Expert: Terry B - 12/28/2008

Question
Hi and I'd like to thank you in advance.

A few weeks ago, I put myself in a high-risk situation and now I'm losing sleep over it.  I was with a transgendered sex worker who inserted my penis, without a condom, into her anus.  I didn't ejaculate inside her, but I'm worried about a possible exposure to HIV (amongst other STA's)
because she's a sex worker and I was unprotected.  The only thing I can do until I can take my test is do some research.  I've gathered that the transmission rate for HIV without ejaculation is pretty low.  But the fact that she's a stranger, who has sex for money, augments this risk.  Also, I've seen some info that says the infection rate among TS sex workers is
rather high.

I guess my question is; how worried should I be?  My comment about losing sleep is literal.  I'm writing this at 6 am, and not because I'm an early riser.  I plan to take a test in a few weeks, the earliest I can take a reliable test.  And I'm going to call the young lady to see if she can assuage my fears a bit.  I put myself in a horrible situation and steeling myself for the worst.  Is my panic deserved?

This was long, but I hope it can help a few people out there.  Thanks again.

Sid

Answer
Dear Sid:

Peace and all good things to you.  Your research thus far seems well reasoned, with the exception of the reference to ejaculation - her risk from you, not your risk, would have increased if you ejaculated.  That being said, while your behavior certainly put you at risk, it is the presence and amount of blood, semen, and vaginal secretions that represents the risk of HIV transmission; I don't know to what fluids you were exposed, but based on what I read, it seems significant but not highest risk - if you had been receptive in the incident you would be exposed to more fluids for a longer period of time.  Don't get me wrong, I am not saying you don't have significant risk, but it is less than you might be reading and worrying.  While one incident can transmit HIV, the frequency of your exposure (one) is very low.

Regarding sleep, there is nothing you can do to change the past, and short of risking a false positive with an expensive test, nothing you can do to rush your test.  Know that your relative risk is lower than you thought, you are asking these questions at a time in history where testing and treatment are far beyond what they were, and whatever your results, you're forewarned that abstaining, mutual monogamy, and carrying a condom and using it will better protect you and others.

I hope this helps a bit.

Best to you and yours,

Terry