HIV Risk

[rina84]

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

[Edward W Hook, MD]

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

[rina84]

Doctor,

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

[Edward W Hook, MD]

Going backwards, yes you are at vry low risk

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

[rina84]

Last question. If we were to consider the riskiest situation ie. the condom fell off without me noticing and we engaged in brief unprotected anal sex what are the chances of transmision.

This is my last post. I want to thank you for your replies.

All the best

[Edward W Hook, MD]

Worst case scenario, assuming no condom and rectal sex without it with a partner with advances HIV - 1 in 100 chance.  Very unlikely however.  On the other hand, as I've already said, why engage in this sort on debate?  In many places over the course o fthe day as we've carried on this discussion, you coul dhave had a rapid HIV test and know for sure.  Repeating myself, why not just get teted and know what's up.  there is really no reason whatsoever no to get tested and many reasons to get tested.  EWH

[rina84]

I am just extremely anxious to get the test. If it comes back positive I don't know what I would do. I guess I am just waiting for a time when i could handle the possibility of a positive result; and right now completing my Masters and writing an exam in a month's time doesnt seem like a good time. I just wanted to calm my nerves in the meantime. But I will be getting the test soon. Thank you for all of your comments.

[Edward W Hook, MD]

It wil come back negative.  My guess is that the anxiety "cost" to you is substantial.  You will be better off getting this out of the way.  Again, the tet will be negative.  EWH

[rina84]

Thank you doctor once again for the confirmation. My anxiety is mainly due to the fact that I was intoxicated and not 100% sure at what point the condom was no longer on the penis. The fact that we engaged in anal sex, and the fact that this was with a person who lives in Cancun Mexico, has increased my anxiety significantly. With reference to my previous education on HIV as well as research through the internet, anal sex especially if it draws blood is seen as a high risk situation; and the fact that it was with a male from Mexico would most likely increase that risk.

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.

[rina84]

Also, are condoms purchased in mexico as affective as US/Canada?

[Edward W Hook, MD]

Condoms in Mexico as just as effective as those boought iin the US

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

[rina84]

So even though there is a possibility that the condom slipped off and I had unprotected sex with a male who is from Cancun Mexico, you are still almost certain that the test will be negative?

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.

[alienshadow]

Look I have read this entire thread Dr Hook has repeated himself a number of times. Just get tested and all of your fears will subside. I collected my negative at 84 days with a rapid uni gold test I knew the results in 10 mins. What a stress reliever for me and it will be for you too.Dont let the fear and ANXIETY run your brain TAKE CONTROL and just get tested.Oh and by the way I have never looked back once I got my results you should move on as well. GOODLUCK

[rina84]

Alienshadow..thank you for the comment. I am going to get tested it's just a matter of a good time. I just wanted to get one final comment from the doctor in regards if he considered all of the possible risk factors ie. possible unprotected sex with a man from cancun mexico, when stating that the result would most likely be negative.

[alienshadow]

Well I think if you reread his replys you will find your answer I would not expect him to reply back . The answer is above REREAD

[Edward W Hook, MD]

My assessment is unchanged.  I will not reply to further posts until I can tell you that I'm glad to hear that your test was positive as I am confident that it will be.  EWH

[neilg2008]

Don't panic...the doctor meant he was confident your test would be NEGATIVE.  It was a typo, possibly resulting from exhaustion due to answering the same question over and over again.

You're going to be fine.  Go get tested because you clearly aren't functioning rationally.  I find it hard to believe that you'll be able to study with this hanging over your head.

[rina84]

Thank you everyone. You are right I am not functioning rationally. Ok you are right that typo really made me panic!!!!

[alienshadow]

See what happens when you ask OVER AND OVER ???? dont panic LOL

[rina84]

haha I will try not to panic..:p

[rina84]

Doctor,

You will be happy to know that I just went to the lab and gave blood for an HIV and Syphillis test. Since today is July 21, and my exposure occurred April 25, it has been about 96 days since the act. I assume that if this exam is negative that it will be conclusive and you do not recommend further testing at the 6 month mark?

Also, do you know around how many days it takes to process the blood work?

Thank you once again for all of your help in calming down my nerves and making me realize that the risk of being HIV positive from this exposure is very slim. I will be patiently awaiting my results.

[rina84]

sorry I meant 86 days not 96.

[Edward W Hook, MD]

You answer will be conclusive, and negative.  At that time you should forget this entire scare and move forward with your life.

Processing in the lab takes only a day.  Shipping and reporting results take another day each,, however some labs do not run the tests every day.  You should certainly be able to get results within five working days.  EWH

[rina84]

Doctor,

I still havn't gotten my results but i think they will be in by Friday. I was reading the post in regards to Indeterminate tests and was wondering if that happens often?

[rina84]

Dr. Hook,

So I just went to get my results and they were Negative!! The incident happened April 26, 2008 and I got the blood test on July 21, 2008 so pretty much 3 months after. The Anti-HIV 1& 2 were both Negative. I keep thinking that the lab mixed up my blood with someone else's but i know that this is still my anxiety talking and that I need to move on; and since 3 months is pretty conclusive I will not need any further follow up?

I want to thank you very much for all the great advice you have provided me with. I think you provide a great service.

Thank you once again.