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stats, pls explain more
May 30, 2006

Hey doc I'm a former worried well who recovered when you ignored my last question (which is a QTND)

for my question I'm puzzled by the 10 is to 10,000 per episode risk of contracting HIV for unprotected vaginal sex with a confirmed positive. Isn't that low? I mean does it mean that vast majority of unprotected vaginal sex with a poz result in non infection at all?

Or it's quite low but the risk is VERY REAL so CARE to reduce it further down by properly using condoms.

Thanks doc, my students are also bugging me on what is safe and what's not and all I can say is that "JUST USE CONDOMS PROPERLY AND EVERYTHING WILL BE ALRIGHT"

Response from Dr. Frascino

Hello QTND person,

Regarding the estimated HIV-transmission risk statistics, do they mean (1) the vast majority of unprotected vaginal sex exposures with a poz partner do not result in HIV transmission or (2) the risk is low, but VERY REAL, so use condoms?

The answer is actually (3): all of the above!!! The risk is lower than what most folks believe (or fear); however, the risk remains very, very real. Remember there are over 40,000,000 of us cohabitating with the virus at this moment in time!

Regarding your students' questions, I suggest you be more specific and advise them what's safe versus safer. In other words, discuss specific activities and what is most risky versus less risky versus minimally risky. I'll repost a recent question about safer sex guidelines below:

Stay well.

Dr. Bob

Everyone says Have safer sex - What is safer sex? From your Friend Mikey in the Bronx May 29, 2006

What truly is safer sex? Everyone says have safer sex - what is safe anymore? I am a gay 23 year old living in NYC. I hook up some - but I want to be safe and try to find some answers - GMHC tells me that I am big risk with my "oral activities" and I hear I am at extremely low risk. I talking about HIV specifically:

1. Protected anal/vaginal Sex (Safe? no worry?)

2. Oral sex on a buddy but no spunk in the mouth (safer - or worry like a nuttie)

3. Rimming a stud at the gym (safe sex for HIV or freak out that fluids from the ass will pass the virus)

I am so confused. This what I do - I probably am at some risk factor. What would that be - high? low? very low? Extremely low? Or, "Mike - you're really screwed! Or "Mike, your sticking to safer sex practice and are a very low risk for hiv".

I love you man,

Mikey in the Bronx

Response from Dr. Frascino

Hello Mikey in the Bronx,

You're a gay 23-year-old stud living in NYC and you don't know what safer sex is???? That either means (1) you've been living under a rock for your entire adult life, (2) you're the illegitimate lovechild of Jerry Falwell and Phyllis Schlafly or (3) you're yet another victim of our shamefully inadequate public school sex-education program ("abstinence-only").

I'll post a few references below for you to review in addition to briefly responding to your specific questions:

1. Protected sex (choose receptive cavity of your choice) is indeed "protected" if a latex condom is used properly and does not fail. HIV cannot permeate across intact latex. No way. No how.

2. Oral sex carries a very low risk for HIV transmission. Not spunking decreases the risk. Worrying like a nuttie is not warranted.

3. There are no documented cases of HIV transmission from rimming or getting rimmed. However, it is possible to contract other STD nasties (hepatitis A, intestinal parasites, herpes, etc.) from rimming.

By the way, you did this at the gym??? I've heard of "spotting" guys at the gym, but rimming??? Hmmm . . . . Mikey, your overall HIV risk from the three activities combined is very low at best. Read through the information below. I think you'll find it enlightening. Also check the archives of this forum for more specific information on any of these specific activities.

Love you, too, Mikey.

Dr. Bob

AIDS INFONET FACT SHEET 151 Safer Sex Guidelines August 18, 2005

How Does HIV Spread During Sex?

Unsafe Activities

Safer Activities

Safe Activities

What if Both People Are Already Infected?

Know What You're Doing

Set Your Limits

The Bottom Line

How Does HIV Spread During Sex?

To spread HIV during sex, HIV infection in blood or sexual fluids must be transmitted to someone. Sexual fluids come from a man's penis or from a woman's vagina, before, during, or after orgasm. HIV can be transmitted when infected fluid gets into someone's body. You can't spread HIV if there is no HIV infection. If you and your partners are not infected with HIV, there is no risk. An "undetectable viral load" (see Fact Sheet 125) does NOT mean "no HIV infection." If there is no contact with blood or sexual fluids, there is no risk. HIV needs to get into the body for infection to occur. Safer sex guidelines are ways to reduce the risk of spreading HIV during sexual activity.

Unsafe Activities

Unsafe sex has a high risk of spreading HIV. The greatest risk is when blood or sexual fluid touches the soft, moist areas (mucous membrane) inside the rectum, vagina, mouth, nose, or at the tip of the penis. These can be damaged easily, which gives HIV a way to get into the body.

Vaginal or rectal intercourse without protection is very unsafe. Sexual fluids enter the body, and wherever a man's penis is inserted, it can cause small tears that make HIV infection more likely. The receptive partner is more likely to be infected, although HIV might be able to enter the penis, especially if it has contact with HIV-infected blood or vaginal fluids for a long time or if it has any open sores.

Some men think that they can't transmit HIV if they pull their penis out before they reach orgasm. This isn't true, because HIV can be in the fluid that comes out of the penis before orgasm.

Safer Activities

Most sexual activity carries some risk of spreading HIV. To reduce the risk, make it more difficult for blood or sexual fluid to get into your body.

Be aware of your body and your partner's. Cuts, sores, or bleeding gums increase the risk of spreading HIV. Rough physical activity also increases the risk. Even small injuries give HIV a way to get into the body.

Use a barrier to prevent contact with blood or sexual fluid. Remember that the body's natural barrier is the skin. If you don't have any cuts or sores, your skin will protect you against infection. However, in rare cases HIV can get into the body through healthy mucous membranes. The risk of infection is much higher if the membranes are damaged.

The most common artificial barrier is a condom for men. You can also use a female condom to protect the vagina or rectum during intercourse. Fact Sheet 153 has more information on condoms. Lubricants can increase sexual stimulation. They also reduce the chance that condoms or other barriers will break. Oil-based lubricants like Vaseline, oils, or creams can damage condoms and other latex barriers. Be sure to use water-based lubricants. Oral sex has some risk of transmitting HIV, especially if sexual fluids get in the mouth and if there are bleeding gums or sores in the mouth. Pieces of latex or plastic wrap over the vagina, or condoms over the penis, can be used as barriers during oral sex. Condoms without lubricants are best for oral sex. Most lubricants taste awful.

Safe activities

Safe activities have no risk for spreading HIV. Abstinence (never having sex) is totally safe. Sex with just one partner is safe as long as neither one of you is infected and if neither one of you ever has sex or shares needles (see Fact Sheet 154) with anyone else.

Fantasy, masturbation or hand jobs (where you keep your fluids to yourself), sexy talk, and non-sexual massage are also safe. These activities avoid contact with blood or sexual fluids, so there is no risk of transmitting HIV.

To be safe, assume that your sex partners are infected with HIV. You can't tell if people are infected by how they look. They could be lying if they tell you they are not infected, especially if they want to have sex with you. Some people got HIV from their steady partners who were unfaithful "just once."

Even people who got a negative test result might be infected. They might have been infected after they got tested, or they might have gotten the test too soon after they were exposed to HIV. Fact Sheet 102 has more information on HIV testing.

What if Both People Are Already Infected?

Some people who are HIV-infected don't see the need to follow safer sex guidelines when they are sexual with other infected people. However, it still makes sense to "play safe." If you don't, you could be exposed to other sexually transmitted infections such as herpes, human papillomavirus (HPV), or syphilis. If you already have HIV, these diseases can be more serious.

Also, you might get "re-infected" with a different strain of HIV. This new version of HIV might not be controlled by the medications you are taking. It might also be resistant to other HIV antiviral drugs. There is no way of knowing how risky it is for two HIV-positive people to have unsafe sex. Following the guidelines for safer sex will reduce the risk.

Know What You're Doing

Using alcohol or drugs before or during sex greatly increases the chances that you will not follow safer sex guidelines. Be very careful if you have used any alcohol or drugs.

Set Your Limits

Decide how much risk you are willing to take. Know how much protection you want to use during different kinds of sexual activities. Before you have sex:

Think about safer sex;

Set your limits;

Get a supply of lubricant and condoms or other barriers, and be sure they are easy to find when you need them; and Talk to your partners so they know your limits.

Stick to your limits. Don't let alcohol or drugs or an attractive partner make you forget to protect yourself.

The Bottom Line

HIV infection can occur during sexual activity. Sex is safe only if there is no HIV, no blood or sexual fluids, or no way for HIV to get into the body.

You can reduce the risk of infection if you avoid unsafe activities or if you use barriers like condoms. Decide on your limits and stick to them.

Our thanks to AIDS InfoNet, which provided this article to The Body. Safer Sex Guides & Information

Next try going to this web address: http://www.thebody.com/safesex/safer.html. It contains the following links:

Safer-Sex Methods (December 2003) A comprehensive look at HIV prevention and the risks of various sexual activities

From HIV InSite

Safer Sex Guidelines (August 18, 2005) From New Mexico AIDS InfoNet A Detailed Explanation of Safer Sex (April 2004)

From Planned Parenthood

A Guide to Safer Sex (1998) From Society for Human Sexuality Safer Sex (1997) An excerpt from the book If I Grow Up: Talking With Teens About AIDS, Love, and Staying Alive, by Scott Fried

Enjoying Safer Sex (Regularly updated) A guide from Williams College Dr. Sex: The Joys of Safer Sex (March/April 2001)

In Positively Aware, from Test Positive Aware Network "Sex Acts and Facts: The Risks" (2000)

An excerpt from Men Like Us, by Daniel Wolfe Can You Have Safer Sex Without Latex Condoms? (December 1998)

From Rick Sowadsky, M.S.P.H. A Kiss Is Just a Kiss (October 1997) Why there's virtually no risk of getting HIV through a kiss From AIDS Care Sex in the Age of AIDS (April 1997)

From AIDS Care STDs: Global Burden and Challenges for Control (1997) An excerpt from the book Control of Sexually Transmitted Diseases: A Handbook for the Design and Management of Programs From Family Health International

Sex and Other Matters of Life and Death (December 1996)

From Thirteen/WNET-TV

What to Tell Your Patients About Safer Sex and Condom Use (August 1996) How to know which patients are at risk, and how to counsel them

From HIV Newsline The Psychological Epidemic (September 1995) An excerpt from the book In the Shadow of the Epidemic: Being HIV-Negative in the Age of AIDS, by Walt Odets



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