection drug users? are you in the US, and if so, where? anybody from AIDS endemic areas, such as parts of Africa or Asia? Your and your partners' race? Risks of heterosexual HIV transmission in industrialized countries vary widely with all these factors--and you probably don't even know the answers for all these issues, at least not for all your partners and all their partners.

But as to the specific question, the way you ask it, the answer is no.  You could have caught HIV from a former partner, had sex hundreds of times with your more recent partner, and not have passed the infection to that partner.  In other words, his negative test does not prove you aren't infected.

Perhaps you have already begun to understand my main advice to you:  GET TESTED!!!  All else is guesswork.  Almost certainly your result will be negative.  That is the only way you're going to stop worrying.  Do it today.  And while you're at it, clearly you need testing for other common STDs, such as chlamydia, gonorrhea and syphilis at a minimum.

In the meantime, don't freak out.  I will be surprised if your test is positive.  Good luck--

HHH, MD

[ajf]

hi dr. thank you for your prompt response. i am in the US. my former boyfriends were not with men, or drug users. that said, i have been to an obgyn consistently with normal pap smears. ummm, dont know if that helps. what do you think the risks are from having unprotected sex twice with the same person? i'm sorry to bother you!

[H. Hunter Handsfield, M.D.]

The risk of HIV transmission for a woman having a single episode of unprotected vaginal intercourse with an infected man averages 1 in 1000.  So having sex twice with that person theoretically raises the risk to 1 in 500, 3 times makes it in 1 in 333, and so on.  This is why most infected women didn't get it as sexually active singles, but after they develop a longstanding relationship with an HIV infected man.

My main advice still holds:  Please go have a general STD evaluation, including HIV testing.

HHH, MD