What is the risk?

[aznpunk989]

Just for context, I'm a gay young adult.

I have had different kinds of sex with a few different people in the past few weeks. Unfortunately, because they were within the past 1-3 weeks, I can't get a conclusive HIV test on this. I've been driving myself insane with worry; I can't even concentrate at work for more than 10 minutes at a time.

I would like to ask what the risk is for two cases.

With the first person, I had only oral sex. I received and performed it with this man. He was divorced until 11 months ago, and since his divorce, he has hooked up with six people, excluding me. He has never been tested, but should be soon. He is very confident of his HIV- status because he only did oral with four of them and protected anal with the other two. This is all hear-say, so it is possible that he lied. We engaged in only oral sex together.

The second person is the riskier case. I have been told several things about this encounter so I would like to have confirmation or correction on some of these claims. This second man and I had oral and anal sex. I was receptive for the anal sex and he did not use a condom. The man is married, but since his last HIV test 11 months ago, he has had anal sex with one man in Thailand and oral sex with a man in Maryland. The man in Thailand was not Thai, but another married Canadian man. He did ejaculate into me, which is the riskiest part, but we only had anal sex for about a minute. It wasn't a long process and it was over quickly.

My question about the second guy is whether the following (which I've been told) are true. FIRST, I've been told that the fact that it was quick (a minute or maybe a little less) makes the risk very small. SECOND, I've been told that even if he was HIV-positive, there is only a 1 in 50 chance to have contracted HIV from him. THIRD, I've been told that saliva from all the oral sex can act as a defense against HIV (although I don't know how reliable this is).

Also what's this about CNC statistics?

Thanks

[H. Hunter Handsfield, M.D.]

Both events were very low risk.  As for the first, you describe a partner who almost certainly doesn't have HIV, and sexual practices that are very unlikely to transmit it even if he were infected.

For the second, you were really playing with fire.  Since he apparently was tested recently and negative, it is likely he was not HIV infected.  Still, unprotected anal sex between men, especially new partners who you might not know well, is a very high risk activity.

To your specific questions:  1) It stands to reason that the risk of HIV transmission is lower with a brief exposure than a prolonged one, but there are no data. I cannot estimate how much lower the chance might have been.  2) That figure is a little high. The average chance of transmission by anal sex, for male bottoms when top has HIV, has been calculated around 1 in 100 to 1 in 200.  3) HIV is rarely if ever transmitted by saliva.  However, saliva almost certainly does not protect when used as a sexual lubricant.  There is no significant reduction in your risk because oral sex preceded the anal contact.

I don't know what "CNC" means and cannot answer the last question.

At this point, you should be under the care of an HIV knowledgeable provider and follow his or her advice.  Most likely, s/he will recommend another antibody test about 4 weeks after the second event; if that's negative, you can be highly confident you weren't infected. A final test 6-8 weeks after the event will be even more conclusive.

Finally, good for you for inquiring about your partners' HIV status.  That is a critical element of safe sex, as long as you do it before the sexual exposure and not afterward.  But a reassuring reply does not eliminate the obligation to use condoms for anal sex.  Probably you dodged the bullet this time. But continue such practices with any regularity, and there is a good chance that HIV is in your future.  

I hope this helps.  Best wishes--  HHH, MD

[aznpunk989]

Sorry, I meant CDC. I looked it up and it's looking like Center for Disease Control, I think.

[H. Hunter Handsfield, M.D.]

OK, but I still don't know what your question means.  What CDC statistics do you not understand?

[aznpunk989]

I figured out what they mean. I read a few more of your responses using risk analysis. Mine is looking like 1/100 * 1/100 = 1/10000 or .01%. Does the 1/100 statistic apply to only anal in general or is that specific to anal bottoming without a condom?

[H. Hunter Handsfield, M.D.]

All such calcualtions are very rough, but you have the right idea.  They do not originate from CDC, except for the data to esimate transmission risk.  Those numbers are for unprotected sex with known-infected persons -- i.e. the 1 in 200 estimate for receptive anal sex apply when the infected top does not wear a condom.

That will have to do it for this thread.  I won't have any further comments.  Best wishes.

[aznpunk989]

Thanks, doctor. As an update, HE tested negative. I still can't get my test done for a while.

[vitaminC85]

A related discussion, HIV/STD transmitted chances. was started.