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update on semen washing
May 16, 1997

We have been following the information available on the semen washing issue. We have been unable to find anyone in the US who is perfoming the procedure and due to the legal issues, I doubt anyone will be brave enough to do so until it is offically sanctioned by a group such as the CDC. That will happen when pigs fly and we don't have that kind of time to wait. A couple of questions: 1. In one of your responses I believe that you thought the process may be done in Toronto in addition to Italy and Germany. Do you have any new info on that? 2. Am I correct in understanding that the transmission rate from male to female sexual contact is acutally quite low assuming no open lesions etc. 3. Any studies or theories on the affect of the virus in the semen due to the protease inhibitors. 4. Any studies or theories as to the affect on a fetus when the male is taking the protease inhibitors. We are at a decision making point in our lives and very much want to be like other normal couples in having a family. US researchers are familiar with the studies and some would participate tomorrow, if sancitoned. Without someone to help us (regardless that we are willing to assume all of the risk), one of our choices seems to be a self-insemination (to avoid any excoriations from intercourse) done when the viral load is low to undetectable. Are you aware of any theories or care to share an opinion on this choice?? We would much prefer the assistance of medical personnel but if Toronto isn't a reality, we won't get any help here. thanks for your time, we appreciate your ability to share information without judging. HIV affects our lives in so many ways, but the desire for a family only grows.

Response from Mr. Sowadsky

Hi. Thank you for your questions. Let me answer them one at a time.

1. In one of your responses I believe that you thought the process may be done in Toronto in addition to Italy and Germany. Do you have any new info on that?

As of this date, to my knowledge, this experimental procedure is only being done in Munich, Germany and Milan, Italy. I am not aware of this procedure being done anywhere else in the world at this time. I recently checked to see if this procedure was being tried in the USA. I was unable to find any place in the USA where this procedure is being tried.

2. Am I correct in understanding that the transmission rate from male to female sexual contact is acutally quite low assuming no open lesions etc.

No. Over 15 years of worldwide data have shown that both partners during intercourse are at high risk of HIV infection. During intercourse (vaginal or anal), the insertive partner is at high risk, and the receptive partner is at even higher risk. Note that when the other partner is infected, neither partner is at low risk.

Let's look at HIV transmission in greater detail. To understand why both partners are at risk of infection during intercourse, we need to review the basic requirements for HIV transmission to occur.

In order for infection to occur, 3 things must happen:

Requirement #1) You must be exposed to pre-cum, semen, vaginal secretions, blood, or breastmilk, AND

Requirement #2) The virus must get directly into your bloodstream through some fresh cut, open sore, abrasion etc., AND

Requirement #3) Transmission must go directly from 1 person to the other very quickly...the virus does not survive more than a few minutes outside the body.

Let's now apply this information to vaginal intercourse specifically. In regard to the receiving partner:

Requirement #1:

This partner is exposed to pre-cum and/or semen. The more of these body fluids they are exposed to, the greater the risk of infection.

Requirement #2:

HIV can get into the bloodstream through microscopic cuts and abrasions in the walls of the vagina that normally occur during vaginal intercourse. The more cuts/abrasions there are, the greater the risk for infection. In addition, if the partner has another STD that has open lesions (for example syphilis or herpes), this can make HIV enter the bloodstream even easier.

Requirement #3:

HIV is directly going from one partner to the other during intercourse itself.

Now let's look at the risks as far as the insertive partner is concerned:

Requirement #1:

This partner is being exposed to vaginal secretions, and potentially menstrual blood, which normally occurs during vaginal intercourse. The more of these body fluids the man is exposed to, the greater the risk of infection.

Requirement #2:

HIV can enter his bloodstream through microscopic cuts and abrasions that normally occur on the head of the penis. These microscopic openings are a result of the friction that normally occurs during intercourse, and are too small to visually see, but large enough for HIV to enter. These small cuts/abrasions are most likely to occur on the head of the penis, since this is made of mucous membranes, which tend to abrade easier than regular skin. The more cuts/abrasions there are, the greater the risk for infection. Also, if a man were to have any open lesions on his penis due to other STD's (like herpes, syphilis etc.), it would be much easier for HIV to enter his bloodstream.

Requirement #3:

HIV is directly going from one partner to the other during intercourse itself.

These same principals of transmission risk can be applied to other sexual activities as well (anal intercourse, oral sex etc.). No matter what the circumstances are, if you think about these 3 requirements for transmission, you'll be able to determine whether you're at risk for HIV or not. But do remember that other sexually transmitted diseases (STD's) can be transmitted easier than HIV, so what might be low risk for HIV may be high risk for other STD's.

For a related question, see the post, "Why male-to-female not 100%?"

3. Any studies or theories on the affect of the virus in the semen due to the protease inhibitors.

Recent studies suggest that if protease inhibitors reduce the viral load in the blood, that viral load is reduced in other parts of the body as well. If the viral load is reduced "below detectable levels," this merely means your risk would be lower through his semen, than exposure to semen from a man with a high viral load. But "lower" risk is NOT the same as "low" risk. There is no evidence to date that low viral loads (or viral loads below detectable levels) would lead to a low risk of infection from semen. It may lead to a lower risk, but not a low risk. Having unprotected sex with a man whose viral load is low (or below detectable levels), is still considered risky, as far as transmission of HIV is concerned.

For related questions on this topic see, "HIV Transmission From Patient with Nondetectable Viral Load," and "AFFECT OF MAGIC'S WIFE'S REVELATION THAT MAGIC HAS BEEN CURED."

4. Any studies or theories as to the affect on a fetus when the male is taking the protease inhibitors.

Because protease inhibitors are so new, the answer to this question is presently unknown.

In summary, in a couple where the man is positive and the woman is negative, they have several options if they wish to have a child:

1) Contact the researchers in Italy or Germany to see if they can get into the experimental sperm washing procedures. For more information on this issue, see the posting, "washing semen of HIV in the lab."

2) Adopt a child (this would then pose no risk to the mother). There are many children out there who need caring parents.

3) Take their chances using the sperm of the man. This is the riskiest and least desirable of your options, since this is the riskiest option, in terms of the woman and her baby becoming infected. Remember, there's still a significant chance of infection, even if the viral load of the man is low.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).



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