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Author Topic: Looking for insight and advise  (Read 1376 times)

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Offline wilykiote

  • Member
  • Posts: 4
Looking for insight and advise
« on: February 10, 2009, 05:24:39 PM »
Before I discuss my situation I would like to say that this site and the insights of the moderators is invaluable.  I can only imagine how worn out and sometimes exasperated the moderators must feel dealing with people who are almost always stressed and anxious and occasionally unreasonable.  I also imagine that the exasperation you must feel at times is nothing compared to the exhilaration when a close case comes back negative.  Thank you for your hard work and understanding and most importantly, for living through these situations with us.
 
My situation is that on Feb. 6, I had unprotected insertive anal sex with a transsexual sex worker.  The insertion was for approximately 1 to 2 minutes.  I and my partner were well lubricated with a water based lube.  Additionally, she was very "open" and "loose" (for lack of better words) and there was little or no resistance upon entry or during this episode.  There were no visible cuts, abrasions etc., on my penis before or after this episode.  Additionally, there was no blood on my penis upon withdrawal.  My partner told me that she was HIV-, however, I realize this is meaningless as I was not the first with whom she has barebacked.
 
After the episode, I considered PEP treatment but concluded, perhaps erroneously, that my risk was minimal and that PEP was not warranted.  I based this on information gleaned from the web including the fact that it has been concluded that a top having unprotected insertive anal sex has a 3.0 to 6.5 out 10,000 chance of contracting HIV,  that the CDC indicates that if the HIV status of the bottom is "unknown" PEP is to be only "considered" and perhaps not administered, that I am circumcised, that my exposure was (at least in my eyes) "brief", that studies, as indicated on this site and elsewhere, have not proven that tops can be infected from a "+" bottom.
 
Now, in addition to beating myself up over barebacking in the first place,  I am having second thoughts, after it is too late, about not doing PEP. 
 
My questions:
1.   Should I have taken PEP?  Was it a reasonable decision not to?  (I already made one unreasonable decision by barebacking in the first place I hope I haven't made another.)
2.  Since I had no visible wounds on my penis, I assume that the only point of entry would be the urethra.  Are there any animal or other scientific studies that have shown that HIV can be transmitted through the urethra or is that conclusion an educated guess or hypothesis?
3.  Is 1 to 2 minutes insertion period considered "brief"?
4.  What is the likelihood of infection based on the fact that I was the top, there was ample lubrication, little resistance upon entry and during the episode (thereby reducing the likelihood of tissue tearing and bleeding) and that this episode was (I hope) brief?
 
Also, I would love to hear your comments on a recent abstract of an article I found at aidsonline.com from the January 14, 2009 edition, where the authors conducted a study and reported the following: "Compared with those who reported no UAI, the risk of HIV infection was not raised in negotiated safety [hazard ratio = 1.67, 95% confidence interval (CI) 0.59-4.76] and strategic positioning (hazard ratio = 1.54, 95% CI 0.45-5.26)."  (The link is posted below.)
 
I take this to mean that, at least among the participants of this study, unprotected anal sex while engaged in strategic positioning, (i.e the positive partner as bottom and the negative partner as top) did not pose any greater risk for HIV transmission than refraining from unprotected anal intercourse.  Am I correct?
 
Finally, while I am able to function in my job etc., every waking minute that is not consumed by work is filled with doubt, regret, self-loathing over dumb decision making, and tremendous fear and anxiety.  To make matters worse, business is slow so I have plenty of time to fill. (LOL) 

Thank you for taking the time to read this lengthy post and I look forward to your replies.
 
http://www.aidsonline.com/pt/re/aids/abstract.00002030-200901140-00012.htm;jsessionid=JRgY1Lt1zyxHlhY4TMTYzbskmYbvgc2GqVkHvlYpz3LxJRG7tzpG!-1035908147!181195628!8091!-1
 

Offline RapidRod

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  • Posts: 15,280
Re: Looking for insight and advise
« Reply #1 on: February 10, 2009, 06:26:42 PM »
Anytime you have unprotected anal or vaginal sex you put yourself at risk. You are beyond the time line for PEP. Recommended testing is at 6 weeks and if that test is negative, retesting at 3 months will be conclusive.

Offline wilykiote

  • Member
  • Posts: 4
Re: Looking for insight and advise
« Reply #2 on: February 10, 2009, 06:58:48 PM »
Thanks for your response.  I fully intend to test.  I know that PEP is no longer an option.  Any thoughts on any of the other issues I raised?

Offline RapidRod

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  • Posts: 15,280
Re: Looking for insight and advise
« Reply #3 on: February 10, 2009, 07:01:13 PM »
No. The only thing reliable is a test.
« Last Edit: February 10, 2009, 07:33:06 PM by RapidRod »

Offline wilykiote

  • Member
  • Posts: 4
Re: Looking for insight and advise
« Reply #4 on: February 10, 2009, 07:22:46 PM »
Thanks a lot.

Offline Andy Velez

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  • Member
  • Posts: 24,405
Re: Looking for insight and advise
« Reply #5 on: February 11, 2009, 08:26:32 AM »
It is true that being the insertive partner does make for less risk. This was a single and relatively brief incident. Both of those are important factors in your favor. However, as you understand, lower risk is not the same as no risk.   

Stop trying to live up to your name Wily, by figuring all the angles. You'll just continue to drive yourself nutz that way. During your waiting time you need to stay productively busy. And breathe good and deep slow breaths whenever you tense. Don't say you can't do either of those because that isn't going to fly here. By doing those things consistently, the waiting time will pass much more easily than  you may imagine is possible.

You can if you wish get tested initially at 6 weeks. Assuming you test negative, that result is very unlikely to change at 13 weeks, when you do need to re-test.

And for future reference you must use a condom everytime you have intercourse. No stories and no exceptions.

Now, breathe and get on with your life.

Cheers.
Andy Velez

Offline wilykiote

  • Member
  • Posts: 4
Re: Looking for insight and advise
« Reply #6 on: February 11, 2009, 09:14:04 AM »
Thanks Andy for the reply.  I do try to figure out all the angles, I guess that is just my nature.  While I am very anxious about this situation I am able to function and still laugh and eat and sleep.  Also, I am relatively confident that my tests will be negative but there is still some doubt. 

Wondering if you have a comment on my question 1 and 2 and on the statement from aidsonline.com?

Thanks again for your time.

Offline Andy Velez

  • Global Moderator
  • Member
  • Posts: 24,405
Re: Looking for insight and advise
« Reply #7 on: February 11, 2009, 09:28:29 AM »
I don't see the value in shouldawouldacoulda exchanges. So I am not going to get into a guessing game about PEP or not.

It's very well documented that transmission through the penis is via the urethra and the inside of the foreskin for those guys who are not circumcised.

Do yourself a favor and turn to other things in your life now. Really.
Andy Velez

 


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