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Author Topic: Risk assessment/opinion required  (Read 958 times)

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Offline Domino

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Risk assessment/opinion required
« on: August 05, 2020, 06:03:27 pm »
Would like some advice on my risk.

I recently had receptive anal intercourse  with a well-known Brazilian Trans pornstar. At the risk of being prejudice I only state who it was because the occupation/demographic is disproprotionatley effected by HIV - also you can clearly see from porn sites she has had a lot of bareback with a lot of other stars who, in turn, have had a lot of bareback themselves. I imagine my 'sex degrees of seperation' is jow in the tens of millions. That being said I do to try and assume everyone I have sex with could be POZ as you really never know just off demographics.

This encounter was protected, and checking  the condom after it did seem intact. There was no ejaculation at any pont in this encounter if that makes much difference in your risk assesment. I did apso also give oral, I realise this is low/no risk (but there is some documented cases of transmission here so worth noting).

I decided to contact my healthcare provider and seek PEP (which was approved as I lied about the exposure and said the condom broke) I did this for peace of mind more than anything as I'm quite an anxious person when it comes to HIV and thought this would help me not freak out so much over the next few months before I test.

It's funny how I don't think HIV is that bad a disease since objectively things have moved on a lot sinxe the 80s and now it's more of a chronic condition, but when it's YOU and YOU are potentially infected then you feel out of control with the potential exposure then the anxiety takes hold - perhaps it's still the sense of lingering social stigma or simply the realisation a POZ diagnosis would entail a big lifestyle change and mental stress - Idk.

My questions are as follows.

1) is PEP actually effective at 60 hours post exposure? From what I read it's mainly good for 24-36 hours and the rest is 'hit or miss'

2) have I been really reckless getting PEP when in theory there is no risk? Is this medication a risk to me i.e. I imagine it maybe doing a number on my liver/kidneys and am having thoughts that maybe I should discontinue (I've tolerated it well so far and so no obvious side effects)

3) I see a trend on this forum where everyone who has a protected encounter is told universally "no risk" - I'm not disagreeing here, but reading through the "I just tested POZ" posts there is an inverse theme where many people seem to have somehow acquired HIV despite always using condoms? Is there any documented cases of this happening? The sceptic in me thinks that maybe the Aidsmeds mods/admins are (with great intentions) denying any risk with condom encounters simply becuase that is a good healthcare message to project to the masses, but in reality people do actually get HIV from protected encounters/oral.
I'm not intending to put you in the corner here, but am genuinely interested in your opinion on posters that claim to have been infected despite consistent/proper use of condoms.

I'm not an expert on HIV transmission or PEP  so would really welcome your risk assessment, and opinion  on my questions, thanks in advance!

Offline Jim Allen

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Re: Risk assessment/opinion required
« Reply #1 on: August 05, 2020, 06:29:56 pm »
Hiya,

His profession, nationality or the demographic does not change how HIV is or is not transmitted and it makes no diffrence to this risk assessment. None whatsoever.

You had intercourse and gave a BJ, well HIV can't transmit through an intact latex or polyurethane condom. If a condom fails during the act of intercourse it's obvious so there is no reason to be stressing or testing outside of standard routine as long as this obvious issue did not happen.

As for giving a blowjob, it's such a near negligible HIV concern that we don't even recommend specifically testing over it, if this was your only sexual encounter then relax and move on with your life.

1 & 2)

PEP is highly effective when started within 72 hours post exposure, however, starting post exposure as soon as possible is best. As for the meds, yeah they are powerful drugs and with any drug can cause side-effects sometime serious ones.

To be honest instead of lying to the doctor I think you need to go back and be honest with them.

3)

The risk assessment, I think you need to do a bit more reading because if someone has a real-world risk we are the first to tell them to test and we don't sugar coat things for the masses, what masses  ;D

Condoms have been explained above but to elaborate, HIV can't transmit through an intact latex or polyurethane condom. However, incorrect or inconsistent usage is an issue to its effectiveness.

As for other STI's, the level of protection condoms offer also varies on differences in how infections are transmitted. Some infections are transmitted by skin-to-skin contact during viral shedding that may infect areas not covered by a condom.

Regading the stories you read well thankfully stories are just stories, not facts and, there are many reasons why someone would rather not admit to exposure, or simply incorrectly dismiss a real risk without realizing it.

Factoring into stories is that being newly diagnosed is difficult enough time on its own, for some its a time of struggling with a deep fear of HIV stigma, social judgment, Isolation & self-stigma and things like sexuality, facing one's sexual orientation, religion, family, sexual relationships etc might all play a role asides from legal fears for some.

Anyhow, stories and claims mean very little.**

Here's what you need to know to avoid HIV infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions. Consider talking to your healthcare provider about PrEP as an additional layer of HIV protection going forward

Keep in mind that some sexual practices which may be described as ‘safe’ in terms of HIV transmission might still pose a risk for transmission of other STI's, so please do get fully tested regularly and at least yearly for all STI's including but not limited to HIV and test more frequently if unprotected intercourse occurs

Also, note that it is possible to have an STI and show no signs or symptoms and the only way of knowing is by testing.

Kind regards

Jim

Please Note.
As a member of the "Do I have HIV?" Forum you are required to only post in this one thread no matter how long between visits or the subject matter. You can find this thread by going to your profile and selecting show own post and it will take you here. It helps us to help you when you keep all your thoughts or questions in one thread and it helps other readers to follow the discussion. Any additional threads will be deleted.

**

2018
https://doi.org/10.1016/j.eclinm.2018.08.001

STI Risk Perception in the British Population and How It Relates to Sexual Behaviour and STI Healthcare Use: Findings From a Cross-sectional Survey (Natsal-3)

We have identified falsely optimistic views of personal STI risk among a substantial proportion of those at risk of STIs in the British population, which could have a negative impact on efforts to promote safe sex and STI testing, and the control of STIs.

Among those classed as having ‘unsafe sex’ in the past year (comprising approximately 1 in 5 sexually-active 16–44-year-olds), 39.2% of men and 51.0% of women rated themselves as not at all at risk of STIs

2018
http://journals.sagepub.com/doi/abs/10.1177/0032885517753163

Underreporting in HIV-Related High-Risk Behaviors: Comparing the Results of Multiple Data Collection Methods in a Behavioral Survey of Prisoners in Iran

Participants reported more sexual contact in prison for their friends than they did for themselves. In men, NSU provided lower estimates than direct questioning, whereas in women NSU estimates were higher. Different data collection methods provide different estimates and collectively offer a more comprehensive picture of HIV-related risk behaviors in prisons.

2018
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268760/

Socially desirability response bias and other factors that may influence self-reports of substance use and HIV risk behaviors: A qualitative study of drug users in Vietnam

The accuracy of self-report data may be marred by a range of cognitive and motivational biases, including social desirability response bias

2018
http://emj.bmj.com/content/35/1/46
Self-perceived risk of STIs in a population-based study of Scandinavian women

Subjective perception of risk for STI was associated with women’s current risk-taking behaviours, indicating women generally are able to assess their risks for STIs. However, a considerable proportion of women with multiple new partners in the last 6 months and no condom use still considered themselves at no/low risk for STI.

2018
https://www.tandfonline.com/doi/abs/10.1080/09540121.2017.1384787

Social desirability bias and underreporting of HIV risk behaviors are significant challenges to the accurate evaluation of HIV prevention programs for orphans and vulnerable children (OVC) in sub-Saharan Africa

2018
https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(18)30062-6/fulltext

Non-disclosed men who have sex with men in UK HIV transmission networks: phylogenetic analysis of surveillance data

Jim: In short they analysed the genetic code of the virus from HIV-positive people and came to the conclusion that some of the self-reported heterosexual mens HIV was more than likely actually non-disclosed MSM.

2017
https://www.ncbi.nlm.nih.gov/pubmed/28509997

Social Desirability Bias and Prevalence of Sexual HIV Risk Behaviors Among People Who Use Drugs in Baltimore, Maryland: Implications for Identifying Individuals Prone to Underreporting Sexual Risk Behaviors.

2017 --In regards to STI's
https://journals.lww.com/stdjournal/toc/2017/07000
Sexually Transmitted Diseases: July 2017 - Volume 44 - Issue 7 - p 390–392

Is Patient-Reported Exposure a Reliable Indicator for Anogenital Gonorrhea and Chlamydia Screening in Young Black Men Who Have Sex With Men?

Among 485 young black men who have sex with men recruited in Jackson, MS, 90-day anal sexual exposure significantly predicted rectal infection, but 19.4% of rectal infections would have been missed among men denying receptive anal sex. Reports of consistent condom use were associated with lower infection rates only in men reporting insertive anal sex.

2016
https://www.sciencedirect.com/science/article/pii/S0010782416305418
Could misreporting of condom use explain the observed association between injectable hormonal contraceptives and HIV acquisition risk?

Jim - Not a conclusive or in depth study but under the study participants it did find: 9 out of every 20 sex acts reported with condoms are actually unprotected

2013

Rollins School of Public Health, Emory University, and the Kensington Research Institute, Silver Spring, MD 20910, USA https://www.ncbi.nlm.nih.gov/pubmed/14655794

"At risk" women who think that they have no chance of getting HIV: self-assessed perceived risks.

more than one-half of the "no perceived risk of HIV" sample had engaged in at least one risky practice during the preceding year and more than one-quarter had engaged in at least two such behaviors


2009
The Validity of Teens’ and Young Adults’ Self-reported Condom Use
https://jamanetwork.com/journals/jamapediatrics/articlepdf/380711/poa80067_61_64.pdf

A significant degree of discordance between self-reports of consistent condom use and YcPCR positivity was observed. Several rival explanations for the observed discordance exist, including (1) teens and young adults inaccurately reported condom use; (2) teens and young adults used condoms consistently but
used them incorrectly, resulting in user error; and (3) teens and young adults responded with socially desirable answers

BMC Public Health 2007
https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-60

Analyses of data from the Demographic and Health Surveys, Sexual Behaviour Surveys and from other countries show a similar pattern indicating under-reporting
It is probable that as HIV campaigns encouraging delayed sexual debut and abstinence before marriage reach the population, people will report behaviour
assumed to be more socially desirable.

there are some signs of differential reporting bias in our study. We found that controlling for less risky sexual behaviour substantially reduced the association between HIV and survey time among urban men, but less so among women; this may suggest that self-reports from men about sexual behaviour are more reliable. Studies suggest that respondents, especially women, tend to under-report the number of lifetime sexual partners . Therefore, analyses of associations with, and changes in, self-reported sexual behaviour should be interpreted with caution.

2010
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957626/

Self-presentation bias (wishing to be viewed in a positive light) may result in patients underreporting behaviors they perceive to be stigmatizing

Approximately a third of the men in the sample reported that they did not disclose all of their risk behaviors to the HIV counselor during the face-to-face risk assessment. These results echo similar studies of risk disclosure to medical providers
« Last Edit: August 05, 2020, 07:05:52 pm by Jim Allen »
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Offline Jim Allen

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Re: Risk assessment/opinion required
« Reply #2 on: August 05, 2020, 07:16:00 pm »
Oh and if you do talk to your Doctor again be honest with them regarding your risks and anxieties and ask about PrEP (Pre-exposure prophylaxis).

It's a combination drug for people who do not have HIV but who are sexually active to add an additional layer of prevention against acquiring HIV. This may also provide you some peace of mind going forward.
« Last Edit: August 05, 2020, 07:34:50 pm by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline Domino

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Re: Risk assessment/opinion required
« Reply #3 on: August 06, 2020, 10:46:29 am »
Thanks for all the info! I appreciate it.

I do have a question regarding testing - why do they ask to test at 4 weeks (at completion of pep) and then again at 3 months?

Surely at the 4 week mark the result would be highly unreliable as even if pep failed it could have likely delayed seroconversion - doesn't it make more sense to simply test 3 months after finishing pep for a conclusive result?

Offline Jim Allen

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Re: Risk assessment/opinion required
« Reply #4 on: August 06, 2020, 11:08:14 am »
Hiya,

Who are "they"? Anyhow it depends on what test is used, but healthcare providers would want to try and pick up on infection as early as possible and give some peace of mind to people testing.

General guidelines are to test at 6 weeks post finishing pep with a blood-drawn lab antibodies test as it would be closer towards 98% sure and repeat at 3 months for peace of mind if wanted for what would be considered a definite negative result. - 4 weeks post finishing PEP could be around the 90% mark.


« Last Edit: August 06, 2020, 11:19:58 am by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline Domino

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Re: Risk assessment/opinion required
« Reply #5 on: September 08, 2020, 08:03:27 pm »
Update: I tested negative for all STDs at 17 days post Pep (45 post risk). I was shocked to be told by the healthcare prover (at world renown HIV clinic) that the result is convulsive where I am sure I will need to test again at 3 months post Pep. Is there something they know about test windows that I don't?

Offline Jim Allen

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Re: Risk assessment/opinion required
« Reply #6 on: September 08, 2020, 10:02:11 pm »
Hiya,

Look you lied about the exposure to get PEP from a doctor and what you posted did not warrant testing outside of routine, let alone PEP.  Try to relax and move on with your life!

The window has been answered.

Quote
You had intercourse and gave a BJ, well HIV can't transmit through an intact latex or polyurethane condom. If a condom fails during the act of intercourse it's obvious so there is no reason to be stressing or testing outside of standard routine as long as this obvious issue did not happen.

As for giving a blowjob, it's such a near negligible HIV concern that we don't even recommend specifically testing over it, if this was your only sexual encounter then relax and move on with your life.

General guidelines are to test at 6 weeks post finishing pep with a blood-drawn lab antibodies test as it would be closer towards 98% sure and repeat at 3 months for peace of mind if wanted for what would be considered a definite negative result. - 4 weeks post finishing PEP could be around the 90% mark.

« Last Edit: September 08, 2020, 10:04:52 pm by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

 


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