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HIV Prevention (Expert Forum)
HIV Risk
Answered by
Edward W Hook, MD - HIV Prevention, stds
This forum is limited to prevention of HIV and to safe sex in general. If you believe you might have been exposed to HIV and want help to judge your risk, would like advice about HIV testing, or have questions about the effectiveness of condoms or the risks associated with specific sexual practices, this is the site for you.
IMPORTANT
No questions will be accepted on the treatment of HIV/AIDS or its complications, viral load, and similar topics. If you have questions about a specific STD other than HIV/AIDS, please visit the STD Forum. Questions that do not pertain to the above topics will be removed from the forum.
If you have not done so, please review other threads in our archives for questions similar to yours and Dr. Handsfield's replies. Questions that duplicate other frequent ones, for which abundant replies exist, and that have little educational value for other forum users, will be DELETED WITHOUT RESPONSE. YOUR PAYMENT WILL NOT BE REFUNDED. The most common examples of such questions are those about low risk exposures to HIV, such as oral sex, condom- protected intercourse hand-to-genital exposure, and nonsexual contact with possibly infected blood or body fluids as well as symptoms of early HIV infection.
No questions will be accepted on the treatment of HIV/AIDS or its complications, viral load, and similar topics. If you have questions about a specific STD other than HIV/AIDS, please visit the STD Forum. Questions that do not pertain to the above topics will be removed from the forum.
If you have not done so, please review other threads in our archives for questions similar to yours and Dr. Handsfield's replies. Questions that duplicate other frequent ones, for which abundant replies exist, and that have little educational value for other forum users, will be DELETED WITHOUT RESPONSE. YOUR PAYMENT WILL NOT BE REFUNDED. The most common examples of such questions are those about low risk exposures to HIV, such as oral sex, condom- protected intercourse hand-to-genital exposure, and nonsexual contact with possibly infected blood or body fluids as well as symptoms of early HIV infection.
HIV Risk
by rina84, Jul 14, 2008 12:24AM
Dear Doctor,
On April 25th, 2008 I had a sexual encounter with a guy from Cancun Mexico, that I have known since December. I am from Canada.
We bought condoms, he put one on, and we had vaginal protected intercourse. He also inserted into my anus 2 times and both times I stopped it after like a minute. (I knew that I would get a UTI from this, but was too intoxicated to do anything at the moment; I did get a UTI and got it treated) Anyways when he finally pulled out of my vagina (I am not sure if he had ejaculated since he was pretty drunk; and I never asked him) I noticed that the condom was not on his penis. I immediately asked him where the condom was, he looked down and it was right by my vagina or may have been slightly inserted I don’t recall but he picked it up and moved it. My main reasoning here of what happened is that when he pulled out, the condom had slipped off. I saw some blood on the condom from which I assume was from when we had brief anal sex. The next morning I asked him what happened and he said the condom slipped off and that he checked it and it wasn’t broken. He is also uncircumcised; so I know this increases the risk.
Here are my questions:
1.What are the chances that a 20 year old male, who is from Mexico City and working in Cancun Mexico for the past 10 months, who most likely does not do any kind of drugs that involve needles, have HIV? Is Mexico a country that has a higher occurrence of HIV?
2.If he is HIV + what are my chances of getting it if the condom slipped off and some of his semen/pre-semen leaked inside me; especially since we had brief anal sex and I had some blood earlier. Could it have leaked into the anus or is it unlikely that semen that was exposed to air would still carry the virus?
I got tested for Chlamydia and gonorrhea and both came back negative. I also got a pap smear about 1 ½ months after the incident and it was normal; which I know is linked with HPV.
Thank you doctor
On April 25th, 2008 I had a sexual encounter with a guy from Cancun Mexico, that I have known since December. I am from Canada.
We bought condoms, he put one on, and we had vaginal protected intercourse. He also inserted into my anus 2 times and both times I stopped it after like a minute. (I knew that I would get a UTI from this, but was too intoxicated to do anything at the moment; I did get a UTI and got it treated) Anyways when he finally pulled out of my vagina (I am not sure if he had ejaculated since he was pretty drunk; and I never asked him) I noticed that the condom was not on his penis. I immediately asked him where the condom was, he looked down and it was right by my vagina or may have been slightly inserted I don’t recall but he picked it up and moved it. My main reasoning here of what happened is that when he pulled out, the condom had slipped off. I saw some blood on the condom from which I assume was from when we had brief anal sex. The next morning I asked him what happened and he said the condom slipped off and that he checked it and it wasn’t broken. He is also uncircumcised; so I know this increases the risk.
Here are my questions:
1.What are the chances that a 20 year old male, who is from Mexico City and working in Cancun Mexico for the past 10 months, who most likely does not do any kind of drugs that involve needles, have HIV? Is Mexico a country that has a higher occurrence of HIV?
2.If he is HIV + what are my chances of getting it if the condom slipped off and some of his semen/pre-semen leaked inside me; especially since we had brief anal sex and I had some blood earlier. Could it have leaked into the anus or is it unlikely that semen that was exposed to air would still carry the virus?
I got tested for Chlamydia and gonorrhea and both came back negative. I also got a pap smear about 1 ½ months after the incident and it was normal; which I know is linked with HPV.
Thank you doctor
Doctor's Answer
by Edward W Hook, MD, Jul 14, 2008 07:52AM
, Jul 14, 2008 07:52AM
There are many unknowns to the situation you describe which make estimation of your risk from this exposure difficult. These include did not condom come off of not? If so, when and finally what are the chances of his being HIV infected? I will comment of each of these but, really, the best and most direct way to get this sorted out is to go get tested. At this time the results of an HIV blood test will be completely accurate and will put any concerns you have to rest (When I consider all of the factors, I find it quite unlikely that you would have been infected). On to the variables.
Was he HIV infected? His risk of infection may be slightly higher than if your partner had been a 20 YO US resident because the prevalence of HIV in Mexico, and particularly in a resort town like Cancun, is slightly higher that in the US, but not much. In addition, in the he is relatively young and seems unlikely to use IV drugs or have sex with other men, he is also less likely to be infected. I would guess the chances that he is infected are less than 1%.
Did the condom come off and when? As I read your post, it sounds as though the condom was used for several sex acts. This is not the proper way to use condoms. In the future, please change condoms with each sex act. Having said that, with the scenario you describe, it sounds most likely that the condom came off as he was exiting after your vaginal exposure. If it had come off while he was inside of you, it is unlikely that the condom would be partially or completely outside of you but instead would be completely inside. This would mean that your exposure to his genital secretions would be minimal, further lowering your risk.
Putting all of this together, I suspect your risk is very low. All of this however represents an educated guess. At this time, more than 3 months after the exposure, an HIV test would give you completely reliable results. My advice would be to get tested at your convenience. The results will be accurate and rather than needing to wonder if you are infected or not, you would know for sure. Hope this is useful. EWH
Was he HIV infected? His risk of infection may be slightly higher than if your partner had been a 20 YO US resident because the prevalence of HIV in Mexico, and particularly in a resort town like Cancun, is slightly higher that in the US, but not much. In addition, in the he is relatively young and seems unlikely to use IV drugs or have sex with other men, he is also less likely to be infected. I would guess the chances that he is infected are less than 1%.
Did the condom come off and when? As I read your post, it sounds as though the condom was used for several sex acts. This is not the proper way to use condoms. In the future, please change condoms with each sex act. Having said that, with the scenario you describe, it sounds most likely that the condom came off as he was exiting after your vaginal exposure. If it had come off while he was inside of you, it is unlikely that the condom would be partially or completely outside of you but instead would be completely inside. This would mean that your exposure to his genital secretions would be minimal, further lowering your risk.
Putting all of this together, I suspect your risk is very low. All of this however represents an educated guess. At this time, more than 3 months after the exposure, an HIV test would give you completely reliable results. My advice would be to get tested at your convenience. The results will be accurate and rather than needing to wonder if you are infected or not, you would know for sure. Hope this is useful. EWH
Thank you for your quick reply. Just to be clear Cancun Mexico would not be classified as a global endemic area?
If hiv is not as easily transmitted as people may assume why is it so prevalent in areas certain areas?
So, if my partner is assumed to have less than 1% chance of carrying the virus, I assume that I would be at a very low risk of contracting this virus?
Thank you
Why is HIV so prevalent? This is a complex answer involving health care infrastructure, customs and the impact of public health efforts to stem the epidemic about which entire books have been written. To answer your question is beyond the scope of this Forum however. Sadly in some parts of the world or in some population subgroups, there was a "perfect storm" which allowed the epidemic to take hold and grow. Once it starts to grow, without control, it would tend to grow more and more rapidly, at least up to a point. Such situations have now let the rates grow to up to 25% in some areas even though worldwide the 45 million cases represent less than 1% of the population.
And no, I would not consider Cancun to be a high prevalence area, at least in contrast to places like the countries of sub-saharan Africa. EWH
This is my last post. I want to thank you for your replies.
All the best
I will get tested. I just want to make sure sufficient time has passed i.e. over 3 months ( It occurred April 25, 2008) so that I do not question the result.
At 8 weeks 98-99% of tests that are going to be positve will be, at 12 weeks it becomes over 99%, close to 100% (you can never sceintifically say 100% but for practical purposes, it is). You are 2 days shy of 12 weeks. There will be no difference between your likelyhood of a positve test today and at any time in the future. EWH
Thank you for your help. You have definetly allowed me to relax to a certain extent. After the above question it will be the end of my thread.
Thank you once again.