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Dr. Bob: Mixed Status Gay Couple and Oral Sex
Jul 3, 2003

Dr. Bob -

Thank you for sharing that your partner is both negative and supportive. I tested positive in August 2002, and my partner (who is negative) and I will be celebrating 9 years together this summer.

We have come to the decision that it is within our risk tolerance for me to perform oral sex on him without a condom. Are we whistling past the graveyard? I love him very much, and do not want to infect him by accident, through ignorance, or through willful disregard for the true risks involved.

In short, is it OK for me to go down on him without feeling guilty or fearful?

Thank you! Also, without prying into your personal life, how long have your partner and you been having sex safely, without his seroconverting?

I appreciate you!!!

Best,

- D.

Response from Dr. Frascino

Hello D,

Nine years together? Congratulations! (In straight years, youd be celebrating your golden wedding anniversary right? . . . . that is if we are ever allowed to get married in the first place.)

OK, on to your question. Are you whistling past the graveyard? No.

You "do not want to infect your partner by accident, through ignorance, or through willful disregard for the true risks involved." Being in the exact same situation as you, I couldnt agree more! You and your partner have decided that it is within your "risk tolerance" for you to go down on him without a condom. What you have just decided is what we now refer to as negotiated safety (or negotiated risk).

Let me start with some basic concepts:

1. One of the great things about being alive is having sex. 2. Sex is as important to seropositives as it is to seronegatives. 3. A healthy expression of sexuality is an integral part of general health.

OK, what about your specific decision? Well, we know that the risk of contracting HIV from any type of oral sex is extremely low. The risk for the insertive partner is even lower than that for the receptive partner. Several recent studies have found no recent seroconverters despite unprotected oral sex with HIV-positive partners. However, this does not mean there is absolutely no risk, as these studies were not large enough to make that type of absolute assertion. What the studies do indicate is that the risk is even lower than what we originally thought. We know folks engage in a calculated risk analysis all day, every day. Do I drive above the speed limit, try to sneak through a yellow light, smoke a cigarette, fly in an airplane, date Mike Tyson . . . ? Magnetic couples need to discuss what feels safe or unsafe based on their individual comfort levels and the medical facts. The facts are we cant say that insertive oral sex is absolutely risk-free for HIV, but all recent evidence is indicating that whatever risk there might be must be extremely, extremely low.

Many magnetic couples (one I know very well) have a very successful and satisfying sexual relationship. The need for touch, pleasure, intimacy, and hot sex does not decline with your CD4 count, nor should it! For magnetic couples (and couples in general, for that matter), communication is key. I know HIV-positives feel better when HIV negatives share the worry of possible infection. Accepting each other as different is also important. I think the bottom line is that sex is not a luxury we can easily do without. There is no reasonable substitute that is anywhere near to being as pleasurable. Celibacy generally, is not a viable option and can lead to a sense of deprivation, frustration, and ultimately, acting out (just look at the Catholic church!). Besides, I tend to think life-long celibacy, because of fear of infection (giving or receiving), is analogous to never crossing a city street for fear of being hit by a car. Common sense and negotiating risk (safety) are as practical and potentially life saving as looking both ways before crossing a busy intersection. Chances of disaster striking increase in either case, if you tightly close your eyes and just forge ahead. I think you and your partner have your eyes wide open, have looked both ways, and have weighed potential risks accurately. I see no reason for guilt or undue fears if you want to "cross the street". If you are both comfortable with your decision (which I think is reasonable, medically speaking), then enjoy sex for what it is wonderful!

Steve and I have you two beat by a year. Weve been together for 10 years. I seroconverted in 1991. If you two have even half as much fun as we do, you are one very lucky couple!

Stay well D. Give your honey a hug from me.

Dr. Bob



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