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Sick from Sucking

Yes, you can get sick from sucking (err, oral sex), including be infected by HIV and AIDS. But how big is the risk, really?

Hector A.*, 25, insists he never had unsafe anal sex – at least not since his first one, “which would be over 10 years ago,” he recalls, “and I’ve had tests after that that showed my (negative) status.” He, however, had “numerous sexual encounters, mainly oral, since then.” The oral sexual experiences were done in, among others, sex clubs and bath houses (“I’ve been in all of them – those that already closed, and those that are still operational,” he says), pick-ups from clubs (“Meat markets”), sex parties (“Check schedules in G4M and LifeOut.com, among others”), movie houses (“Even SM MegaMall is a sex area”), and encounters in sex beats (“Largely unrecognized, but we do have many in Metro Manila alone”).

“So numerous (the oral sexual encounters), in fact, that I’ve lost count, actually stopped counting, already,” he says. “I guess you can say I’ve been around.”

It was, therefore, with mixed feelings that he met the news not a few months ago that he is HIV positive. “There was this acknowledgment that, yes, mainly because I have been sexually active, getting (HIV) is probable,” he says. “But there was this disbelief, too, that I am (positive), since my sexual practices were limited to what I, and many people I know, believe to be a somewhat safer sexual practices – I was just giving heads, not taking it up the ass.”

Hector A.’s case brings to light, yet again, the link between oral sex with HIV and AIDS, which is actually not a new issue, even if it is only starting to widely get the attention it deserves. After all, as many like Hector A. believe, “who would have thought you can get HIV and AIDS from sucking, too!”

UNINFORMATIVE INFORMATION?

The lack of urgency to stress the link between fellatio and HIV and AIDS may be understandable, even if it’s unforgivable. After all, even if the claim that HIV and AIDS, and other sexually transmitted infections (STIs) for that matter, can be transmitted orogenitally (mouth to genitalia), studies actually fail to prove the veracity of the claim.

A study by NATAP.org and HIVREALTALK.com involving 239 men who have sex with men (MSM) who exclusively practiced fellatio in the past six months (50% had three partners, 98% unprotected; and 28% had an HIV-positive partner), no HIV was detected, making the researchers admit that “the risk of HIV attributable to fellatio is extremely low.”

“(We) acknowledge that fellatio, although not an efficient route of infection, nonetheless appear(s) to carry a small risk. (Other) studies provided quantitative estimates of the low risk among men who have sex with men (MSM), with one (estimating that) the per-contact risk of unprotected fellatio with an HIV-positive or unknown HIV status partner [4/10 000; 95% confidence interval (CI) 0.01%, 0.17%] to be lower than the per-contact risk of acquiring HIV from protected receptive anal intercourse (RAI) (0.18%; 95% CI 0.10%, 0.28%),” the groups say.

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Understandably, in a survey of teens conducted for The Kaiser Family Foundation, 26% of the sexually active 15 to 17 year olds surveyed responded that one “cannot become infected with HIV by having unprotected oral sex.” An additional 15% were not certain if one can be infected with HIV through oral sex.

This is not to say that the position of those advocating safer sexual practices even when “just” sucking is not without merit. NATAP.org and HIVREALTALK.com note a study done on the primary modes of transmission in San Francisco in the US, where 8% of HIV-positive participants acquired HIV from fellatio (Though this is not to say that 8% of people with HIV and AIDS were only infected through oral sex, which is a generalization Outrage Magazine is not claiming – Ed ).

Adds the CDC HIV/STD/TB Prevention News Update in a fact sheet (What You Should Know about Oral Sex: Oral Sex Is Not Considered Safe Sex): “Because anal and vaginal sex are much riskier, and because most individuals who engage in unprotected (i.e. without a condom) oral sex also engage in unprotected anal and/or vaginal sex, the exact proportion of HIV infections attributable to oral sex alone is unknown, but is likely to be very small. This has led some people to believe that oral sex is completely safe. It is not.”

One study cited by the Public Health Agency of Canada (PHAC, phac-aspc.gc.ca) in Oral Sex and HIV Transmission calculates the per-sex-act probability of HIV transmission in a cohort of men who have sex with men (MSM) and determined that for unprotected receptive anal intercourse, the probability was 0.82% per act, for unprotected insertive anal intercourse 0.06%, and for unprotected receptive oral intercourse with ejaculation 0.04%.

Still another study, still cited by PHAC, calculates the “population-attributable risk percentage (PAR%, which refers to the incidence of a disease (in this case, HIV) in a population that can be attributed to a certain risk behavior, e.g. fellatio) at 0.18% for MSM who had had one partner in the previous six months, 0.25% for two partners, and 0.31% for three partners.”

The PHAC insists that “oral sex between MSMs is not as safe as once perceived (since) several epidemiological studies have examined the risk of HIV infection through unprotected receptive oral intercourse (receptive fellatio).”

Among others, there’s a 1996 to 1999 study of MSMs with recent diagnosis of HIV infection, and it was found that 7.8% of subjects (eight of 102) were probably infected through receptive oral sex. In a 1986 to 1988 study of HIV infection and AIDS among MSMs in the Netherlands, “four of 102 cases of seroconversion (3.9%) likely occurred as a result of receptive oral intercourse.” And in the UK, 13 cases of HIV transmission through orogenital contact had been reported to the public health authorities up to December 1998.

So, yes, HIV and AIDS CAN be transmitted through sucking.

HERE COMES THE CUM

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According to the French POSITIFS Association (positifs.org), “concerning fellatio, the risk of HIV transmission is possible in case of a bleeding lesion, like gingivitis, or even just after a teeth brushing.” The big catch is that a “lesion may be microscopic, causing a non-visible bleeding, so a rapid rinsing of the mouth is not sufficient to avoid the risk of transmission. Indeed, if there is a bleeding lesion, the virus may instantaneously penetrate in this opening.”

The CDC HIV/STD/TB Prevention News Update notes that “although the risk is many times smaller than anal or vaginal sex, HIV has been transmitted to receptive partners through fellatio, even in cases when insertive partners didn’t ejaculate (cum).”

“The risk of contamination from a male sex without ejaculation exists. It is possible because of ‘internal micro-ejaculations.’ It mustn’t be forgotten that even during a very short penetration, the risk of HIV transmission exists, because of the presence of seminal liquid just at the extremity of the urethra. Furthermore, an early ejaculation may always occur, as it is difficult to always control the state of excitation,” the PHAC adds.

Fortunately, if it can be considered fortunate at all, “saliva that does not contain blood presents no potential for transmission, as research has shown that an enzyme in saliva inhibits HIV. In general, the mouth and throat are well defended against HIV: the oral mucosal lining contains few of the cells that are the most susceptible to HIV. Other research notes that saliva contains several HIV inhibitors, such as peroxidases and thrombospondin-1, and that the hypotonicity of saliva disrupts the transmission of infected leukocytes (white blood cells),” the PHAC states.

Other factors potentially associated with increased risk of HIV transmission through oral sex include oral trauma, sores, inflammation, concomitant STIs, ejaculation in the mouth, and systemic immune suppression. For receptive fellatio, poor oral health and taking cum in the mouth is a “hazardous combination” that multiplies the risk of HIV transmission.

For safer sex advocates, HIV isn’t the only one that can be transmitted through oral sex. “Scientists have documented a number of other sexually transmitted (infections, or STIs) that have also been transmitted through oral sex. Herpes, syphilis, gonorrhea, genital warts (HPV), intestinal parasites (amoebiasis), and Hepatitis A are examples of STIs that can be transmitted during oral sex with an infected partner,” the CDC HIV/STD/TB Prevention News Update states.

Adds the POSITIFS Association: “We know for instance that a Chlamydia infection may be localized in the pharynx. Pyogenic germs (like streptococcus or staphylococcus) are known to give mouth infections, but also genital infections. And some germs can also be transmitted by oral contact, such as the Epstein-Barr virus, responsible for the infectious mononucleosis.”

FOR THE LOVE OF SUCKING

There is no call to stop sucking – certainly not! But according to the PHAC, there is a need to realize that “while oral sex is a lower risk activity than unprotected anal or vaginal intercourse, repeated exposures may increase the risk. And although the risk of acquiring HIV through oral sex is low, the higher rates of practicing oral sex indicate that it may contribute to significant numbers of HIV cases among MSMs. Safer sex practices should consider oral sex, particularly unprotected receptive fellatio with ejaculation, as a potential risk behavior for HIV transmission.”

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For the CDC HIV/STD/TB Prevention News Update, “you can lower any already low risk of getting HIV from oral sex by using latex condoms each and every time. For cunnilingus or anilingus, plastic food wrap, a condom cut open, or a dental dam can serve as a physical barrier to prevent transmission of HIV and many other STDs.”

When in doubt, see a doctor.

Hector A. is still coming to terms with his new seropositive status. No longer in shock, “in my head, I am, however, still coming to terms with getting infected by sucking – an act I never thought would (enable HIV) to affect my life this way,” he says.

He has already “mended my ways,” he says, foregoing (what I used to do before).” The big plan for him is to “help spread the word out there that, yes, you can get HIV and AIDS from a head job,” he says, although admitting he is, at the moment, “not yet ready to come out in the open.” “The message is important, though, even if it may seem farfetched (for many for now). Here’s the thing: I never thought it could happen, too, until it happened to me. If anything, that should serve as a lesson that needs to be really, really learned.”

*NAME CHANGED UPON REQUEST TO PROTECT INTERVIEWEE’S PRIVACY

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