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I'm being careful but sometimes get confused.
May 21, 2003

Dear Ryan, I have been in a relationship with an HIV+ male for the past two months. I am an HIV- female. I have become obsessed with reading information about safe sex practices but still sometimes get confused as to what is a high risk and what is not. My partner and I always use a condom during intercourse, we mostly engage in vaginal intercourse, but sometimes anal as well. The part that confuses and scares me is oral sex. Sometimes in the shower and also before intercourse, I will give him oral sex but usually only for a few minutes. He has never ejaculated in my mouth but I realize that precum is a risk. Is this something that I should stop all together or is the risk low enough that it might be okay. Giving him oral sex using a condom is just so impersonal and doesn't feel that great for him. Please advise. I just want to be able to relax and enjoy our time together. I've searched for counseling group for mixed HIV status couples in my area but have been unable to find any. Do you have any suggestions? Thank you, STP

Response from Mr. Kull

This is a tough question; the answer to it is ultimately going to have to be up to you and your partner. Safety in relationships is ultimately subjective since sexual activity between you two will never be 100% safe. It will be important for you both to become more educated about HIV transmission and prevention and negotiate a sexual relationship that feels good to the both of you.

Unprotected anal and vaginal sex is the most effective way to transmit HIV (it's great that you are using condoms for this activity as that will greatly reduce your odds for infection). Being the receptive partner increases your risk for infection, and ejaculation in the vagina or rectum may increase that risk further. Some couples decide to not have the positive partner ejaculate inside the condom in case of breakage, tearing, or slippage.

Oral sex is a gray area. Your partner performing oral sex on you poses only a theoretical risk of transmission. Saliva doesn't cause infection. Performing oral sex on your partner without a condom poses a low-risk for infection. There have been cases of transmission through receptive fellatio (putting a penis in your mouth); most of those cases involved contact with semen (ejaculate). You should avoid getting his semen in your mouth, especially if you have any problems with oral health, or there are active STDs on his penis or in your mouth. Putting a condom on his penis for oral sex practically eliminates the risk of transmission (although I do understand, and many people would concur, that it is impersonal, and not so tasty).

Read through the info on Oral Sex at The Body for more info.

Your decision is going to depend on a lot of factors, but ultimately it will have to rely on how comfortable you are with the activity. If you feel anxious every time you are engaging in oral sex, then maybe you need to figure out a better way to approach the situation. I think a support group or individual/couple therapy is a good idea: try contacting your local community AIDS organization for referrals.

RMK



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