Anonymous
Good evening!

I am an American citizen living in Mexico City.

I am a married man, and I have used transgender prostitutes like 5-7 times. Most of them (4 encounters) were only doing me masturbation, one was anal (I was top and I did used a condom and did not broke as the semen was not leaking from the condom), and two were oral sex unprotected (I was the giving).

I decided to stop doing my previous deeds since two weeks ago (January 17).

I went to an HIV testing clinic to see if I am positive or negative as I started on middle November and it would have been two months as I am aware one should go in two to three months to be tested after a sexual encounter. I admit I was very nervous and came crying to the clinic. The doctor who attended me chuckled when I told him I did it 5-7 times and since most encounters were only masturbation, according to him, the chances are low and he considered oral sex to be low risk not to mention in his experience, almost all his patients had much more sexual encounters and he consider that very risky behaviour. I came out negative for the November time period.

I am going to go again for testing on April 11th as it would mark three full months to see if I come positive or negative.

I stopped doing this as I love my wife a lot, and I feel very terrible and guilty that I did it as we are having problems and quarrels constantly about financial matters and used it to cope with the pain. But I learned this is not the way to cope with problems, and I decided to do it.

I am now seeing a therapist and I told my mother, my sister, and my two best friends about my mistake. My mother and sister became very dissapointed, but are fully supportive. One of my best friends is majoring in psychology and sexual education, and in his point of view, chances I will come out negative are high.

I want to ask what are the chances I will come out positive from what I did? If I come out positive, can Medicaid in the US help me with the medications whilst still here in Mexico City or should I contact the American Embassy for help? And lastly, if I come positive, how can I tell my wife about it? I am very afraid she will leave me, and I love her to death and I feel very very guilty about what I did.

I need help, and with anticipation, I want to thank you for your answer.

Mr. E
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Anonymous
Hi there and thank you for reaching out to us at AIDS Vancouver, we are happy to help

It sounds like you are wondering about what your chances are for HIV transmission after sexual encounters involving masturbation,protected anal sex, and unprotected oral sex. You stated that you are feeling guilty about the encounters and that you have spoken to your doctor and your friend about your encounters and have been getting mixed responses.
Unfortunately we are not counsellors and cannot tell you how to approach your wife, but we can say that HIV is not a punishment and we can help you to understand how HIV works in order to better understand your risk for HIV transmission.

HIV can only be transmitted through specific activities involving specific body fluids, as seen in the transmission equation posted below.

BODY FLUID
+
ACTIVITY
+
DIRECT ACCESS TO BLOODSTREAM
---------- -------- ----------------------------
• blood (including menstrual) • unprotected anal or vaginal intercourse • vagina
• semen • sharing needles • anus
• pre-cum • mother to child (in specific cases) • urethra in the penis
• rectal secretions • open cuts and sores (in theory)
• vaginal fluids • other mucosal membranes
• breast milk • points of needle injection
You stated that some of the encounters were only masturbation, which is an activity that does not allow for direct access of the virus to enter the bloodstream. For this reason, this activity is NOT A RISK for HIV transmission, which means that this activity has NEVER led to HIV transmission.

Protected anal sex with a condom is a LOW RISK activity, which means that there have only ever been a few reports of transmission through this activity, usually under identifiable conditions. The factors that would make this activity a risk would be if the condom had broken, if there was blood involved, or if the person had another STI, etc. Without these factors present, this activity can be considered negligible risk.

Finally, the third activity you mentioned was unprotected oral sex (giving). This activity is also considered LOW RISK. The same factors as above would make this activity a risk, but with no other factors present, this activity can be considered a negligible risk.

As you can see from this risk assessment, all of the activities that you mentioned are low/negligible/low risk for HIV transmission. We would say that HIV testing is not required for these specific low risk activities, but we do always encourage routine HIV testing for all individuals who are sexually active. It is great that you have already visited your doctor and got tested, because as we know, this is the ONLY way to know for sure about your status.
You are correct that going for HIV testing after three months will allow you to get completely conclusive results.

As for your question related to medications coverage, we would advise you to call your medical services provider directly to get the most accurate information about what would be covered by Medicaid.

For future reference, here is a link for finding out the risk associated with different sexual activities: http://helpline.aidsvancouver.org/question/risk-assessment-chart

Thank you once again for contacting the AIDS Vancouver Helpline.. If you have any further questions please do not hesitate to contact us again at the helpline and we will do our best to answer your questions.

Sincerely,

Raveena (AV Volunteer)

AIDS Vancouver Helpline/Online

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