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.
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
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.