Question: Hello. I have consulted with one of the non-specialists with this group and with the HIV information group "POS". Both have characterized my risk of having contracted HIV as "extremely unlikely" (and in similar words). Although I intend to test, when the time is appropriate, I thought it would make sense to hear from a specialist -- hence this inquiry. About 10 days ago, I was visiting Haitian friends in their country. Late in the evening, they introduced an attractive woman to me for the purpose of spending the night in my room. We went to bed and engaged in sexual intercourse. I put on a condom before inserting my penis into her vagina. I was on top, and she was on bottom, and we had intercourse for approximately 10-15 minutes. When we flipped, I could tell the condom had slipped (and assume it took place when we flipped). I assume it came all the way off while in her (it was dark), although it is possible it could have been hanging by the tip and slipped off when I removed my penis altogether. In any event, she was able to retrieve the condom very quickly (no fishing around). It had become very dry, as was her vagina. The following evening, I saw the same woman on the street outside the hotel (leading me to think my friends' friend actually was a street walker). My research on Haiti indicates that the country has made major strides in controlling its HIV epidemic, but that approximately 2% of the population is infected. It appears that the numbers are down for younger persons who have had the advantage of a strong education program (this woman was in her mid-20s). As noted, the characterization of risk given to me was "extremely unlikely", coupled with the observation that PEP would be "over-therapy." POS says that it assesses risk with the assumption that the partner is positive when the HIV status is unknown. Despite the higher incidence of HIV in Haiti, both the doctor and POS maintain that infection with HIV under these circumstances is "rare." Based upon these factors (nature of exposure, condom slippage, dry vagina, woman's status, higher incidence in the country) could you please let me know if you agree with their assessments? Thanks.

Hello Dr. Verna. Thank you for your response and insights. There are a few factors that I want to make sure I explained with sufficient coherence and clarity. First, I assume (am not dead certain) the condom slipped off late in the game. The penile shaft for sure was uncovered when I reached down to check. Because it was dark, I could not determine if it was hanging out of her vagina or inside it. My supposition of it slipping late in the game is based upon the fact we had just flipped position (which presumably would have created some enhanced tug and angularity on the condom). I assume the dryness of the condom indicated that she was not secreting much vaginal fluid, which (if I understand correctly) would lessen risk. Her ability to rather readily access the condom, instead of extensively fishing for it, leaves me with the impression that it was not deep inside (and thus slippage likely occurred late in the process or flipped positions). As you know, Haiti has a 2% HIV infection rate. I assume the rate is higher with a "friend of friends" who as it turned out appeared to work the streets. Moreover, I read that chances of getting an HIV infection in connection with vaginal sex in Haiti is around 1 in 125 -- considerably greater than the 1 in 1,500 in the U.S. My general question is whether this elaboration of details alters your analysis. My specific questions are (1) do you think my inference (based upon position change, vaginal and condom dryness, and relative ease of accessing rhe condom from her vagina), makes it reasonable to conclude that the slippage was late in the game? Does vaginal dryness indicate a lesser risk of exposure? I understand that the woman's status can cut in either direction, so no question there. Is it possible that symptoms can manifest themselves a week later (I am producing high levels of phlegm, have a mostly dry cough but am coughing up the phlegm, have a mildly irritated throat, and have what feels like a periodic daytime swelling of the lymph gland in my neck. I realize the mind can play tricks in circumstances like mine, and can follow your advice to simply move on toward normality. Before doing so, however, I wanted to make sure I have not introduced any specific variables that would alter your "nil to slim" analysis (or equivalent of the other medical source). Thank you very much.

Thanks again. Bottom line question is whether any of these factors alter your analysis ( or that of the non-specialists) that risk is "nil to slim"? This will end my inquiries. Don

Thank you for your time and insight. Very encouraging that the mild ambiguity regarding condom slippage did not alter your analysis. I learned today that condom slippage typically is partial, total slippage is somewhat impeded by the penile head until the end of intercourse, and even subtle sensitivity differentials lead to early detection of slippage. Also that current risk predictions are based upon assumptions that the partner is HIV positive and do not take into consideration factors like heightened awareness of risks in key age demographics in developing countries. Good to know also that many are more scared of catching something from the foreigner than vice versa. Barring any symptoms, I will take a pass on testing in deference to my needle phobia. You have a great bedside manner, and I appreciate the learning experience. No need to respond to any of these observations. I will move on to giving you a great review. Thanks. Don