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Re: What do you think?
Oct 17, 2002

Dr. Wohl, with respect to the question asked earlier about HIV via oral sex, while I understand and agree that it is possible,perhaps not likely but possible to transmit HIV via performing oral sex on a male;does performing oral sex on a female perhaps fall into a diffrent catagory of risk? In addition to the Barcelona study that followed serodiscordent couples for 10 years, there appears to be very few if any HIV+ lesbians who are without other major risk factors such as IV drug use, sex with males(particually bisexual males),or a combination of the two. In the HIV+ homosexual community it is easy to find many men who who have been infected who have only one risk factor(MSM) to account for thier HIV infection. Why do we not see this in the female lesbian community? I think the reason may well be that HIV is just not very efficantly transmitted via female to female oral sex. Do you agree? I am having difficulty finding research on the topic and any assistance would be very helpful. By the way the lemons that I mentioned being used to protect agains possible infection, that research was carried out by Dr.Roger Short of the University of Melbourne in Australia. If you are intrested the information appears in BBC News article at http://news.bbc.co.uk/hi/asia-pacific/2318519.stm Maybe you could vist the site and give us your opinon. Please assist in any way you can I would deeply appreciate your opinons on these two topics.

Response from Dr. Wohl

Okay, first lesbians then lemons.

As you say, to my knowledge there is little evidence of HIV transmission from woman to woman. HIV prevalence among women who have sex with women is not very high making observations about HIV transmission risk difficult. Certainly, given the biology of the virus, such transmission should be possible and women who have sex with women are advised to use precautions such as washing sex toys and using dental dams. Whether or not these suggestions are overkill or not is unknown. I suspect the former but I have a healthy respect for a virus that has killed millions of people and that in laboratories is handled in special biolevel rooms with precautions taken straight out of the 'Hot Zone'.

Lemons. Nonoxynol-9 is a spermicide used for years in lubricated condoms and spermicidal gels. In the test tube, n-9 kills HIV on contact. Problem is when inserted into the vagina it leads to inflammation which means more T-cells (targets of HIV infection) congregating along the vaginal tract and irritation that can compromise the normal barrier in place along the surface of the vagina and cervix. In a study of African commercial sex workers use of n-9 INCREASED HIV infection by about 50% compared to those receiving placebo gel and the more women used n-9 the higher their risk for HIV.

Before we leap to the use of lemons or lemon juice as a vaginal microbicide it is essential that we determine this approach is safe and won't actually make matters worse. Thanks - DW



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