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Massage incident, anxiety, PEP

Question: 

Dear Helpline,

I realise you are unable to answer all questions you receive and I did find elements back in previous posts that partly answers my concerns but still, and as I am anxiety ridden I am unable to make a risk assessment of my own situation gathered from these previous posts. It would mean a lot to me if I could receive at some point your risk assessment and advice. It's why I resend my question in more detail than sent-in earlier on Monday. I find myself checking your website for a reply and reading over and over posts that somewhat relate to my experience, some reassuring me, some raising my anxiety.

This is what happened.
I had a back massage in Russian high end hotel, that though not intended to be a sexual massage turned into one. As the therapist progressed through the massage (I was naked under a towel - he was clothed) the therapist started to pay particular attention to my buttocks (and to which I must I kind of encouraged him) rubbing vigorously my ass cheeks, crack and applying pressure to my anus. I don't think there was any in insertion of a finger, I only remember some tapping and applying pressure, but being all oiled up I am in hindsight not entirely sure that there was no shallow insertion or that it remained external (this is how I remember it and reviewing it shortly after the incident when my mind wasn't clouded over with anxiety yet). I tried to recreate amount of pressure that I remember, by pressuring my own finger against my anus, to see if that would constitute finger insertion). The problem is that my anus tends to bleed easily from wiping or toweling (almost always leaving a tiny red dot or mark on toilet paper or towel). I reckon that with the pressure used it might be torn, just as it would be when wiping.
At some point and while at it the therapist asked me something in Russian that I couldn't understand. He also locked the door. I now fear that he might have used spit or cum or even ejaculated on me while massaging. I didn't see him ever getting naked, but earlier his crotch brushed against my hand and I could feel he was aroused. My question now is and in a scenario that he did ejaculate on my buttocks or had sperm on his hands from masturbating or coming in his pants at some point and would have rubbed my torn anus with it or shallowly inserted a finger, what that would mean in terms of risk for transmission. At the same time I had 2 open blisters/ wounds on my ankles from wearing the wrong shoes the day before. they were covered with silicone bandaids of which one had come loose already. So there was another wound/broken skin there.

Again, I don't know for a fact that he would have used spit or ejaculate on me. I was face down all the time. But it really freaks me out now thinking that he might have. I had just done an HIV test early July in order to get my visum and now find myself worrying sick about a possible change in status.

This to the point that I flew home earlier to Belgium and went straight into emergency in order to get a PEP prescription. For that I aggravated the incident in order to make sure to qualify for a prescription. I am not proud of that. Please don't judge me for it but I felt I needed to do something with my panic. I took my first pill at 45 hours after the incident. That being said, I now find that the prospect of continuing a PEP treatment for a month to come is already mentally exhausting and not necessarily helpful for my anxiety. Can I please get your professional advise on this mess I brought myself in/your risk assesment?

So I guess my questions are:
Does rubbing spit on a torn anus consists a risk?
Same question for being ejaculated on or having sperm rubbed onto the anus, or a foot wound, or a shallow insertion?

Thank you!

Answer: 

Hi there,

Thank you for your inquiry. From what we gather from the question, you were asking about the risk of HIV transmission in the event that your massage therapist had:

a) Inserted his thumb containing saliva on/in your torn anus

b) Inserted ejaculate/sperm on/in your torn anus, or foot wound

Saliva is not considered to be an avenue for HIV transmission. Saliva contains active enzymes that maintain a volatile environment for HIV to exist. For this reason, there is No Risk (transmission of HIV is not possible in the given scenario) to you if your massage therapist had indeed rubbed spit on or into your torn anus.

Semen is considered to be a method of HIV transmission. If, theoretically, fresh ejaculate had been rubbed onto/into the anus, this would provide a Negligible Risk (there is no evidence or documented cases of transmission). We would consider this to be a Negligible Risk because this encounter does not completely satisfy our HIV Transmission Equation.

In order for there to be an HIV risk, each act requires the combination of HIV positive bodily fluids + a high/low risk activity + direct access to the bloodstream.

Your scenario does not involve a direct access to the bloodstream. The act of rubbing semen onto an open wound or into your anus does not necessarily constitute a high or low HIV risk. When exposed to oxygen or environmental surfaces, HIV is quickly rendered inactive and does not survive long outside of the host (1). HIV outside of the body causes a rapid reduction in HIV concentration within the fluid involved, which significantly reduces the risk of transmission (1). For this reason, although there is the theoretical presence of HIV positive fluids, the lack of direct access to the bloodstream does not warrant a high or low risk, but may be considered a Negligible Risk due to the presence of HIV positive fluid.

In this case, you made a responsible decision in seeking biomedical measures in order to protect yourself from HIV acquisition. PEP can be extremely effective in preventing HIV transmission if taken within the window period, and adhered to correctly. However, it would be wise to seek advice from a physician before you stop taking PEP.

Although we technically deem this theoretical act as a Negligible Risk, it appears as though there was no actual presence of HIV positive fluids (that you know of), making HIV transmission highly unlikely in this case.

It is always wise to know your HIV status, and you may find solace in HIV screening confirmation in this case. Based on our HIV risk assessment, there is no evidence or documented cases of transmission in this case.

For this reason, we recommend you refer to a physician for more personalized answers.

I hope this answers all your questions. Feel free to write to us any time with any additional questions regarding HIV risk.

All the best,

AIDS Vancouver Online/Helpline, Cody