HIV Anxiety from low/no risk exposure

[GuiltyHusband]

Dear Dr. Kokil Mathur

I've been troubled by a recent unprotected oral sex experience with a sex worker and I'm having a great deal of trouble getting over it.

After the experience, I asked a specialist on medhelp.org for a risk assessment and was told that I did not have to worry about HIV or STD contraction and did not need testing.  In reading other posts from experts and moderators, most indicate no risk and that the estimate risk is like getting hit by an astroid.

Below is a link of the post I wrote to medhelp's HIV expert. http://www.medhelp.org/posts/HIV---Prevention/HIV-from-giving-Cunnilingus-with-Bleeding-Gum/show/2200980

Even in knowing these details, I'm still experience severe anxiety and stress.  It's hard to keep the events out of my head, it's causing my severe physical duress nevertheless, even with taking melatonin, I can't more than 5 hours of sleep with panic during the day and fatique

I'm transitioning to a senior level position in a few weeks at a new firm and I'm really worried how this physical and mental deterioration will severely impact my initial probation.  I'm starting to learn meditation as well as mindfulness of sitting with the emotion since yesterday but getting through the day sometimes is still very tough.  

I had 2 unprotected sexual experiences in the past where the HIV risk was a lot higher (unprotected vaginal intercourse) and warranted testing.  After each event I was extremely stressed and counted the days in the 4 weeks before I could a meaningful HIV test.  Going through those 4 weeks twice was like walking down death-row twice.  It impacted everything and in fact I had become so week that each time I experience prolonged respiratory infection.  And I have a feeling those experiences are influencing this severe reaction now.  

I'm really looking for some advice how to deal with this anxiety and prevent it from taking over me like it did in the past.

[GuiltyHusband]

Thank you for the advice and I had tried jogging yesterday afternoon.  Afterwards I realized one thing, and that is the root of my problems lie not with the encounter but the values/dependecny I have unconsciously placed my sexual compulsions that lead me here.  It was a depressing 24 hours, but I forced myself to find out the roots that led me to be here.  I took surveys and tests on sexual addiction online and realized I'm a borderline sex addict.  My immoral/disloyal behavior in the past years stems from self-esteem issues in the youth (never thinking I can get hot girls), to an overblown Ego now that is really Greedy leading to my Gluttony of sex consumption, and a way to escape the sexual loneliness I have experienced in my love life.  I think recognizing this addiction is a good first step, as I have started to use online self recovery resources like SAA and will put together a plan to change myself into the man I want to be.  Like you mentioned,  I just have to go now a grab it.  I've also planned for a date night with the wife that I hope to involve a session protected sex, not to feed a compulsion but to feel and remember her embrace as each rare time we had sex in the past few years, it felt Golden.   Nothing outside the relationship could compare.

I've also mentally created another box, an image I used in the past to get over painful relationships, and placed all the experiences I had in the past into that box and threw it into the abyss of my mind.  I had some trouble doing it at first because there were some lingering experiences, so I mentally revisited each experience and broke down why they felt good, and realized they were just ILLUSIONS, caused by my neglect to my loving wife.  With that I threw those memories into the dark, because as you said, self-nurturing and acceptance is very important to recovery.

I'm glad that I came to this conclusion and while I feel ashamed in knowing I'm an addict, I also know this problems exist among many many men (many that I know personally) who don't know it themselves.  So I'm not alone but I WILL be among the ones who will recover to new heights.  It starts today, and it starts now.  I'm dedicated to it.

Could you let me know your feedback?  Or tips on how I approach this road of recovery (like when not to push myself too hard or vice versa?)

The urgency to get tested subsided after I made these revelations, I'm still leaning towards doing it, but I am now able to see more of the HIV Doctor's reasoning because now I know a lot of that anxiety stems from me finally realizing that I'm living wrong because my values are wrong.

Thanks Dr. Mathur.  Hope to read your comments soon.

Best.

[Dr. Kokil Mathur]

All I can say is that you should try and keep yourself as busy as possible so that you have less time to dwell on the test. Also, you must try and cultivate the physical angle of your relationship with your wife. Talk to each other. There may be reasons for which she is not interested in the physical aspect. Developing an understanding of that may help overcome this barrier.
Take up some activities like sports, gym etc to keep yourself busy. The less free time you have the less you will dwell on these things. Also, physical exhaustion would help you sleep. Ask your doctor to prescribe an anti-anxiety medication--you may sight your upcoming job as the cause of anxiety. Hope this helps.

[GuiltyHusband]

I really appreciate your kind words and for your understanding.  I find your analysis very insightful.  I've been starting to learn about mindfulness medication (using letting the anxiety sit with you as a friend method) and so far today it has helped calm me momentarily when anxiety sprung up out of nowhere.  

My main concern still is how to deal with the time window between now and the test.  Given that I have such a stressful transition coming up I'm really concerned about my health.  My body is hurting from lacking sleep for this entire week.  Even with melatonin I can't manage more than 5 hours of sleep.  I'm the sole breadwinner and I have to make this new job (a rare senior executive position) work.

2nd and this is where it's causing me the most inner conflict is actually whether to take the test or not.  I have placed myself in 2 risky situations in the past (unprotected intercourse) and each time the planning for testing and waiting to test and test arrangement really killed me mentally.  Logically I know that my chances of acquiring HIV is less than one in 20million, so in rare moments of calmness I question myself why the heck am I thinking of this.  And the fact that this 20million number exist is primarily due to a mathematical model because no scientific research ever found credible actual transmission.  But like you said,  it nags at me.  So how should I deal with this?  If I chose to forget this episode as suggested by the doctor how could I approach to achieve this?  If I plan to test but given that my work won't allow me to do this perhaps in 4 weeks how should I pass the time with this having minimal impact and still achieve maximum work output.

As for the wife,  I know the root cause is not that we don't have love or really enjoy each other's company.  It's because she has no interest in sex which I respect.  I love her not for the physical but her inner beauty.  But of course she is physically also a goddess.  I know that's something we will work on long term.  It's my addiction or dependency on commercial sex in the past that I need to overcome, and actively appreciate her.  Each time I tested negative in the past I noticed just shortly after I go back to the same form of neglect instead of moving heaven and earth to see/love/touch her while I went through the 4 torturous test waiting period. So in fact I almost don't want to test because I feel like maintaining a conscious awareness of this minuscule insignificant risk will help me become a better man.

Overall I know every else I'm doing now is 20million times more important.  But I can't just act on it.  

FYI I live in Shanghai and local therapists are horrible.

[Dr. Kokil Mathur]

Hi!

I do appreciate your worries! I have read through your and medical expert’s posts and agree with the expert that the risk of HIV is too low to be really worried about. However, for a married man planning to have a baby (as you mention in the other post), it is natural to be worried about passing HIV infection to wife and unborn kid.

There are two aspects to the problem. One is guilt and the other is anxiety about HIV. The anxiety about HIV is high because of your gum issues and this can be overcome by going for tests for HIV. Even if many experts tell you that the risk is too low to be worried about, it is keep nagging you until you see a negative report for HIV infection. So, it would be worth spending money on.

The guilt aspect needs to be worked upon. Once the anxiety reduces, the guilt will also come down. Also, work with a therapist. You must make yourself understand that it was an oral sex and not a proper intercourse. So, though you broke your wife’s trust to some extent, at least you did not go all the way through. Plus you were under the effect of alcohol. So, you must promise yourself that you will never drink again to the extent that you lose control over your ability to differentiate between right and wrong. Once you take this step, and are confident that you will not repeat this in future, you will feel much better. Meditation, deep breathing exercises, music, painting, gardening, cycling, swimming, jogging etc are a few thing you can take up to keep your mind off the episode. Also, please consult a therapist.

Once you can get the test done at 4 weeks and get a negative report, set up romantic dates with your wife, relive the romance and plan for the future. Being a part of a loving relationship can be very therapeutic. Learn not to dwell in the past, accept it as a mistake (acceptance is very important) and learn important lesson from it. This positive introspection (of not blaming but of learning from mistake) is often the key to success. Keep yourself busy with work and other activities.

A strategy for future: drink in moderation only, so that you remain alert, in senses and have the ability to discern between right and wrong. Second is to practice a completely monogamous relationship. Please do not take this as a lecture, but an advice to be followed for future.

Please consult a therapist and get HIV test done. Try and follow other measures. Hope you feel better soon! Good Luck and take care! Hope you become the proud father a lovely baby soon and scale great heights in your profession! You have so much to look forward to—just go out and grab that!