Anonymous
I am homosexual. I went to a gay sauna last Friday. My exposure included:

a) Protected anal sex with a guy for less than 30 seconds. He ejaculated in the condom while he was still inside me. I then carefully pulled out while his penis was still hard, and checked if the condom was intact. The condom didn’t break, therefore I think it should be safe.b) Another guy ejaculated on my chest area, and then after a while (a few seconds to a minute), he used his semen AND some lube to finger me quite roughly. I didn’t have any bleeding in my anus.b) above kind of worried me even though I know there has been no proven/documented case where being fingered with semen lead to transmission of HIV (or even other STIs) due to the fact that the amount of semen that could be introduced into the rectum by fingering is miniscule and that HIV virus die very quickly outside the body in the way that the organisms become hardly infectious even if there are any present.

To ensure my research/information was accurate, I went to a sexual clinic the next day on Saturday for a quick PEP assessment. The doctor initially just confirmed my information and told me PEP was not recommended for exposure like mine. I then left with comfort and reassurance. However, 1 hour later I received a call from the doctor and she changed her assessment. She mentioned she was told by a very senior heath advisor that during the past 7 years at the clinic there was one person who reported contraction of HIV through fingering with semen. My doctor told me while it was likely that that patient may not have told the truth (like many to avoid judgments) and the PEP would seem like an ‘‘overkill’’ for me, she STILL would like me to take PEP very much. I have therefore been on PEP since then (20 hours after exposure)

Now I am extremely anxious because the fact that I was given PEP seems to me that my exposure actually indicates a ''real risk'' as opposed to the ‘‘negligible risk’’ to my knowledge. Could you shed some light for me please?

1) Is my initial information accurate about fingering with semen? Am I at any risk of HIV infection from my exposure?

2) Why did the doctor prescribe PEP for me? I thought it’s very costly and shouldn't be used on low/negligible risk.

3) I reviewed some relevant medical journals and learned that PEP can reduce risk of HIV infection by around 80-85% from occupational exposure study and that there is usually around 1-2% seroconversion rate from non-occupational exposure study (even though limitation in methodology cannot lead us to conclude PEP is 98-99% effective). I started PEP relatively early (20 hours which is within 24 hours time frame), If fully adhere to the treatment in the next 24 days, could I say my risk of infection is even lower than negligible?

Thanks so much for your help!

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Anonymous
Hello and thank you for contacting the AIDS Vancouver Helpline.

These are all very good questions and we would be happy to clarify some of the information you have received.

* We use information that is specific to British Columbia when we talk about the risk associated with activities. Having said that, there is a negligible risk associated with fingering since, in British Columbia, there has never been a confirmed report of HIV being acquired from fingering. In other regions, reports may vary. The conditions that are present during fingering do not normally meet the conditions required for HIV transmission to occur.

* Information about HIV transmission in your region may be accessed by contacting the [CDC (Atlanta)](http://wwwn.cdc.gov/dcs/RequestForm.aspx): 1-800-CDC-INFO OR 1-888-232-6348


* P.E.P. is considered a "*low-barrier*" drug in BC and, it may be prescribed following a private conversation between a healthcare professional and individuals. It is usually prescribed if *an individual* believes the risk of acquiring HIV from their exposure outweighs enduring possible side effects of P.E.P. treatment (side effects are known to be harsh).

* Using P.E.P. treatment to prevent HIV transmission is a personal choice, just like other measures of prevention. The healthcare professional prescribed P.E.P. treatment in response to your request for it. However, it does sound like the healthcare professional took all of your concerns about acquiring HIV into consideration, and not just the activity (fingering).

* It's great to hear that you were able to begin your P.E.P. treatment promptly after your exposure. It is true that the risk of acquiring HIV associated with fingering (negligible) may be reduced when P.E.P. treatment is adhered to.


We are glad that you have been reading materials to learn more about HIV transmission, and may suggest that you discuss these materials further with the healthcare professional you are seeing. We trust that your questions have been answered, and thank you again for contacting AIDS Vancouver! Please feel free to contact us again if you have any more questions.

Marta

AIDS Vancouver Helpline/Online

Monday - Friday 10am-4pm (PST)

604 253 0566 Ext. 299

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