Welcome to the forum and thanks for your very articulate question. We don't get many questions about confirmed sexual exposures to partners with known HIV infection. I can help and will go directly to your questions. The bottom line is that you are at little if any risk for HIV from this event.
1,2) Fellatio (oral-penile sex) is safe sex with regard to HIV, and you have correctly dug out accurate statistics about it. The 1 in 10,000 estimate is equivalent to giving oral sex to infected men once daily for 27 years before transmission might be likely, and some experts believe even this is too high a risk. For sure your risk was even lower, for exactly the resons you state: no ejaculation in your mouth and his undetectable viral load. There are good data that low or undetecable viral load markedly reduces transmission risk, independent of antiviral drug treatment. (However, heaving alcohol intake is not known to reduce transmission risk; I doubt it makes any difference.)
The risk is sufficiently low that I don't see a particular need even for HIV testing. On the other hand, most people in your situation probably should be tested anyway, simply for its reassurance value. I imagine that a negative test result in a few weeks will be more reassuring than my assessment based on probability and statistics. If you do it, stay mellow in the meantime. There is no realistic chance you were infected.
3) Your dismay about your partner's behavior is entirely justified. No HIV infected person has a right to put a potential partner at even miniscule risk of transmission without the partner's knowledge and I condemn his failure to tell you before the event. Even with essentially zero risk of transmission -- which your partner might correctly assume -- it isn't fair or appropriate to raise the fear when it is so easily preventable. Not all HIV prevention experts agree on this, and some sexually active HIV infected people obviously do not, expressing the opinion that both partners have an equal responsibility for safe sex. But they are in the minority, and the fact is that you have been unnecessarily frightened -- not to mention your sense of personal betrayal by a friend, which I also consider a normal, rational reaction on your part.
Having said all that, I imagine your partner agrees at least in part, and probably regrets his actions. After all, he did inform you after the fact, which probably was difficult for him. (You don't describe how he presented it and whether it was with regret and apology.) He may be a very well meaning person who was caught by surprise with your generous offer! Obviously, it will be up to you to determine how to put all this into context and what impact it will have on your friendship up 'til now. I would be interested, as other forum users might as well, how it all shakes out.
I hope this has helped. Best wishes-- HHH, MD
Thank you, Dr Handsfield. At first I wondered at the benefit of posting, but you and Dr. Hook have amazing "e-bedside manner!" I also hope this helps anyone else reading.
He was shaken and crying. He said he had never done that before and that the fact he did it to me "shook him to the core." He was afraid of losing my friendship. I have come to understand his fear and trepidation. I informed him that his HIV status would have never driven me away, but that his disregard for my trust and mental wellbeing could. I have decided to not make a decision until I am in a less angry, and less frightened, place. I just have to continually reassure myself that my anxiety is at the betrayal and is in no way proportional or related to my likelihood of being infected.
The day after he told, one week exactly after contact, I had an Ora-Quick done to establish a baseline. As expected, I was unreactive. Would testing at 6 weeks be sufficient? I plan to test at 6 weeks and 3 months.
Thank you again, Doctors, on behalf of myself and all the people who come across this forum.
Thanks for the thanks about our services. I'm glad to have helped.
You may not need both the tests you are planning on. See http://www.medhelp.org/posts/show/1704700
This isn't a personal counseling service, but you might consider a "pay it forward" approach with your friend. If I were in your position, given his shame and regret, I probably would be inclined to forgive him and continue the friendship if he pledges to not put any future partners in the same position -- to include casual contacts, not just personal friends. (The ethical obligation doesn't change with how well you know someone.) If you think he has learned an unpleasant lesson, your future friendship may be all the more important to him.
You, sir, are a gentleman and a scholar!
I have learned a lot in the past two weeks about what it means for my friend to have and live with HIV. I thought about what you said and chose to speak to him last night. With your help, I realized that my biggest concern was that a friend would exploit me. I asked him that even though I felt I should have been informed, if he would have told me had we decided to engage in anything higher risk...he said yes, and it has made all the difference in the world in helping me cope. I am still a little anxious but I have "paid it forward" and we have agreed to work things out if we both go to counseling.
I can't thank you enough
I will also "pay it forward" and post my results on the 6 week mark for the benefit of everyone who visits the forum.
I'm glad you have come to understand "what it means for my friend to have and live with HIV". I meant to suggest that point myself.
Best wishes. I have enjoyed this exchange.
Hello Dr. Handsfield and everyone else
Today, 09/24, I had an OraQuick Advance test done (30 days after exposure) and it was negative
I fell short of 6 weeks (couldn't help myself, the test was being offered for free for today only). How reliable would this be?
A negative antibody test at 4 weeks is at least 90% reliable. Given the very low risk of infection discussed above, you should find it very reassuring.
Thank you very much, Dr. Handsfield
My friend and I are doing much better. While in many ways it was a scary experience at first, I think this has been a perspective changer for me...in terms of HIV and my friend. I have a deeper respect for him, and our friendship may end up coming out even stronger than before.
I hope this experience can help anyone else who reads it in the forum.
I'm glad to hear the happy outcome.