HIV risk in Africa

[lostinafrica]

I have been living in Kampala, Uganda for the last two years with my fiancée.

On Friday 4 August, I visited a local massage parlour to get a massage. The lady used a lot of oil and after 40 minutes, she managed to make me quite hard. She then wiped me with a towel and put her mouth to my penis. She lightly licked me (no friction) for about 30 seconds (I’m certain it was for no more than a minute) and then took me out and gave me a handjob. I came on her breasts. During this time, I fingered her a little but I had no cuts on my fingers. Afterwards, I got really scared that she may have passed HIV to me. She stressed that she was HIV –ve and that she had no wounds in her mouth.

I was racked with worry and did not sleep the whole night. The next morning, I visited a HIV clinic and an excellent doctor told me he was certain that I could not have gotten HIV from this contact. He thoroughly examined my penis and confirmed that there were no cuts and/or abrasions. He said that he was ‘100% sure’.

Later that same day, the worrying continued. I then went to the massage parlour and met the same girl. She readily agreed to come with me to have a HIV test done. She said that she had had one on 20 July, which was negative and she was sure that she could not be positive. She said that she was in a committed relationship and had only been working at the massage parlour for a week. She was so calm and actually very kind.

I took her to the clinic and she spent some time with the doctor. The doctor said to me that he had superficially examined her mouth and there were no abrasions. He also said that he believed that she was negative but agreed to test her. As she had predicted, her test came out negative. But as there could have been a window where the test result was inaccurate (in the last few weeks), I am reluctant to accept this as final proof.

The guilt continued and I told my fiancée about it on 6 August. She has been wonderful and as she has worked with HIV victims, she was clear that I had no chance of contracting it.

The next day (7 Aug), I decided to take a test to put my mind at ease. In the past, I have received two handjobs and I have fingered two girls. As far as I know, my hands have never had any serious cuts. My result came back negative.

I am still feeling anxious. I am going back home tonight for a few weeks to see my family and I am worried that I won’t be able to relax. From what I have told you,  is there any chance that I could be positive. I have planned to take the PCR test on return to Uganda to put my mind at rest but if you don’t believe it is necessary then I will leave it. Am I overreacting? Is there any risk from fingering and/or handjobs?

Many thanks for your help.

[H. Hunter Handsfield, M.D.]

Indeed you are overreacting--badly.  Your only problem is your guilt over the event.  The doctor who you saw is entirely right; even if your massage partner had HIV, your risk of catching HIV was too low to measure. Hand-to-genital HIV transmission simply does not occur, and it probably doesn't happen with the brief sort of oral sex you experienced.  And you provide pretty reliable evidence she isn't infected anyway.

PCR testing would be a waste of money and energy, and also carries a risk of a false positive result, and there certainly is no reason for a frightened, anxious person to take that risk.  Just mellow out and relax.  You don't need any HIV testing at all, except to allay your anxiety; if you decide to be tested, just have standard antibody testing in a few weeks.

Good luck--  HHH, MD

[lostinafrica]

Thanks Doctor. I know that the chance is small but a slim possibility still exists. Would a normal test on return to Uganda (28 August - 24 days after the event)) be fairly conclusive? In your 30 years in Aids work, how many people have you seen who have gotten HIV from oral contact? Is there a chance that the girl could have contracted HIV in the weeks before her test with me? Would that makes her more likely to pass it on?
I desparately wish that I could stop this paranoia.

[H. Hunter Handsfield, M.D.]

No, a "slim possibility" does not exist.  In the quarter century of working in an STD clinic in the AIDS era, I have never had a patient who was believed to acquire HIV by receiving oral sex.  Sure there's a chance your partner was in the window period when you were with her.  There's also a chance you will be hit by a meteorite tomorrow.

If you cannot shake your fears despite all objective data and assessment by both me and an "excellent doctor" (your words) in Uganda (who probably knows more than I do anyway), then you need to seek psychological counseling, not further HIV testing.  I suggest it out of compassion, not criticism.

HHH, MD