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Follow-up to 'Shades of Grey' RE: Oral Sex

Jan 9, 2007

Dr Bob,

I've seen your responses on the Shades of Grey question (from another poster) and other related to oral sex. But I think we lay people are still having difficulty making a confident, informed decision with regard to oral sex.

So, I'll try to word the questions a little differently:

If you were HIV-, would you:

...perform oral sex with a condom... ...on someone of unknown serostatus? ...on someone you knew to be HIV+?

If so, are there any special precautions you'd take? For example: -no ejaculation in the mouth... -If the person is HIV+, unprotected oral ONLY if his viral load is < x...

Since you are HIV+, would you: -Allow an HIV- partner to perform unprotected oral sex on you? Including ejaculation? -Perform unprotected oral sex on an HIV+ partner (risk for infection with different mutation of HIV)? -Rate, on a scale of 1-10, your level of comfort with sexual risks (such as unprotected receptive oral) with 1 being EXTREMELY SAFE (status of both partners for STIs is well known before sex and protection is always used for oral/anal/etc) and 10 being EXTREMELY RISKY ("Can I borrow your needle before we start the bareback gang bang?").

Some public health sources offer these sorts of guidelines, but the impression (rightly or wrongly) seems to be that these guidelines are created by lawyers or bureaucrats with a particular agenda. Since your opinion is one that many of the readers trust because of your experience (both personal and professional) and your candidness, I think it would help many of us to come to peace with this question.



Response from Dr. Frascino

Hello AB,

Sorry AB, but you are asking for me to make a black or white decision for you when there really is a gray zone of circumstances to be considered here. I can make a "confident, informed decision with regard to oral sex" for myself, based on what is known medically and how much risk I am willing to personally accept. However, my comfort zone may not be identical to yours. For instance take an analogous situation; there is a quantifiable and undisputed risk for driving above the speed limit. Sometimes I, probably like many others, find that I'm cruising along at speeds that are indeed above the posted limit. I have made a personal decision under the circumstances of that moment to accept the increased level of risk involved. Perhaps it was a very safe road with little or no traffic and I had a very safe responsive car, etc., etc., etc. It's worth noting under other circumstances, say a whiteout snowstorm, icy roads or foggy conditions and an unreliable car or a very congested road I would not choose to drive above the speed limit. See what I mean? Risk is not an exact science when circumstances are variable. You could make an oral sex analogy quite easily. My job here is to tell you what in essence the "speed limit" is for general accepted safety. It's worth noting that some folks may find even going 60 miles per hour in a 60 mph zone too risky for their particular comfort level. That's fine and it's a personal decision. What I can't do is tell you driving 70 or 80 in a 60 mph zone won't get you into trouble, even though most of the time it won't. However, it could get you a speeding ticket or, if you have an accident, increased speed could cause more severe consequences. Consequently, answering your hypothetical questions about what I personally would do in a specific sexual situation really isn't helpful, because these are merely my personal choices. My purpose here is not to convince folks of my choices, but rather to provide information so that they can make their own "confident, informed decisions." In other words, I'll advise you of the speed limits and remind you to use your seatbelts, but only you can decide whether to proceed through a yellow caution light or drive faster than the speed limit in any given situation, OK?

I hope that helps.

Dr. Bob

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