confirmed exposure but how to i weigh my options?

[concerned256]

I broke a condom during vaginal sex. there was no blood and i finished inside. we immediately tested. i the male was hiv- and she was hiv+. the clinic gave me a does of pep that night within 2 hours of it happening and gave me a full month packet the next morning. my questions and concerns are.
1. I am in sub-Saharan Africa and want to know if my risk goes up because i have heard the strain here is more easily transmitted vaginally so is pep recommended? also i am circumcised.
2. pep is free here and it may be given out in cases that do not warrant it so i am asking if u think my case warrants it?
3.  This is absolutely my only exposure and i want to get on with my life without the constant reminder every night when i take pep but i have a wife who can never know about this happening so what is recommended because i know this forum assumes all people are positive in these events but mine is not an assumption. she is absolutely positive.

please calm me down because using condoms with my wife for the next 3 months is out of the question. i might as well just never go home.

[Ann]

Concerned,

I've yet to see the insertive partner end up hiv positive following a condom break - PEP or no PEP - and I do not expect you will be the first. Saying that, you're on PEP now and you may as well stick with it to be certain you won't become infected.

Taking PEP will increase your testing window period by four weeks (the amount of time you need to take PEP.)

The vast majority of people who have actually been infected will seroconvert and test positive by six weeks (or six weeks post-PEP).

A six week negative must be confirmed at the three month point (post-PEP), but is highly unlikely to change.

About your wife - you need to be using condoms with her until you've had a conclusive negative result. You should also test for all the other MUCH more easily transmitted STIs.

You can test for them ten days to two weeks following this incident, although syphilis shares a three month testing period with hiv for a conclusive negative result. (You can test for syphilis three months after the incident, not three months post-PEP.)

The other STIs don't always have obvious symptoms, so the ONLY way to know is to test.

This is absolutely my only exposure and i want to get on with my life without the constant reminder every night when i take pep

Would you rather have a daily reminder that you're poz if you are one of the unlucky few who ends up infected after a one-off incident?

Correctly used condoms rarely break. Please check out the links in my signature line so you can avoid breakage in future.

Ann

[concerned256]

i am taking the pep but i was four hours late on the 7th dose and im afraid i have ruined the whole 28 day cycle. i was on a once a day dose of two pills. i have nobody to ask. i dont have a doctor they just gave me the pills at the clinic

[Ann]

Concerned,

Four hours isn't going to make any difference. Just make sure you take them every day.

I still do not expect you to end up hiv positive over this broken condom incident as the insertive partner.

Ann

[concerned256]

Do u believe the cdc stats for my risk of 1 in 2000 for a singal exposure are acurrate and do u think the risks of liver damage or drug resistance is greater than these that. i have been reading about my chances. please dont be one of these forums that only say risk or zero risk because all medical decisions are made by evaluating the risk versus the reward. would most clinics u have experience with given pep for my event

[Ann]

Concerned,

The numbers frequently bandied about concerning risk levels are meaningless as they were pretty much pulled out of a hat. They were guesses, estimates, and pure conjecture.

All I can tell you is that from my own experience of over twelve years of participation in this risk-assessment and safer-sex advice forum, I have yet to see the insertive partner end up hiv positive following a condom break, PEP or no PEP.

Unprotected intercourse is a risk nonetheless and you WILL need to test at six weeks and three months following your last dose of PEP.

The risk of serious liver damage and/or drug resistance from one month of PEP is not something you need to worry about. Any problems with your liver (if they even happen) will not be permanent. The only way you'd become drug resistant is if you consistently miss taking your meds for several days (not hours, days) - and then only if you're actually infected.

Whether or not you decide to continue with PEP is up to you. I cannot make that decision for you.

Ann