scared

Hi -

I'm a 30 year old male living in NYC.  I recently met a girl who was visiting from Brazil at a bar. The next night we had sex. I did not know here well (we are now facebook friends and to the best of my knowledge she is not a prositute or injenction drug user). We had oral sex but after browsing this forum on oral sex risks I'm not concerned at all about that.

Since I was unaware of her history I used a condom. She also wanted to make sure I used a condom so I'd like to think this is a good sign that she takes similar precautions with other partners.

but.. the condom slipped off completely towards the end. When I pulled out, I noticed that my penis was completely exposed and free of the condom. I was sober, and we switched positions a few times so I have a good sense of when the condom was on and when it was off. I know that the condom was on for most of the intercourse. My guess was that I was exposed for a about 1 minute - probably less. I hope the brevity is in my favor.

I understand that heterosexual transmission is less risk than other acts. But i'm unaware of hiv prevalence in Brazil. I'm also uncircumsized so I now that this increases my risk.

Obviously - you cannot predict whether or not I have HIV. But could you assess the risk? thanks for all you do.

[Edward W Hook, MD]

Welcome back to the Forum.  While the prevalence of HIV among heterosexuals is higher in Brazil than in North America, it is still relatively low and your risk from the exposure you describe is low.  I say this for several reasons, as listed below:

1.  Most heterosexual women in Brazil do not have HIV.
2.  Your partner's desire to use a condom, as you suggest, may indicate that she was concerned about getting something from you - a good sign.
3.  Your condom was on for most of the encounter.  While the effect of duration of exposure has never been studied, common sense tells us that the briefer the exposure the less likely infection is to occur.
4.  Following a single exposure, IF she was infected (unlikely), the average risk of infection is less than 1 in 1000 and probably lower than that, even though you have not been circumcised.

So, what to do?  Waiting is sometimes tough, even when the odds are in your favor.  If you can contact her again, it might be worthwhile for both of you to go together to the Health Department and be tested.  Thus you could reassure each other than neither of you was a risk to the other.  The NYC Health Department is very good.  Alternatively, if you cannot get her to get tested, you might go on an get tested at this time for regular STDs (statistically more likely than HIV) and then, in 6-8 weeks, get tested for HIV in order to ease you mind.  In the interim, try not to worry, the odds are very much in your favor.  EWH