rjwill6@PacBell.COM (Rod Williams) (05/25/91)
In a recent issue of "Christopher Street", Andrew Holleran writes about
the inconsistent way gay men tend to behave sexually with someone they
know to be HIV+, and someone whose HIV status they don't know at all.
He recalls visiting a friend with AIDS while the friend was administering
IV medication to himself. As he was leaving, he mentioned to the friend,
"they're now saying that oral sex is safe". "Fine", said his friend,
"then suck *me*". He realized that he certainly would not have oral sex
with someone he knew to be HIV+, or to have AIDS, but also recognized
that he'd be only too willing to do so with a total stranger, about whom
he knew nothing.
--
--------------------------------------------------------------------------------
R O D W I L L I A M S P A C I F I C * B E L L
S A N F R A N C I S C O , C A L I F O R N I A
================================================================================gb661@leah.albany.edu (BROADWELL GEORGE AARON) (05/26/91)
In article <1991May25.032600.29979@cs.ucla.edu> rjwill6@PacBell.COM (Rod Williams) writes: >In a recent issue of "Christopher Street", Andrew Holleran writes about >the inconsistent way gay men tend to behave sexually with someone they >know to be HIV+, and someone whose HIV status they don't know at all. >He recalls visiting a friend with AIDS while the friend was administering >IV medication to himself. As he was leaving, he mentioned to the friend, >"they're now saying that oral sex is safe". "Fine", said his friend, >"then suck *me*". He realized that he certainly would not have oral sex >with someone he knew to be HIV+, or to have AIDS, but also recognized >that he'd be only too willing to do so with a total stranger, about whom >he knew nothing. >-- I think any reasonable person would have to admit that there is some risk for HIV transmission from oral sex. But I think the evidence shows that that risk is comparatively small compared to other modes of transmission. Here are three studies that support this conclusion: 1. Kingsley, Lawrence A et al. 'Risk factors for seroconversion to HIV among male homosexuals' Lancet, Feb. 14, 1987 pp. 345-348 A study of 2507 men was conducted. The men tested negative at the beginning of the study, and were followed to see how many seroconverted. Their conclusion: "On multivariate analysis, receptive anal intercourse was the only significant risk factor for seroconversion to HIV; the risk ratio increasing from 3-fold for one partner to 18-fold for 5+ partners....Of the 147 men who engaged in oral receptive intercourse with at least one partner during the six-month follow-up, but reported no receptive or insertive anal intercourse within 12 months, *no* seroconversions were observed. The only 3 men to seroconvert without reported receptive anal intercourse were among those 344 men who reported anal intercourse as the receptive partner only -- a seroconversion rate of 0.9%. ... The absence of detectable risk for seroconversion due to receptive oral-genital intercourse is striking." (emphasis in original) 2.) Schechter et al. 'Can HTLV-III be transmitted orally?' Lancet Feb. 14, 1986, p. 379. Based on a study of 700 gay men in Vancouver, the authors concluded, "Our analysis of risk factors for seropositivity for homsexual men showed that any apparent risk associated with oral sexual contact was confounded by the known risks of number of sexual partners and receptive anal intercourse. In multivariate analyses, no risk associated with oral sexual contact was detected. We know of no study that has impli- cated any oral sexual activity as a mode of transmission in male homosexuals....Our findings corroborate the lack or oral transmission of HTLV-III." 3. Lyman, David et al. 'Minimal risk of transmission of AIDS- associated retrovirus by oral-genital contact'. Journal of the American Medical Association. April 4, 1986, v. 255(13) p. 1703. Showed essentially the same result, though I've lost my notes on the number of men in the study. If anyone knows of other group studies that give a different conclusion, I'd like to know about them. Not being a doctor, it's often hard to keep up with the medical literature. And it's also hard to get doctors to be honest with you (as in the case of my doctor who insisted that rimming was a high-risk activity, but could not provide me with any evidence that this was true.) To be fair, I should say that this view is not undisputed in the medical literature. Published objections in general take one of two lines: a.) I have a patient who is HIV positive and says that he only engaged in oral sex, or b.) Since we know that there is some theoretical risk associated with oral sex, as a matter of public policy we ought not to allow people to believe that it is safe. Objections of the (a) type don't cut the mustard in my view. Anecdotal evidence is inherently suspect, since patients may misrepresent their sexual histories for various reasons. Objections of the (b) type are paternalistic, and assume that the medical/health care establishment should decide what kind of information people have. I myself believe that we should be totally frank about what evidence there is for various sorts of risk. I would speculate that oral sex without a condom is safer than anal sex with a condom, based on the failure rates of condoms. That's information (if correct) that could play an important role in the decisions that people make about sex.