Thread by @DMalebranche

1/ A dear friend called me yesterday to talk how he had anal sex without a condom 24 hours earlier. He wanted advice on if he should be worried.

He used phrases like:

"I did something stupid"
"I know I'm being paranoid"
"I know I'm a hypochondriac"

2/ I asked if he had enjoyed the sexual and intimate experience he had - his first in 9 months of self-imposed celibacy.

"Hell yeah!" he responded. "It was nice."

I asked about his HIV status.

He was negative. The sexual partner said he was negative when asked directly.

3/ "But, you never know..." he added.

I understood. People lie.

He was worried. He goes for STI check ups regularly when he is active. The last health care provider he saw didnt even know what pre-exposure prophylaxis (PrEP) was.

4/ I counseled him about potential HIV risk.

Before we discussed options for HIV post-exposure prophylaxis (PEP), I asked him to rethink his perspective and language around sexual health:

Instead of saying "I did something stupid," say "I had some good sex last night."

5/ Instead of saying "I know I'm being paranoid," say "I know the reality of HIV and STIs out there."

Instead of saying "I know I'm being a hypochondriac," say "I'm pro-active about my sexual health."

He paused.

"I really needed to hear that. Sometimes I think I'm crazy."

Last/ "You're not," I told him. "You're someone who enjoys sex and takes his health seriously."

He got PEP and follow-up for a health provider.

Meds work. If only we had pills to cure sexual and HIV stigma.

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