Preparing for a Possible HIV-Positive Result?
June 20, 2012 11:16 PM   Subscribe

Preparing for a Possible HIV-Positive Result?

Hi everyone,

So this question isn't going to be one of my usual rants about how unfair the world of dating is. I have a more pressing concern. I was last tested for HIV and other STD's on January 12th at NYC's public health clinic and was negative. This was both the antibody test and the new test which looks directly for the virus (but doesn't generate false positives as often as PCR etc.) But because of my depression and low self-esteem I developed an alcohol abuse problem. I plan to seek counseling for this as soon as I get home; I've already stopped drinking and plan to stay sober for good. Right now, I'm overseas with no access to HIV testing, but will be getting tested when I return to the US in a couple of weeks.

I am very worried that my test may be positive. I am not a promiscuous guy in general, but I'm gay and so belong to a high-risk group. I've combed through my calendar since January. I made it home alone in one piece each weekend, but there are two nights which are troubling. On February 11th, I went out with a friend to a gay club in Williamsburg, Brooklyn and got way too drunk. I was fine for most of the night. But at around 3.30 AM I remember texting my friend and some other people (mostly incoherently) outside the club and calling him several times. At some point, I gave up and left. I remember nothing after that and woke up in my apartment in Manhattan with my coat, wallet, keys, and phone in my possession. I immediately wondered, "I have all my stuff and feel fine, but how the hell did I get home?" I saw in my online banking account that I paid $6.70 for a cab at 4.45 AM. I didn't feel any pain, discomfort, or soreness anywhere and figured that I probably took the subway from Brooklyn for most of the way back to mid-town Manhattan and then, at some point, hailed a cab for the rest of the way. But how do I know whether I went to someone's place first and had unprotected sex without remembering? I feel deeply guilty and ashamed because my irresponsible behaviour.

That is the only night in January and February that is worrisome. At the end of February, I left the US to come overseas for four months. On April 16th, I hooked up with a friend, his boyfriend, and another friend of his. I had had too much to drink and passed out in the bathroom at a house party. The host tells me that he found me there after people asked him where I'd gone. He says he dressed me and that I started kissing him (I don't remember this part). I then remember him tapping me on the shoulder to come out and say bye to everyone as the sun was rising; I was sitting on the couch near that bathroom. Then I remember coming to my senses again upstairs in the host's bedroom with my friend and his boyfriend; the host was undoing my belt as I snapped out of it. At this point I was completely awake and knew that I wasn't about to enjoy any of it but went along with it anyway. We had some brief unprotected oral sex and when it was my turn to do the host, I specifically asked for a condom, which I used. That part is fine as far as HIV is concerned, but what if the host did something to me while I was on the bathroom floor or at some point before the (protected) foursome began? I didn't feel any pain, soreness, or discomfort in my nether regions then or later. But I guess I'll never know with certainty.

Anyway, as you can imagine, not knowing exactly what happened those nights and being in a high-risk group means I need to get tested in two weeks. I'm afraid of the worst. Has anyone ever been in a similar situation? Has anyone gone to a clinic and tested positive? How did you respond and cope with the diagnosis? I know that HIV is no longer a death sentence, but I've read and heard that the side effects of the medication are almost unbearable and that often many other health complications ensue (i.e. osteoporosis, lipoatrophy, etc.) Sigh. Sorry for another lengthy question ...
posted by cscott to Health & Fitness (18 answers total) 1 user marked this as a favorite
Also, in the 2 to 4 weeks after these nights I never experienced anything like ARS symptoms. But since being overseas in a developing country I've had some joint pains in my arms and legs (which I guess could be related to a couple of back muscle strains at the gym) and some mild urinary symptoms which may indicate prostatitis (my urine test/culture came back negative for any infection). Other than that I've generally felt healthy. Probably not crucial information, but thought I'd throw that in ...
posted by cscott at 11:23 PM on June 20, 2012

I don't know about preparing yourself for an HIV+ result, but from your description, you don't sound like you're at particularly high risk for it. As I understand it, HIV is transmitted blood to blood. If you had zero pain, soreness or discomfort, I'm guessing that if you had sex it was so gentle that blood was at a minimum. Personally, I can't imagine having sex once after some time of abstinence and not feeling it at ALL the next day, and that's just PIV (hetero) sex.

posted by small_ruminant at 11:30 PM on June 20, 2012 [1 favorite]

I stopped obsessing over unknowable, uncontrollable and unlikely stuff like this after I started taking anxiolytics.

But because of my depression and low self-esteem I developed an alcohol abuse problem.
I feel deeply guilty and ashamed because of my irresponsible behaviour.
I'm afraid of the worst.

Honey, I feel bad about myself just reading this question! You are not cutting yourself any slack, here. Is it late at night where you are? Are you sitting up, worrying about this? Truly, I would focus more on getting counseling and maybe medication for what sound like mental health problems that are significantly hindering your ability to enjoy your life than I would about worrying over the very slim possibility that your HIV status has changed in the past six months. Especially when there is absolutely nothing you can do about a change in status between now and your next test that you aren't already doing.
posted by Snarl Furillo at 11:34 PM on June 20, 2012 [23 favorites]

Ugh, you sound miserable, I'm so sorry. I'll echo the sentiment above that you are very overwhelmingly likely to be okay. However, I sometimes try to soothe myself in scary situations by reminding myself that I can rise to the challenge or cope or manage no matter what. Excessive worrying doesn't help anything.

Overwhelming fear that you have a life-threatening disease is a classic, classic symptom of anxiety. Your whole question just vibrates with misery, fear and sadness. Have you considered talking to someone (therapist, doctor) about how you've been feeling? It might help more than you realize. Best of luck.
posted by bonheur at 11:36 PM on June 20, 2012 [4 favorites]

Earlier this year I developed a condition that resembled ALS, and another condition that resembled leukemia. It was pretty frightening, but as my doctor said, you kind of have to figure out the actual likelihood of a worst-case scenario, and maybe compare with some other likely scenarios.

With the ALS thing, I had a pinched nerve in my forearm. With the leukemia thing, it turns out it's caused by the way I sit.

So take a deep breath, try to determine how likely it was that you had sex or whatever on those nights, and how likely it would be that a sexual partner had HIV, and how likely it would be that you would contract it.

You've already had a negative test result. So don't sweat it.

However, you need to do something about your relationship with alcohol. You're blacking out, you're getting put in dangerous situations... If you were to spend emotional energy, spend it trying to change the way you consume alcohol.
posted by KokuRyu at 11:49 PM on June 20, 2012 [2 favorites]

can you talk to some people at the local aids service org, they are usually good people who are trained for this work.
posted by PinkMoose at 11:54 PM on June 20, 2012

You are unlikely to be HIV positive even if you had unprotected sex on both those occasions (which is also unlikely). First, off these other sex partners are likely to be HIV negative themselves, since most people, including most gay men, are HIV negative, and even if you did have sex with one of those two potential partners and one of them is indeed positive that in itself does not guarantee HIV transmission, as most sex acts between sero-discrodant partners do not result in HIV transmission.

It is possible you have HIV -- you definitely have an anxiety problem and an alcohol problem. Focus on figuring out how to treat your known issues before you worry about a remotely possible condition.

Finally, you are misinformed about the status of HIV treatment. The side effects you are worrying about are now rare. Lipoatrophy was associated with antiretrovirals now rarely used in the U.S. and other rich nations. There are long-term health effects of HIV, even with treatment, but the life expectancy of a person diagnosed with HIV early is now many, many decades. You can educate yourself on the state of HIV treatment and other issues surrounding HIV diagnosis here.
posted by reren at 12:07 AM on June 21, 2012 [4 favorites]

Thanks, guys. I really appreciate the advice. Reren, since you seem to know a lot about this (and out of curiosity), is lipodystrophy also a rare side effect of current and/or earlier HIV medications? I agree that I have to solve my anxiety and alcohol problems irrespective of what happens. I suppose I'm just going to have to be strong and brave when I get tested ...
posted by cscott at 12:39 AM on June 21, 2012

I'm certainly no expert on lipodystrophy, so I will only point you in the direction of a good summation of the issue written a few years ago. Lipohypertrophy (fact accumulation) is difficult to study because weight gain can be associated with a return to health and those with HIV may be at higher risk of overweight or obesity for reasons unrelated to their HIV status.

But, again, you are getting way ahead of yourself. Be strong and brave and get that HIV test and then move on to solving the real problems. (Or better yet, start thinking about productive solutions for those real problems right now.) Good luck!
posted by reren at 1:46 AM on June 21, 2012

Hey, cscott, as the other posters have noted, you are massively overestimating your likelihood of a positive HIV test. You DON'T know that you had unprotected sex on either of those occasions; you also DON'T know that any of the people you *might* have had sex with were actually HIV+. Even if you *had* had unprotected receptive anal sex (the riskiest sexual activity) with a known-positive partner who was not on any antiretroviral medication (the riskiest partner), your risk of getting HIV from that act would STILL be only around 0.5%. (That's a CDC link; note the risks quoted in the table are per 10,000 single acts.)

By all means, get tested -- regular testing is the responsible thing to do for any non-monogamous sexually active person. But try to remember that the scenarios you describe are very low risk for HIV transmission. Your feeling that you will be diagnosed positive is a reflection of your anxiety, not of reality. It sounds like yes, you could do with some re-evaluation of your drinking, but be gentle with yourself -- you do not need to punish yourself for things that already happened by worrying yourself to the point of misery, and just because you made some unwise choices, it does *not* mean that something terrible is going to happen to you. Be safe, get tested once you get home, and in the meantime, be kind to yourself.
posted by TheLittlestRobot at 1:50 AM on June 21, 2012 [4 favorites]

You're over-thinking this, for sure. Both incidents you mention are incidents of being black-out drunk, which is a bigger issue, I think, than the possibility of somehow having unprotected sex with HIV-positive individuals while unconscious, getting dressed, and winding up going home.

HIV isn't an easy disease to catch, and if you do happen to be diagnosed HIV-positive, medications have been developed that are much, much less life-altering than the first generation of antivirals. However, the obsessive worry over testing, and especially the bogeyman-like place your mind is going to with regard to the people you're hanging around with ("What did he do to me in the bathroom while I was passed out?") is really the problem here.
posted by xingcat at 4:02 AM on June 21, 2012 [1 favorite]

I'm very invovled in the gay community in my city and I don't think any of my friends would consider themselves at any higher risk for HIV then me (a straight lady).

You seem like a pretty smart lad, who is trying to keep himself out of harms way. As you know, the best way to do that is to lay off the booze and maybe surround yourself with friends who are looking to get away from the "stereotypical queer" lifestyle (as in partying, drugs, promiscuous sex, etc.).

The only thing you can do now is get a test. When I was single I had STD tests done every 6 months, whether I used protection or not -- it's always nerve racking, but like other posters said, the chances of contracting anything seems unlikely. In any event, take the test and then go from there.
posted by Danithegirl at 5:29 AM on June 21, 2012

HIV isn't an easy disease to catch, and if you do happen to be diagnosed HIV-positive, medications have been developed that are much, much less life-altering than the first generation of antivirals.

Seconding this. I met a doctor treating HIV+ patients who are into their 60s and 70s now.
posted by jquinby at 7:08 AM on June 21, 2012

But how do I know whether I went to someone's place first and had unprotected sex without remembering? I feel deeply guilty and ashamed because my irresponsible behaviour.

what if the host did something to me while I was on the bathroom floor or at some point before the (protected) foursome began? I didn't feel any pain, soreness, or discomfort in my nether regions then or later. But I guess I'll never know with certainty.

You can just regret this and move on and let it go, you don't need to punish yourself with highly unlikely could-have-beens leading to worst-case scenarios of HIV-treatment side-effects.

You don't need to punish yourself for your insecurities by sabotaging your ability to enjoy or remember sex, either. Go ahead and get an HIV test to be on the safe side. But try to put your energy into taking care of your emotional welfare in general.
posted by desuetude at 7:10 AM on June 21, 2012 [2 favorites]

Anixety and health related OCD (often HIV is the focus) is often magnified x100000 with stress. You just left the country, that is an enormous stress. It is so many more times infinitely likely that you are having this obsession flare-up because of the stress of being overseas, not because you did something beyond-the-pale risky. I say this as someone who completely understands what you are going through: please do not let this ruin your trip or your life or your sex life. Obsessing about something that might not even have happened, that you have precious little evidence of, instead of enjoying your very real life NOW is just an awful and sad way to live.

Overcoming this kind of obsession is about living with uncertainty. Reassurance is not enough. I guarantee once you get tested, a few weeks later you will think of some other "incident" that you feel you need to wait and test for and you will fill your life with anxiety until then and the next time and the next time. Do not be ashamed of yourself. HIV is a target of this kind of anxiety because you can blame yourself. We live with uncertainty everyday. How do you know your best friend isn't dead? Are they in the room with you? You assume they are alive because you have no evidence of them being dead, and you assume the best so you can get on with your life instead of paralyzing yourself with the thought that maybe they are dead because you have no evidence they're not not dead... As cliche as it is, you only have now. What is happening around you is what is real. Trust yourself that you can deal with consequences as they come, until then don't live your life as if they've already happened.
posted by Katine at 7:46 AM on June 21, 2012 [3 favorites]

I was you a couple years ago. I had a drinking problem that was out of control, and I engaged in a lot of questionable behavior which may or may not have been higher-risk for HIV transmission. Including having penetrative sex with at least one person I *knew* to be HIV+. I think we used protection. I'm pretty sure we did, at his insistence. But I honestly couldn't tell you because I was so drunk.

I got sober and getting tested was one of the hardest steps in the whole process because I HAD to do it alone because of all the shame and anxiety associated with my drinking problem and dangerous behavior.

Take a friend. Prepare for potential news by having a support network. I did this whole thing alone, and that was ridiculously stupid of me. I thought that I was alone. (I was wrong.)

In fact, I guarantee that I could have walked into my first (gay) AA meeting, said, "Look, I need to get tested for HIV and I am really concerned about the outcome of this test," and three people would have volunteered to come with me for support. And they would have been perfect strangers. There are a lot of valid criticisms about AA and it does as much wrong as it does right. But part of the miracle of AA is that no matter where you've been, no matter how out of control you've been, someone else has been there and come back from it, and all they want is to help you do the same.

You've been tested before, so you probably know the routine with an anonymous testing site. When your results are ready, the staff member typically asks a series of questions about your mental state. Anticipate these questions and think about them yourself. How WOULD you react if you found out that you were HIV+? Do you have any thoughts of self harm? Do you have someone to call if you learn that you're HIV+? (For what it's worth, when I was in your position, I would have melted down. I was suicidal and would have tried to hurt myself. I didn't think I had anyone who I could call.) If you feel as though you are not in the right place to have this test done, mentally, then wait until you are.

Others have evaluated the potential risk of the behaviors that you've indicated, and I tend to agree with them about the relative risk of your having contracted HIV+ from these encounters (low). But I am not a medical professional, and you should seek professional evaluation of your health.

I'd be happy to sit with you while you're tested. But I don't think we live close to each other. Instead, I'll just offer that if you need someone to talk to who has been there before, feel free to memail me.
posted by this *is* my happy face at 8:08 AM on June 21, 2012 [1 favorite]

If you've been drinking a whole lot and abruptly stopped you are probably having rebound anxiety. I'm not an expert but I daresay anxiety about consequences (real or imagined) from said drinking is pretty classic and one of the things that keep people drinking. You'll do better when you seek treatment but right now it's probably normal to feel crummy but at least you can know you're doing the right things for yourself.
posted by BibiRose at 8:10 AM on June 21, 2012 [1 favorite]

If you've been drinking a whole lot and abruptly stopped you are probably having rebound anxiety. I'm not an expert but I daresay anxiety about consequences (real or imagined) from said drinking is pretty classic and one of the things that keep people drinking.

Yes. I used to drink more than was reasonable, largely self-medicating for anxiety, though I don't think I really realized it, or at least was in denial about it, at the time. When I quit drinking, my anxiety sky-rocketed and manifested chiefly in health worries. I became a hypochondriac. I was convinced that my drinking had destroyed my liver, my heart. I had tests done. Everything was fine, but I worried a lot. I still do - but therapy and medication have made it much more manageable, and I can even enjoy a drink now and then without feeling like I need to to mitigate my anxiety and depression. Your anxiety is a much more pressing concern than your potential acquisition of HIV.
posted by Lutoslawski at 12:11 PM on June 21, 2012 [1 favorite]

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