DR THOMAS STUTTAFORD
Christmas is supposed to be a season for glad tidings and so I am very sorry
to have to hand on bad news. But it is a popular myth that HIV can’t be
transmitted through oral sex. It can.
It is not the fault of the public that this misunderstanding has arisen. When
HIV was first recognised in the early 1980s, the Ministry of Health
initially emphasised evidence suggesting that HIV was passed on only through
rectal homosexual intercourse. The authorities insisted that there was no
evidence, at that time, that HIV could be spread by women, and no evidence
that they caught it or that their genital secretions carried it. They were
wrong.
HIV is present in many different body fluids, including tears, spit and urine,
as well as those from the male and female genital tract, whether semen or
cervical and vaginal secretions. In most other body fluids, HIV is also
present but in too low a concentration, so that infection doesn’t follow
from contact with them. The exception is genito-oral contact.
The three main ways in which HIV is transmitted are by sexual contact,
exposure to infected body tissue or fluid, or from mother to the foetus or
newborn child at the time of, or soon after, delivery.
The usual route of infection in HIV is by having unprotected penetrative sex
with an infected person or by having an infected transfusion of blood either
intentionally in hospital or unintentionally from a contaminated needle. The
sexual transmission follows contact between the infected person’s sexual
secretions or blood, whether male or female, with the rectal, genital or
oral mucus membrane of the other partner.
Oral sex is risky because the mucus membrane of the mouth is one of the
tissues that is vulnerable to the virus. It used to be taught, except in the
columns of The Times, that oral sex was safe sex. This seemed highly
unlikely as both semen and female discharges are highly infectious; and not
only is the oral mucus membrane receptive of the virus but gums frequently
bleed.
The good news is that if you read the literature on the estimated risk of
acquiring HIV, depending on the nature of the sex performed, oral sex is the
least dangerous of the usual sexual acts. Infected blood transfusion is more
dangerous than sex and is in a different league from other risky behaviour.
Vaginal intercourse is twice as risky for a woman as for a man. Passive anal
intercourse is 50 times more risky than passive oral intercourse. And being
the penetrating partner during oral sex is safer than being the passive one;
the risk for a man is further reduced if he is circumcised.
There is a real risk associated with unprotected oral sex, but not as much as
unprotected anal or vaginal sex. Even so, one Swedish study showed that a
minority, but an unacceptably large minority, of long-term couples who
deliberately didn’t have genital or anal penetrative sex, but confined
themselves to oral sex, eventually infected a previously uninfected partner,
although sometimes later rather than sooner.
Using condoms makes oral sex safer, if not entirely safe. The condoms should
always be within their sell-by date (they become permeable with time) and
should be put on before foreplay starts in earnest.
SUZI GODSON
The good news is that in terms of HIV transmission, oral sex is comparatively
safe. However, if your girlfriend happened to have a cut or a cold sore in
her mouth, or you had a slight abrasion on your penis, she could have passed
on any number of infections to you. Though there appears to be little
information on exactly how risky female-to-male oral sex is, that’s only
because it is virtually impossible to find a group of people for whom the
only risk factor has been oral sex with HIV-positive women.
Although the risk is believed to be small, I still think you should make an
appointment at your nearest genito-urinary medicine clinic. HIV testing is
free and confidential, and it is the only way to truly put your mind at
ease.
Because HIV is no longer regarded as an automatic death sentence, people seem
to have become a bit blasé about it, but life on antiretroviral drugs (the
medicine used to delay the onset of Aids) is no picnic. They have all sorts
of appalling side-effects: headache, nausea, diarrhoea, fatigue, hair loss,
insomnia, low white blood cells, anaemia, facial wasting, anxiety,
depression, rash, abdominal pain to name but a few, and one person in ten is
thought to be resistant to them anyway.
Every year 200 people in the UK die because they found out they were HIV
positive too late for any of the available treatments to be effective, so
the sooner you sort this out the better. Your girlfriend has been truthful
about her status and you shouldn’t underestimate how difficult that has been
for her.
Though HIV has been a fact of life for 20 years or more, and most of us would
agree that those who suffer from the disease deserve to be treated with as
much respect as any other person suffering from a serious illness, in
reality, people who are honest about being HIV positive get little thanks
for it and their experience of relationships is continually compromised by
their condition. When they meet someone at a party and swap numbers they
know that as soon as things progress to the next level they will have to
reveal the fact that they are positive, and nine times out of ten, that’s
the end of it. Party over. Number deleted.
Despite continual sexual rejection, most people living with HIV are intensely
aware of the burden they bear and wouldn’t dream of transmitting the disease
intentionally. In fact, many HIV-positive people are so scared of inflicting
HIV on anyone else that they would rather deprive themselves of emotional
and physical intimacy than put someone else in their position.
And that is what worries me about you. If your sexual relationship with this
girl consists of her giving you blow jobs, I want to know what is in it for
her? Where do her needs get met? How do her sexual desires get fulfilled?
And why in the name of God haven’t you been using condoms and Femidoms, you
big dope? You may view your relationship as just a bit of fun, but HIV is no
joke and if your girlfriend’s positive status hasn’t persuaded you to
protect yourself to date, then I don’t know what will.
In the long term, few men are prepared to confine themselves to blow jobs, so
if you are not positive already, then you need to think very carefully about
how this relationship can progress in a way that is safe and satisfying for
both you and your girlfriend.
E-mail your sexual dilemmas to body&soul@thetimes.co.uk or write to
Body&Soul, The Times, 1 Pennington Street, London E98 1TT
