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ultimate HIV anxiety

Question: 

dear sir/madame

I have very unhappy life this previews 3 months.

I have a boyfriend who already in relationship with me since January 2015. If you asking about my role, I am the TOP. Since the beginning i usually had sex without condom as I feel safe, only have sex with my partner.
But life has changed, when one day on 27 November 2015 my boyfriend told me that he was diagnosed HIV positive, on October 2015. I was shocked, and I decided to take the test in the same day when he disclose his HIV status. on that day I, i remembered that it was 2 months since the last time I have unprotected sex with him. It was 2 months since the last possibility exposed by the HIV virus. And the result becomes NEGATIVE. But the nurse told me that I have to take the test 3 months from the first test I took. Now today is almost 3 months since the last test I took. I am so crazy this last many months, wondering that my result will change to be POSITIVE. I have many question:

1. How it is possible when my boyfriend is positive, and i am negative this far, since I always had an unprotected sex.

2. Does my test will be changed in my next test? How accurate my first test in 2 months after exposure?

3. Is it 100% I will be HIV positive since I had sex with HIV + people?

4. Is it possible for me to continue my relationship with him? I love him so much.

I am definitely looking forward your your reply. I am so freaking out.

Best Regards.

Answer: 

Hello, and thanks a lot for your question to the AIDS Vancouver Helpline.

It sounds like you're stressed out about the possibility of acquiring HIV from your partner, and what this could mean for your relationship. We're happy to provide some information here that will help you better understand the risks involved, testing, and what options you have from here.

Unprotected anal or vaginal sex (no matter who is doing what) is a high risk activity for both partners, meaning that of the transmissions observed, most are due to activities such as these. This does not, however, mean transmission always occurs in every encounter, so it is possible that despite having unprotected sex with your partner transmission did not occur (even if he is HIV positive). This also does not mean it is not important to prevent transmission from occurring through various ways (which we will explain later in this answer).

Generally, HIV tests are considered conclusive 12 weeks post exposure. This does not mean the test you had at 8 weeks was inaccurate, just that it is not sufficiently accurate to say the results are conclusive. It was still a very good indicator of your status at that time (and your status would not change). According to our resources, you could have gone for a test 1 month after your last test and its results would have been conclusive (not 3 months after your last test). For example, here is a bit of information on the 3rd generation EIA test, which is 95% accurate at even 4-6 weeks:

Test Name
Method
Window Period
Conditions
EIA (Enzyme Immunoassay) antibody 3rd Generation aka ELISA Blood test that looks for antibodies 4 weeks to 3 months (although up to 95% of infections are detectable within 4-6 weeks). Most people develop detectable antibodies in 21-25 days. Most commonly available testing method. Conclusive at 3 months

And here is a bit of information on the 4th generation test, which the WHO considers conclusive at 6 weeks (but here in BC, Canada the 4th generation test is still considered conclusive at 12 weeks): 4th Gen

Test Name
Method
Window Period
Conditions
4th Generation EIA Blood test that looks for antibodies AND p24 protein antigens. Commonly referred to as the "combination," "combo" or "DUO" test. Antigen (ag) test - P24 protein is detectable immediately after infection, & only for the first few weeks. The antibody (ab) test has a window period of 4-12 weeks. Most HIV specialists consider this test to be conclusive at 6 weeks. This is the screening methods used in Victoria and many parts of Ontario. Vancouver still uses the 3rd generation test unless it was a high risk exposure. The testing centre will evaluate people on a case by case basis to assess if this test would be helpful in early detection. Official HIV testing guidelines still recommend re-testing at 12 weeks for conclusive results. Accuracy is 99.9%

It is absolutely possible to continue your relationship while maintaining your negative status. There are a lot of options available. One of our favourite resources at CATIE has some great information on preventing transmission in serodiscordant relationships.

First off, if your partner is currently on an antiretroviral medication regimen, his viral load should be low enough (or undetectable) that the risk of transmission is drastically reduced. It is also an option for you to go on a prevention regimen called PrEP (or pre-exposure prophylaxis) to prevent transmission from occurring. Check out this resource for more information on PrEP, but it is basically a pill you take every day to prevent transmission occurring. This, coupled with the use of protection during sex, drastically reduces the risk of HIV transmission. Also, we'd encourage you to check out our risk assessment page to see the risks involved in other activities. Perhaps you might feel more comfortable engaging in lower risk activities. We encourage you to seek out a medical professional to discuss these options with them.

You love your partner, and we encourage you not to see his status as a barrier to expressing it.

Thanks a lot for your question to the AIDS Vancouver Helpline. We wish you and your partner well.

Trevor

AIDS Vancouver Helpline/Online
helpline.aidsvancouver.org
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