| Transcript |
HOUSTON VOICE • FEBRUARY 4, 2000
NEWS
15
'For some, orol sex is
equated with safe sex.
This false assumption has
led to tragic lifelong consequences/—Dr. Helene
Gayle, director of the
(DCs National Center for
HIV, STD and TB
Prevention
Successful HIV drugs prompt risky behavior
'Receptive' partner
in most danger
>■ Continued from Page 1
The CDC study—conducted by Dr. Beth Dillion in collaboration with the University of California, San Francisco's Options
Project—surveyed 102 gay and bisexual men who had recently
become infected with HIV
Using a new testing technology developed by the CDC,
researchers pinpointed those with recent infections, enabling
them to then conduct Intensive interviews with the HIV-positive
men to determine risk factors near the time of infection.
Of the 102 participants, eight, or 7.8 percent, appeared to have
been infected through oral sex.
"If any other risk behaviors were identified by the infected
individual or their partner, oral sex was excluded as the route of
transmission," according to a CDC summary of the study.
"Because of these stringent requirements, 7.8 percent may be an
underestimate of transmission through oral sex in this group."
The receptive partner in oral sex is at the most risk, said Dr.
Richard Valdiserri, deputy director of the CDC's National
Center for HIV, STD & TB Prevention. All of the men in the study
believed to be infected through oral sex were the recepbve partners, Valdiserri told Houston Voice.
"For the individual who became the oral partner, with either
semen or pre-ejaculate in their mouth, that is where the risk is,"
he said. "If the receptive partner is HIV-positive and the insertive
partner is negative, the risk is not as great of transmission to the
inserHve partner."
Simply abstaining from ejaculating into the mouth is not sufficient, Valdiserri said, because pre-ejaculate also contains HIV.
The new study "is perhaps the most definibve to date" on the
risks of oral sex, "and the most important message is that most of
these men reported they really didn't think much risk at all was
associated. Irtey thought low risk means no risk," Valdiserri said,
noting that risk appears to increase with repeated exposures.
"Oral sex is lower risk than receptive anal intercourse, but
because it is low risk doesn't mean it can't result in infection.
You can't put oral sex on the same level as mutual masturbation, for example," he said.
The study focused on men having oral sex with men, but
the results could reasonably be expected to apply also to oral
sex performed on a man by a woman, Valdiserri said.
As for cunnilingus, oral sex performed on a woman by
either another woman or a man, "what we have said is it is
certainly possible [to transmit HIV], but we don't have a lot
ot ^ood data about that," he said. g
11IV can be present in vaginal secretions ,md menstrual blood,
making transmission theoretically possible, he explained.
"Abstaining Irom vaginal, anal ,m<.\ oral sex is the most
effective way to prevent the sexual transmission ot HIV," the
CI HC's summary of the study concluded.
"Individuals who choose to be sexually active can protect
themselves b\ having sex with only one uninfected partner
who has sex only with them, or using a latex condom with all
forms of sexual intercourse—anal, vaginal and oral."
According to Valdiserri, individuals need to understand
the nsk associated with oral sex, know their partners' HIV
status, a^uhn^e^.on^
by LAURA BROWN
The success of new treatments for HIV/AIDS has led
some at-risk individuals to take fewer precautions to
avoid becoming infected, according to another CDC study
presented at the seventh Conference on Retroviruses and
Opportunistic Infections.
The study, led by CDC epidemiologist Stan Lehman,
confirms the results of several smaller surveys that have
reached the same conclusion: New treatments may be
leading to complacency about HIV prevention.
Lehman and his colleagues studied 1,976 HIV-negative
or untested individuals in seven states who are considered
at risk for contracting HIV: 693 gay and bisexual men
recruited at gay bars, 600 street-recruited injection drug
users, and 683 heterosexuals recruited at STD treatment
clinics.
Overall, 31 percent reported being "less concerned"
about HIV infection because of the new drugs, and 17 percent reported being "less careful" during sex or drug use.
Among gay men, 25 percent said they were less concerned and 13 percent said they were less safe; 30 percent
of heterosexuals reported being less concerned and 15 percent reported being less safe; and among injection drug
users, 40 percent said they were less concerned and 25
percent said they were less safe.
While gay and bisexual men had the lowest numbers in
the study, that doesn't necessarily translate to mean this
group is the least complacent because of the new drugs,
Lehman told Houston Voice.
As a* group, gay men showed the highest correlation
between saying they are "less safe" and reporting engaging in specific risky behaviors, Lehman said.
Even gay men who answered "no" when asked if they
were "less safe" still reported engaging in specific high
risk behaviors at relatively high numbers.
For example, while 71 percent of gay men who said
they were "less safe" acknowledged having unprotected
receptive anal intercourse in the last year, 43 percent of
those who said they were not "less safe" still reported
engaging in the activity.
"When it comes to stopping HIV, nobody knows as
much—from a personal perspective and just because it is
important to the community—as what gay men know, ...
so possibly the lower reports [of being less concerned and
less safe] are based on the higher levels of knowledge,"
Lehman said.
"But people are apparently not translating that knowledge into action, or they are putting too much faith in the
efficacy of treatments," he said.
Study participants were recruited from Arizona,
Colorado, Missouri, Mississippi, New Mexico, Oregon and
Texas, including Houston, where gay men were recruited
in the Montrose district popular with many gays.
Weighing the relative risk
Most early AIDS prevention programs focused on the
message delivered in the CDC's study summary: Practice
abstinence, or use a condom every time, all the time, for
every sexual act that involves any contact with another
person.
While that remains sound advice, many AIDS educators say they have realized that such simple, forceful
approaches can end up alienating the very people who
most need to get the message.
Instead, they advocate a "harm reducHon" or "negotiated safety" model of safer sex education. Such programs
focus on encouraging people to make decisions about
their sexual boundaries thoughtfully, before they are confronted with a sexual situation, by weighing what is
known about the relative dangers of particular acts and
considering how much risk they are willing to take.
Compared with acts like unprotected anal intercourse,
unprotected oral sex has generally been considered relatively low risk, and some men have considered it as a
good compromise when deciding on their own sexual
behavior, said Tony Bras well, AID Atlanta executive
director, especially because many men consider oral sex
less pleasurable with a condom.
"Most folks believe that oral sex is their best trade off—
you are crossing the line just a little bit, being physically
intimate without the barrier of a condom, but in the
minds of some of our clients, you are not putting yourself
at as great a risk," Braswell said.
A harm reducHon approach to HIV prevention, he
said, "is all about negotiating in your own mind what
you will absolutely never do, what you will do only if the
person is really hot as a one-time thing, and what you
will do all thehme.
"For people who felt secure in unprotected oral sex,
this study will probably rattle their cage and cause them
to think twice," Braswell predicted. He called the new
studv "alarming."
"I think the value of this study is it gives us one more
opportunity to scare people into a little more responsibility," Braswell said. "I think it is one more warning sign
that we cannot guarantee you won't catch any infectious
disease if you engage in a sexual act with another person,
although you can take steps to limit your risk."
Some people avoid brushing or flossing their teeth
before performing oral sec to try and avoid opening an
easy route tor HIV to enter the blood stream, Braswell said.
Dr. Richard Valdiserri, deputy director of the CDC's
National Center for HIV, STD & TB Prevention, declined
comment on the efficacy of such measures in preventing
HIV transmission.
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