I was bored this evening and was interested to see how many times some of the common, everyday questions/situations have come up on the HIV Prevention Community. So, I started plugging in search terms and logged the results. Here are the findings:

Search Term   # Hits

prostitute  1875
CSW  1315
sex worker  2239
condom  9708
condom break  1508
oral sex  7744
kissing  2152
blo w job  536
hand job  802
masturbation  1082
rubbing  1372
unprotected  7744
protected  7157
vaginal  7086
anal  4180
cunnilingus  392
finger  3609
top  1783
bottom  1067
insertive  1634
receptive  807
cut  4139
wound  1259
abrasion  333
blood  8484
bleeding gums  539
needle  1682
ARS  4327
lymph nodes  2915
rash  3549
fever  4780
white tongue  1127
spots  1635
window period  2371
conclusive  9053
delayed seroconversion   274
ELISA  2738
orasure  303
DUO  672
subtypes  254

Remember, these are just the results from posts in which people could actually spell the words correctly. There are probably hundreds if not thousands of others.

The point of this exercise is to demonstrate that there is ABSOLUTELY NO NEED for 95%+ of the people who come to the HIV Prevention Community to post there. You don't even need to know how to search the forum- all it takes is 1 or 2 days of trolling to know what the answer is going to be.

It's all been said hundreds and thousands of times, and there is no situation that is too bizarre that hasn't been posted.

J.

Imagine that you go to see your doctor over concern about a recent exposure (let's say that an oral sex episode). You are in the examination room and the doctor asks, "How can I help you?". You tell your doctor about your recent exposure, and your concern that you might have HIV. To your surprise, your doctor replies, "Since you have an HIV concern, I cannot examine you or perform any medical tests. Please come with me."

Your doctor then takes you to another room. Inside the room is a small computer desk with a computer and printer, and two chairs. Nothing else. The doctor takes his seat at the computer, and asks you to take the other seat on the other side of the computer desk. Your doctor says, "Ahhhh.....that is MUCH better. Now I can figure out what is going on with you. Please tell me what symptoms you are experiencing."  You tell the doctor, "Well, I think that I might have a couple of enlarged lymph nodes in my armpit, and one in my neck. Also, my tongue looks kinda white recently. And I have these red dots on my chest every so often."

Your doctor then precedes to type into the computer. He appears to be reading the computer screen VERY INTENTLY. Every so often, you hear the mouse click, more typing, the sound of the printer printing, and an occasional "hmmmm...." from the doctor. After about 20 minutes of this, the doctor precedes to make several notes in your medical file, and gathers the printouts and puts them in your file.

Your doctor then turns to face you. His face is very grave. To your utmost shock, the doctor says, "I'm sorry to tell you this, but you have HIV. You see, on AIDMEDS.com, there was this guy who says he got HIV from oral sex. Therefore, it must be possible. And when I Google your symptoms with HIV,  I always get something in the top 10 hits that states that white tongue, swollen lymph nodes, and red dots are all HIV symptoms. Unfortunately, this combination of information is always 100% accurate. However, the good news is that we caught this early, and with medication and a healthy lifestyle, you can live a full life."

Your doctor then writes you a prescription for ATRIPLA and hands it to you. He says, "Please make an appointment to see me in three months", and sends you on your way.  


Questions:

1. If your doctor ACTUALLY DID this, would you ACCEPT your HIV diagnosis??

2. If your answer to the above is "No", THEN WHY ARE YOU DOING THIS TO DIAGNOSE YOURSELF??


J.

Your condom broke. Or, you just forgot to use one in the heat (or drunkenness) of the moment. If this applies to you and you had unprotected sex with a heterosexual partner of unknown status, please read on. If you are reading this, you are probably obsessing over the possibility of having contracted HIV and/or are dreading getting an HIV test. However, it is my aim to teach you that you really have nothing to worry about concerning such an exposure.

First, HIV is a very difficult virus to transmit sexually. Based on a number of studies, the average frequency of transmission is between 1 in 1000-2000 episodes of unprotected vaginal sex, IF the partner is infected, with somewhat higher frequency from male to female. Under certain circumstances, there are other risk factors that may come into play such as viral load, concurrent STDs, etc., that may increase this risk, but for most people the 1 in 1000-2000 statistic applies.

Second, in North America, most heterosexuals do not have HIV.  Unless someone lives in an HIV endemic area such as an inner city, is an immigrant from a country with high HIV prevalence, is bisexual or a partner of a bisexual, or is an injection drug user or commercial sex worker, the prevalence of HIV in people without these risk factors is extremely low- less than 1 in 1000 people. Even in commercial sex workers, the incidence is less than 1 in 100, with most infections in 'street walkers' who use narcotics; the prevalence in high class call girls and escorts is no different than the rest of the population.

A person’s HIV risk is a product of the frequency of transmission for the particular sex act and the odds that the partner was infected. This means that unless your partner had any of the aforementioned risk factors, the chance of getting infected from a single episode of unprotected sex is 1 in a MILLION!

So let’s put 1 in a million (1/1,000,000) in perspective:

Odds of being struck by lightning in a given year: 1/400,000 (1)

Odds of being struck in your lifetime: 1/5000 (1)

Odds of dying in an accident in a given year: 1/ 2,517 (2)

Odds of dying in an accident in your lifetime: 1/ 32 (2)

Odds of dying by assault by firearm in a given year: 1/24,005 (2)

Odds of dying by assault by firearm in your lifetime: 1/309 (2)

Odds of dying from a fire in a building in a given year: 1/113,300 (2)

Odds of dying from a fire in a building in your lifetime: 1/1,456 (2)

Odds of dying from accidental drowning in a given year: 1/82,777 (2)

Odds of dying from accidental drowning in your lifetime: 1/1,064 (2)


As you can see, if you are going to worry about having contracted HIV from a single episode of unprotected sex, don’t forget about accidents, guns, house fires, water, and lightning, as all of these things are much more likely to lead to your demise than HIV!

Medical authorities DO NOT EVEN RECOMMEND TESTING after a single episode of unprotected sex in most situations (3)(4)(5). If you are a heterosexual who has had unprotected sex outside of a mutually monogamous relationship and do not have symptoms, all you need is an annual health screen that includes testing for HIV and common STDs (chlamydia, gonorrhea, and syphilis)- you are far more likely to contract these during unprotected sex than HIV. HIV/STD testing is also advised if you are about to start a long-term sexual relationship with someone, so that you both know your status going into the relationship.

If you are one of the many who will remain concerned about an exposure despite being given the facts that your chance of contracting HIV was close to nil, then by all means test. There is never a downside to getting tested. But you should fully expect a negative result. The odds are overwhelmingly on your side- your negative result is 99.9999% ASSURED before you even walk in the door at the testing clinic!

ALMOST NOBODY gets infected from a single episode of unprotected sex with a partner of unknown status. Almost all sexually acquired HIV cases occur in people with multiple, repeated, unprotected high risk exposures (6)(7). HIV risk is a "numbers game" (8), the more you take a chance, then of course the more likely you are to be infected. If you have had only one or just a few exposures to someone -even if they happened to be HIV positive- the odds would still be in your favor. But as I said, chances are that your partner didn’t even have HIV in the first place, and it is of course impossible to contract it if your partner doesn’t have it.

Do not believe alarmists that will tell you that all unprotected sex is high risk and requires immediate testing. Can someone contract HIV from a single episode of unprotected sex? Absolutely. It has happened before and will happen again. And people have also been hit by lightning or planes crashing into their houses and more will in the future, but that doesn’t mean everyone is at high risk for getting hit every time they hear thunder or a plane flying overhead, or that public health policies should be designed around such rare occurrences.

Think about all the episodes of unprotected sex that occurred in the United States, in just the last week. Now project that out to a full year. We’re talking millions and million of episodes. Do you think the diagnostic testing capacity of the United States could handle such a load if everyone tested after single episodes? Not a chance (9). Would such testing have any measurable effect on the HIV epidemic? Not at all, not when only a handful of people -at most, probably none at all- would be expected to get infected from such low risk exposures (10).

Now if you are reading this and think that I am advocating unprotected sex- you’ve missed the entire point of this article! If someone accidentally puts themselves at higher risk for getting hit by lightning, is telling that person that they were still at relatively low risk an advocation that they repeat their behavior? While people should not worry about an individual lapse in judgment, it is equally important that they learn from their mistakes and not put themselves at risk in the future. Doing so repeatedly will inevitably lead to more HIV anxiety, STDs, unwanted pregnancy, and potentially turn a few moments of pleasure into a significant problem, potentially of life changing importance.

The bottom line: there is no need to punish yourself with worry over a single lapse in judgment or a condom break accident. Your course of action should be:

1. Take steps to commit to using condoms consistently in the future, before any penetration has occurred and with plenty of lube to minimize the chance of breakage- do so and you will have nothing to worry about. Keep them handy so that next time you are in a situation when you may need them you are prepared. You are ultimately responsible for your own health and well being.
  
2. Get regular HIV and STD tests every 1-2 years, fully expecting negative results. If you are still concerned about an individual exposure that is driving you crazy with paranoia and anxiety, then you need to get tested for your own psychological well being. But don’t sweat it. Your result will be negative.

J.


References

(1) National Weather Service- Lightning Safety Medical Information
http://www.lightningsafety.noaa.gov/medical.htm

(2) National Safety Council- Odds of Dying
http://www.nsc.org/research/odds.aspx

(3) Handsfield, HH. Medhelp HIV Expert Forum- Thread 256477 http://www.medhelp.org/posts/HIV-Prevention/Unique-Question-About-my-Risks/show/256477

(4) Branson, BM, Handsfield, HH, Lampe, MA,  Janssen, RS, Taylor, AW,  Lyss, SB, and Clark, JE. Center for Disease Control- Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm

(5) Gallenberg, M, et. Al. Mayo Clinic- Sexually Transmitted Diseases
http://www.mayoclinic.com/health/std-testing/ID00047

(6) Handsfield, HH. Medhelp HIV Expert Forum- Thread 648073 http://www.medhelp.org/posts/STDs/Broken-Condom-Encounter-in-Costa-Rica/show/648073

(7) Handsfield, HH. Safe Sex- Preventing HIV and STD http://knol.google.com/k/h-hunter-handsfield-md/safe-sex/nAi5F17X/WdH0tg?domain=knol.google.com&locale=en#

(8) Hook, EW. Medhelp HIV Expert Forum- Thread 957549 http://www.medhelp.org/posts/HIV-Prevention/Bad-decision-Need-reassurance-Dr-H-/show/957549

(9) Handsfield, HH. Medhelp HIV Expert Forum- Thread 288806 http://www.medhelp.org/posts/HIV-Prevention/Symptoms-and-Risk/show/288806

(10) Handsfield, HH. Medhelp HIV Expert Forum- Thread 467613 http://www.medhelp.org/posts/HIV-Prevention/DO-I-NEED-TO-WORRY/show/467613

The one thing that I learned from my own experience with HIV anxiety as well as from helping others here that I thought I should share is the power of "What if?" thoughts to trump logic and completely derail someone, and how this can be overcome. They almost always fall into the same themes of 'exceptional circumstance'. What if the condom broke or failed and I didn't know? What if I am the 1 in a million that the doctor referred to? What if I am one of the few that don't produce antibodies at three months? What if (insert your own overly imaginative scenario for getting infected here)? These thoughts lead to a sense of danger, which produce anxiety symptoms and a heightened awareness of normal body features and sensations, the person makes the wrong connection between the anxiety symptoms and the body features/sensations and HIV from his/her internet 'research', and the whole thing just feeds on itself and progresses to a downward spiral. It is really the same pattern over and over.

My advice for people in that situation is that if you can't accept the answers you receive after posting your question in either of the HIV forums, then read the expert forum archives. It is clear that many people with HIV anxiety need reinforcement for logic and reasoning to gain the upper hand. The original answer and reasonable clarifications are never enough for these people. However, the best way to get that reinforcement is to just read multiple threads that are similar to your situation, NOT badger the volunteers who are dedicated to this site by repeating the same question over and over. Certainly, almost every possible sexual exposure that one can imagine has already been asked there multiple times.  It's really best to limit yourself to this site; you will inevitably find conflicting information that upsets you if you search elsewhere.

Reading multiple answers helps you learn that your specific situation, however unique and special you think it is, really is just 'yet another' version of the same no risk or very low risk situation that the doctors have seen time and time again. The key lesson that is learned that helps you to move on is that you are NOT the exception.

Finally, you should know that your awareness of HIV that brought you to this site is a blessing that can go a long way in protecting yourself in the future. Just use it wisely.

J.