Question:

I am a gay male, 31, in the US, and have had unprotected anal sex with quite a few guys. I am strictly a top, I never receive anal, and I have never swallowed and have no cuts on my penis or in my mouth that I know of. I have heard that the chances of a total top contracting HIV through anal sex (giving) is very, very low but still a possibility. I know I need to be tested and I will, but to bottom line it, if I have had unprotected anal sex with someone who is HIV positive, is it safe to assume that I most likely did not contract HIV from them? I am healthy and have had no sickness or problems, or anything.

I am going to go to my physician and get a test done, but your opinions are very valuable and I would like your thoughts on it as well. I am worried that I haven't been more careful, and that's my own fault, but are my chances extremely low since I have been the top only in my relationships and one nighters? I have also heard that HIV can be absorbed through the skin of the penis even if you have no cuts? Is this true? Also I am an active blood donor, if I were infected, would it show up or is there a more invasive test that I should get? I have always used donating my blood as my HIV test as well, is this a dependable method?

Thank you for your insight, it is most valuable and your web site is fantastic.

Answer provided by:

Mark H. Katz, M.D.
Regional HIV/AIDS Physician Coordinator
Kaiser Permanente of Southern California

Thanks for your kind words about our column and service; we feel privileged to be able to educate people and often respond to their fears and anxieties.

Regarding your 3 questions: First of all, as the attached Table shows, the chance of acquiring HIV from unprotected sex, from being the insertive partner, is estimated to be somewhere on the order of 6.5 per 10,000 (or about one-eighth the risk of being the receptive partner). This is indeed small, although not zero. I agree with your plan to get tested--this is the only way you can know for sure. And please consider doing what you need to do so that your sexual activity is (more) protected, so that you will not have to worry about this on a continuous basis.

The unbroken skin of the body is an excellent barrier to HIV. However, several studies have confirmed that uncircumcised men have a greater risk of acquiring HIV than those who are circumcised--and the inference here is that the tip of the penis (the glans) remains more porous in an uncircumcised male, since it is generally covered by the foreskin. Thus, it might be more able to allow for passage of HIV. This is not a proven fact, however, just a clever conjecture, and one which is generally agreed upon.

As for the issue of your donating blood as the means of being tested for HIV, this is a landmine of ethics: It means that you lie each time you are asked if you have had sex with another man over the past decades. This is, simply put, wrong, and something I would urge you to rethink: In case you were to acquire HIV at some point, the antibody test they use to screen the blood, the only test, may not turn positive for weeks to months. BUT the virus is still present and can be transmitted to others. Thus, you could have the virus, have the test not detect it, and then your virus is passed on to recipients of the blood. I'm not sure how a person with a conscience goes on with his/her life if this were to occur. You must never do this again; it is illegal and certainly unethical. HIV testing can be done free, and anonymously, at any number of centers in your community or state.

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