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Ask Dr. K

Around three weeks ago, I had unprotected anal sex with a man that I now know has been HIV positive for several years. I believe he is currently on HIV medications. I was the bottom, we barebacked, and I took his ejaculation into my anus. It stayed there for a long time.

For a long time now I've periodically had blood in or after bowel movements. I think this would indicate that I have internal and/or external hemorrhoids. I've mentally prepared for the likelihood that I'm infected with HIV. I still have to wait a while for the HIV test.

Can you tell me now what you think my situation is? Am I likely infected in your best opinion? When do you think I should go get a test? One month? Also, I have not gotten sick as of yet, but I know not everyone does during seroconversion.

Having anal sex with someone who is HIV positive without a condom is considered high risk for HIV infection. The more often you engage in unprotected sex with any infected person, the more likely you will become HIV positive.

The risk of unprotected receptive anal intercourse with a partner who is HIV positive is between 1 in 50 and 1 in 200, about 1 in 100 on average, so the risk is far from 100%. Duration of intercourse, top or bottom position, infectiousness of HIV+ partner, and presence of STDs in either partner are important factors in determining the risk of viral transmission.

I would suggest you get a test as soon as possible to establish your current status. HIV tests work by detecting certain antibodies that the body produces to fight HIV, indicating the presence of the virus. Most people develop detectable antibodies within 3 months--the average being 20 days. In rare cases, it can take some people 6-12 months to produce such antibodies. In any case, it is important that you choose a place to get tested where they also offer HIV and AIDS counseling, so you understand what behaviors not to engage in and how to proceed with treatment.

Increasingly common are HIV tests that include blood testing for HIV RNA, the actual virus in addition to the HIV antibody. Ask your doctor about that. HIV RNA is found in the blood a couple of weeks before the antibody and is a useful way to rule out very recent infection.

People who test positive for HIV do not necessarily have AIDS. Many people are HIV+ but don't show symptoms of illness for years, if at all. People who do get AIDS can get very ill and die from infectious diseases and cancers that usually don't cause problems for other people. While there is currently no cure for HIV or AIDS, current treatments are as simple as two pills a day and long term side effects can be managed.

Newer tests can detect HIV antibodies in saliva, a scraping from inside the cheek, or urine. A rapid blood HIV test was approved by the FDA in November 2002 and rapid oral fluid test in 2005. Rapid test results are available within a half an hour after a sample is taken. For more information on types of HIV tests, click here.

There are a number of places you can get tested in San Francisco. Click here for a current listing.

For further information, you can also call the Centers for Disease Prevention and Control (CDC) STD hotline at 1-800-232-4636. When you call, you can speak to someone directly and ask any questions related to STD transmission, risk, and prevention. It is completely confidential.

To your health,
Dr. K

Last modified on Wednesday, May 05, 2010.
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