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Kissing, protective-insertive oral sex and Freebasing
Oct 2, 1996

Please advise a terrified young male . . . I'm really messed up. I tried "freebasing" (smoking cocaine) for the first (and only) time this last weekend. One person I was with was a man in drag - I didn't know !! We smoked a lot - for a whole day. Before I knew he was a man, he had given me oral sex - using a condom. We also kissed - deeply. We also exchanged smoke by "shotgunning" - blowing smoke between our lungs. Those are all the possible routes of transmission we opened up. I now have VERY good reason to believe he was HIV positive and he knew it. I'm nearly certain and it's not paranoia. I called the CDC hotline and they said not to worry. Protected oral sex is not a mode of transmission. Also kissing - even deep, is not a mode of transmission. I did not mention the smoking part. They said I could test if I wanted to, but given what happened - and my history - they weren't even going to recommend it. However, I failed to mention the smoking cocaine part. What about what the (rough) smoke does to your throat, lungs, etc. I don't know about my lungs, but my throat hurt from the smoke and was in real rough shape. Like I said, he gave me protected oral sex. Do you agree with the CDC's assessment of my risk (~none) for that act. Like I said, I didn't tell them about the smoking - his mouth/throat may very well have been in rough shape. How about the kissing ? My throat was really sore from the smoke - I have no idea what the condition of his mouth was. Could we have passed it by kissing given these circumstances ? The CDC left me feeling a lot better about the above two things. What about this one - the "shotgunning" - blowing smoke directly between us, mouths together - air directly from his lungs to mine. My throat was sore and I suspect after all the smoking my lungs weren't in top-notch shape either. This seems very dangerous to me, I'm so stupid. I was tested last year - negative - no sex since then - what's my exposure from this horrible incident ? Other possibly relevant facts perhaps - My genitals in fine shape, no cuts or anything like that. Rubber remained on at all times (but of course didn't cover the scrotum). Tongue was involved during some kissing. The receptive, protected oral sex was the only sex act. Other than this screw up, I don't do drugs. I'm in great physical shape with a strong constitution. I feel like I've been raped. I was tricked. Sincerely, Afraid to die terribly

Response from Mr. Sowadsky

Hi. Thank you for your question.

In all honesty, your risk for HIV in this case was very low. In order to get infected with HIV, three things must occur:

You must be exposed to pre-cum, semen, vaginal secretions, blood, or breastmilk.

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

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.

In your circumstances, the liklihood of all 3 conditions being met are very, very small.

When a person is receiving oral sex, they are only being exposed to saliva, and nobody has ever been infected through saliva. So receiving oral sex is a very low risk activity. The fact that you used a condom made your low risk even lower.

When you are kissing a person, you are normally only being exposed to saliva, and again, nobody has ever been infected through saliva. And nobody has ever been infected from kissing either. There would only be a risk from kissing if there were visible blood in your partners mouth. But realistically, the chances of you kissing a person with visible blood in their mouth is very very small.

So based on everything you told me, your risks would be very very low. This includes your "shotgunning" with them (blowing smoke directly between both of you, mouths together, and the smoke going directly from their lungs to yours). That would not be a risk for HIV, since you would not be exposed to your partners blood during this activity.

However, I do have concerns about your potential future risks. Anytime you use drugs that affect your judgment (cocaine, pot, alcohol, intravenous drugs etc), your risk for HIV and other Sexually Transmitted Diseases (STD's) goes up significantly. This is because, while under the influence of these drugs, you tend to put yourself at risk for these diseases. You tend to have sex with people who you normally wouldn't have sex with, you're less likely to use condoms, and you're less likely to use condoms correctly. You're also more likely to share needles (IV or tattoo needles) while under the influence of these drugs. So if you get high/stoned in the future (or if you get drunk), you may be putting yourself at risk when you do so. So seriously consider avoiding the use (and abuse) of these drugs. You were lucky this time......you may not be so lucky next time. Think about it. If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide). Rick Sowadsky MSPH CDS



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