Unprotected sex two times with heterosexual male

[dolly718]

Dear Dr. HHH,
I had a traumatic experience several weeks ago and I'm concerned about HIV.  I was dating a man for a couple weeks; we have known each other for years and had been having sex on a semi-regular basis [protected].  I was out with him one night and got incredibly drunk, I could barely walk.  We went home and, I don't want to say it was totally non-consentual, but I felt very taken advantage of.  He had sex with me twice even though I told him to stop and to use a condom, which he didn't.  He didn't ejaculate or finish at all either time.  

I know in the past year he's had 5 partners, including me, he's white, 34 years old [I'm a female], non-IV drug user, and heterosexual.  I broke up with him immediately after this happened and went my doctor for advice.  She said it would be good to test for common STD's but never brought up HIV so I didn't think about it.  But now I can't get it out of my head.  I've been dating someone new and we've had sex several times, a few times unprotected [he's a sperm doner so gets tested regularly], and I really care about him.  I'm paranoid now that I'm infected and I'm going to give something to him.  My results for common STDs came up negative which I'm happy about but I don't know if I should be tested for HIV.

My question: from a strictly medical stand-point, do I NEED to test for HIV based on what happened with my previous partner?  I've been through a lot lately and I'm scared!

[nomore11]

I think one of the major problem about campaigning in areas such as Washington, DC, and parts of New York is that some many parts are forgotten. and the aim seem to only focus in those areas. places like LA, or parts of california may be just as worse but there seem little or no campaign to keep people aware. When im in those high risk city im 100% aware and conscious. I just think its unfair more should be done in all areas.

[dolly718]

Thanks for the reply. It most definitely does not seem easy, but it is very interesting and definitely makes a lot of sense. Definitely a fine line, but I guess education is key, as well as being realistic about the information one receives. That was very enlightening, thank you.

[H. Hunter Handsfield, M.D.]

Those are good questions.  There is no campaign intended to frighten people into safe sex, at least not by CDC or responsible authorities like state or local public health departments.  Some politically or regiously motivated agencies my have that goal, however -- and such groups sometimes influence school-based education.

The issue isn't trying to scare people, but finding ways to reach those who truly are at risk.  Although people at risk for heterosexually transmitted HIV are few in number overall, they do exist.  For example, the rate of heterosexually transmitted HIV is just as high (or higher) in African American populations in Washington, DC, parts of New York, and other urban pockets as in some sub-tropical African countries.  If you had to craft educational messages to reach such persons, how would you do it without frightening those who really don't need to hear the same message?  Also consider that official agencies like CDC cannot seem to discriminate -- and it's a difficult balance to stress higher risks in African Americans without seeming to play the "race card".   And there are nother, non-race-base risk groups as well -- small in number, but still deserving prevention messages.  Think about it:  not so easy, is it?

[dolly718]

Hi Dr. HHH,
Thanks so much for your quick reply. I was hardly able to sleep last night because I was so worried about this so I woke up early and stopped by my local free clinic for a rapid test. The result was, as predicted, negative. Thanks for your reassurance, but you're right, sometimes a test is truly the best way to deal with the anxiety.

I have a question though, if you don't mind, and I understand if you're busy and don't have time. Why is it, if heterosexually transmitted HIV in US/industrialized countries is so rare, that there is such a huge campaign to frighten people into believing it's everywhere? I understand campaigns aimed at the gay community as they are at higher risk for HIV but, if it's not so risky for heterosexuals here, why make people so afraid rather than aware and educated? Just wanted to get your opinion if you feel that's appropriate to share.

[H. Hunter Handsfield, M.D.]

Welcome back to the HIV forum.  Bottom line:  There is no appreciable risk of HIV from the exposures you describe.

It is the rare heterosexual male in the US (or other industrialzed countries) who has HIV.  Further, if his story of being a sperm donor is accurate, for sure he has tested negative.  And even if he did, the odds of transmission from any single episode of unprotected vaginal sex, is in the range of 1 in 1,000.  Considering both the low chance he had HIV plus the relatively low transmission risk, there is no realistic chance you have been infected.

So the direct answer to your direct question is that from a strictly medical standpoint, you do not need HIV testing.  On the other hand, anyone who is "scared" they may have been infected should be tested.  Most likely a negative test result will be more effective in reassuring than anything I can say.

Since seveal weeks have passed, you can have an accurate test at any time.  If you decide to get tested, feel free to return with a comment to tell me the result.  But in the meantime, I really wouldn't worry about this at all -- especially since your tests for other STDs were negative.

Regards--  HHH, MD