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Oral/Anal Sex

Sep 24, 1997

Rick, I have read numerous Internet articles concerning oral sex and HIV transmission and most indicate that there have been no recorded cases of HIV being transmitted through oral anal contact; however, the CDC and other health organizations consider mouth to rectum contact a high risk activity. This confuses me. Most community based organizations consider it low risk. In Europe, it is considered an extremely unlikely source of HIV transmission. In your writings, it appears that you believe it to be low risk as well. Why would the CDC list it as high risk? Is the risk to the receiving partner or the receptive partner? Is the risk getting fecal matter in the giving partners mouth or is it saliva in the receptive partner's anus? Any information that you can give me with regard to this question would be greatly appreciated. Thanks.

Response from Mr. Sowadsky

Hi. Thank you for your question. Let me review with you about the risks from oral-anal sex (also known as "rimming"). As you will see, the risk for HIV depends on the specific circumstances. But the health risks are actually higher for infections other than HIV.

If you are on the receiving end from someone rimming you (oral-anal sex), you are only being exposed to saliva, and nobody has ever been infected with HIV through saliva. This activity is very low risk for HIV.

If you are rimming another person (giving them oral-anal sex with potential exposure to feces), normally you would also be at low risk for HIV. There would only be a risk for HIV if you were directly exposed to visible blood (which is usually not the case during rimming). The only time a person may be exposed to blood, would be if rimming took place after anally fingering them, after anal intercourse, or after fisting them. Other than this, a person would usually not be exposed to blood, and the risk for HIV would normally be low.

However, although you would be at low risk for HIV (when being exposed to feces) you would be at HIGH risk for other diseases, including bacterial infections (such as E. coli), parasitic infections (such as Giardia), and viral infections (such as Hepatitis A). On the bright side, there is now a very effective vaccine available against Hepatitis A. If you enjoy rimming your partner, and if you get vaccinated, this would be one less disease you would have to worry about.

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

You must be exposed to pre-cum, semen, vaginal secretions, blood, or breast milk, AND

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

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.

No matter what the circumstances are, if you think about these 3 criteria for transmission, you will be able to determine whether you are at risk for HIV or not. Since rimming does not normally involve exposure to pre-cum, semen, vaginal secretions, blood, or breast milk, normally this is a low risk activity for HIV (other than the blood exposure possibilities discussed above). But do remember that other diseases can be transmitted easier than HIV, so what might be low risk for HIV may be high risk for other infections (as discussed above).

So in summary, if your partner is rimming you, your risk for HIV is low. If you are rimming your partner, your risk for HIV is also low (assuming no blood is present), but you would be at high risk for other infectious diseases.

If someone tells you rimming is high risk for HIV, ask them where they are getting their information from. But remember, rimming can be high risk for infections other than HIV.

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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