Requirements For Transmission To Occur
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Three conditions must be met for HIV
transmission to occur:
HIV must be present
Infection can only happen if one of the
persons involved is infected with HIV. Some people assume that certain
behaviors (such as anal sex) cause AIDS, even if HIV is not present. This is
not true.
In sufficient quantity
The concentration of HIV
determines whether infection may happen. In blood, for example, the virus is
very concentrated. A small amount of blood is enough to infect someone. A
much larger amount of other fluids would be needed for HIV transmission.
And it must get into the bloodstream.
It is not enough to be in
contact with an infected fluid to become infected. Healthy, unbroken skin
does not allow HIV to get into the body; it is an excellent barrier to HIV
infection. HIV can only enter through an open cut or sore, or through
contact with the mucous membranes in the anus and rectum, the genitals, the
mouth, and the eyes.
Sexual intercourse (vaginal and anal):
In the genitals and the rectum, HIV may infect the mucous membranes directly
or enter through cuts and sores caused during intercourse (many of which
would be unnoticed).
Oral sex (mouth-penis, mouth-vagina):
The mouth is an inhospitable environment for HIV (in semen, vaginal fluid or
blood), meaning the risk of HIV transmission through the throat, gums, and
oral membranes is lower than through vaginal or anal membranes. There are
however, documented cases where HIV was transmitted orally, so we can't say
that getting HIV-infected semen, vaginal fluid or blood in the mouth is
without risk.
Heterosexual transmission studies:
It is evident, from epidemiological studies as well as common sense, that
AIDS can be transmitted sexually between men and women. Several studies,
usually with the female partners of hemophiliacs who have been infected,
show that male to female sexual transmission does occur. This conclusion is
supported by the statistics of women who have AIDS, whose only risk factor
was sex with a man with AIDS or a man at risk for AIDS. Female to male
sexual transmission seems to be less efficient, but it certainly does occur.
Anal or Vaginal Intercourse. Anal and
vaginal intercourse are considered to be sexual practices that carry a high
risk of HIV transmission.
Although many experts regard anal
intercourse as intrinsically riskier than vaginal intercourse, sexual
activity in either area can cause small cuts or abrasions. Semen
containing HIV can gain exposure to the blood-stream through these areas
when the normal protective barriers are damaged. Although most experts
agree that the receptive partner is at greatest risk of being infected,
the insertive partner is certainly at risk, too. During sexual activity
small abrasions can form over the skin of the penis, and any bleeding
from the lining of the vagina or rectum (or blood in the stool in the
case of anal intercourse) can introduce HIV into the bloodstream.
Preexisting sores or lesions (e.g., from a sexually transmitted disease)
on the penis or in or around the vagina or rectum further increase the
risk of transmission.
When used correctly, condoms help prevent
the mixing of body fluids from one partner with those of the other
during vaginal or anal intercourse. Lubrication is also important during
either vaginal or anal intercourse: A lubricant can help prevent tissue
damage, which increases the risk of viral transmission.
Moderate-risk sexual practices are those
where the chances of transmitting HIV are lower but still significant if
one of the sexual partners is infected with the virus. To be absolutely
safe, these practices should also be avoided. Should you choose to
engage in them, they should be performed with some form of barrier
protection (e.g., a condom when performing oral sex on a man) whenever
possible.
Oral Sex.
Fellatio (use of the mouth to
stimulate or maneuver the penis) is particularly risky when one partner
ejaculates into the other's mouth. Small cuts or sores in the mucous
membranes of the mouth provide a route for HIV-infected semen to contact
the blood. Even if the penis is removed from the partner's mouth before
ejaculation, small amounts of pre-ejaculatory fluid may contain
substantial amounts of virus, and can potentially cause infection.
Cunnilingus (oral stimulation of
the vagina) is risky because vaginal secretions may contain HIV, and
abrasions in the mouth (even small ones such as those from brushing or
flossing) can provide the virus contained in these secretions access to
the bloodstream.
Intimate Kissing (also known as
French kissing or tongue kissing). Small amounts of HIV are thought to be
present in saliva, and although the amount may be insufficient to transmit
infection, cuts or sores in the mucous membranes of the mouth can
potentially provide a route of entry for the virus.
While there have been no cases of AIDS
attributable solely to kissing, it should be avoided if there is any
possibility that your partner is infected.
Although some people may be willing to
forego sexual activity to protect themselves against HIV infection, many do
not feel that the risk of disease warrants such drastic measures. However,
it is essential that steps be taken to reduce the risk as much as possible.
At a minimum, you should:
Limit your number of sexual partners
Use condoms
Refrain from high-risk sexual practices
While these actions can greatly reduce your risk of contracting HIV, it's
important to point out that they do not decrease the risk to zero (only
total abstinence can do that).
Some sexual activities carry virtually no risk of
transmitting HIV(Back to top)
Any erotic activity that does not involve
the exchange of body fluids or place one partner's mucous membranes (e.g.,
mouth, vagina, rectum) in contact with body fluids (e.g., semen, vaginal
secretions, saliva, urine) from the other partner is considered to be
perfectly safe.
Mutual masturbation (provided that the
skin is intact).
Massage and rubbing bodies (provided that
the skin is intact).
Kissing on the face or skin (provided that
the skin is intact).
Anal intercourse without a condom is
the riskiest activity for HIV transmission. The receptive partner (or
"bottom") is at risk because the anal area provides easy access to the
bloodstream for HIV carried in semen. The insertive partner (or "top")
is also at risk because the membranes inside the urethra can provide an
entry for HIV, possibly present in blood inside the anus, into the
bloodstream.
Using a condom from start to finish
greatly reduces the risk. However, the risk is not zero because the
condom could break. It is important that you understand that condoms are
only effective against HIV if they are used properly and do not break.
Vaginal intercourse
In a heterosexual encounter, HIV passes
more easily from male to female than vice versa. Therefore, the woman is
at more risk. No matter what the gender of the partners, latex can
reduce the risk of HIV transmission and other sexually transmitted
diseases. Studies show that an UNCIRCUMCISED MALE has a much higher risk
of contracting HIV from a female (or male) who is HIV+. The "extra" skin
is not more protection by any means, this skin is very thin and
sensitive and can get small tears very easily.
Oral sex
This is the "grayest" area when
discussing risk, and is very controversial.
In general, oral sex is much
less risky for HIV transmission than anal or vaginal intercourse.
But to properly
assess risk, you must consider whether there is ejaculate, vaginal
fluid, or blood present, because there are no absolute answers regarding
oral sex and risk.
Risk assessments involve "what
substance/fluid" and "where it goes." Remember in HIV Transmission, we
said the mouth is a less likely path for transmission because the mucous
membranes are more protective than those in the anus/rectum or vagina
and because fluids can't remain in the mouth (they are swallowed or spit
out). So the "where it goes" part of the risk equation means
oral sex is inherently less risky than anal or vaginal sex.
However, you must consider the "what
substance/fluid" as well. If there is infected ejaculate,
vaginal fluid, or blood present, it increases the risk for infection.
Blood contains the highest concentration of virus, followed by semen,
vaginal fluid, and a distant last place, pre-seminal fluid.
How much does it increase the risk? We
can't say for sure. Certainly, not to the level of risk from ejaculation
inside an anus or vagina. And we can definitely say that there are only
a few documented cases of HIV in which the only possible source of
infection was through oral sex, so the risk is still very low.
But it is incorrect to equate the risk of oral sex with
ejaculation to the risk of oral sex without.
A person receiving oral sex is
generally not at risk, because that person is coming into contact only
with saliva. (There is a theoretical risk of transmission if
the person performing oral sex had blood in her/his mouth.) Many people
find using a condom unacceptable and are practicing oral sex on men
without ejaculation. They are coming into contact with pre-cum
(pre-ejaculate fluid). There is no conclusive evidence that pre-cum
transmits HIV, but some studies suggest that HIV is present in this
fluid. Again, go back to the two questions: "Is HIV present?" and "How
much HIV is present?" Although HIV may be present in pre-cum, it is in
very small amounts, and the mouth is not an easy path
for transmission. This means unprotected oral sex without
ejaculation is a very low risk activity for HIV transmission.
Performing oral sex on a woman who is
menstruating increases the risk because blood has more HIV than vaginal
fluid. There is little data on how often HIV is transmitted via oral sex
from an infected woman to an uninfected man.
Watersports / Urine in sex or
sex-play
Urine does not
transmit HIV. Even if the urine contained small amounts of blood,
the fragile virus would be battered by acid, heat, friction, enzymes,
and dilution. And again, it's important to think about how this fluid is
coming into contact with another person. To transmit HIV, there would
have to be a source of bleeding, and then we're not talking about urine
transmitting HIV, we're talking about blood.
Rimming (oral-anal contact)
Feces may contain some blood, but it
poses very minimal risk for HIV transmission. However, rimming is a risk
for transmission of hepatitis, parasites, and many other sexually
transmitted diseases. Safe rimming means using a dental dam or
plastic wrap.
Fisting
Fisting refers to inserting the fingers
or hand into the rectum or vagina. When people talk about fisting, they
almost always mean anal fisting, but the precautions are the same for
both. Fisting could be risky for the insertive partner (or "top") if
there is broken skin that would allow blood from the rectum or vagina
into the bloodstream. Using a latex glove reduces the risk.
Kissing
This activity is not known to pose any
risk for HIV infection. Saliva does not transmit HIV. One should be
aware of cuts or sores in the mouth and, if concerned, not floss or
brush right before French kissing. "Dry" or "social" kissing (with the
lips closed) poses no risk for transmitting HIV.
Mutual masturbation
The skin is an effective barrier
against all sorts of organisms, and will stop HIV. Any possibly infected
fluid on the skin should be washed off. An intact scab is as effective
as unbroken skin. Open cuts in the skin might allow passage of the
virus, but the breaks need to be open and/or bleeding to pose a risk. If
there is any question, latex gloves or finger cots should be used. It is
not (if one wants to be perfectly safe) advisable to ejaculate on
someone else's penis or labia, nor to touch the genitals with someone
else's fresh semen or vaginal secretions on the hand.
Solo masturbation
With solo masturbation there is no fear
of self-infection. Anything done solo is okay as long as someone else's
infectious fluids are not present.
Body massage, hugging,
rubbing
With only skin-to-skin contact, these
activities are risk free. This includes body-to-body rubbing
("frottage").
SM activities
This is safe, unless someone's blood,
semen or vaginal fluid enters the bloodstream of another person. It can
include bondage, tit or nipple play, spanking, discipline or any of a
number of other activities, limited only by the imagination.
Fantasy, voyeurism,
exhibitionism, phone sex
These can be elements of many safe
activities. They can include costumes or uniforms, and can appeal to
senses other than touch.
The U.S. Preventive Services Task Force
recommends that condoms be used in accordance with the following guidelines:
Latex condoms, rather than natural
membrane condoms, should be used. Torn condoms, those in damaged
packages, or those with signs of age (brittle, sticky, discolored)
should not be used.
The condom should be put on an erect
penis, before any intimate contact, and should be unrolled completely to
the base.
A space should be left at the tip of the
condom to collect semen; air pockets in the space should be removed by
pressing the air out toward the base.
Use water-based lubricants. Avoid those
made with petroleum jelly, mineral oil, cold cream, and other oil-based
lubricants, which may damage the condom.
Insertion of Nonoxynol 9 in the condom
increases protection, and vaginal application in addition to condom use
is likely to provide greater protection.
If a condom breaks, it should be
replaced immediately.
After ejaculation and while the penis is
still erect, the penis should be withdrawn while carefully holding the
condom against the base of the penis so that the condom remains in
place.
Condoms should not be reused.
Types Of Condoms
There are a wide variety of condoms on
the market. They can be lubricated or non-lubricated. They come in
different colors, shapes, sizes, textures and thickness. There are
condoms that are flavored, that glow in the dark, that play a short song
when opened, etc. There is practically no limit to the selection.
Some men complain that condoms make them
lose sensitivity in the penis during sex. We encourage these men to try
out different brands and types of condoms and select the ones with which
they are more comfortable (they can masturbate with them to get used to
them and feel more comfortable during sex with their partners). Some
people find that although they may lose their sensitivity at first,
after using condoms for a while they can regain it. And, of course, they
feel more relaxed about sex since they know they are protected.
There are no rules about what condom to
use. Some men feel better with a thicker condom while others prefer a
thinner one. Some people get excited about colors and flavors while
others find these features boring or irrelevant. [see the subject of
lubricants above and the concern over use of Nonoxynol-9 (N-9)].
Some men claim that their penis is too
big for a condom. We encourage them to try different brands (which fit
different people in different ways; there are no "better" brands). There
are also brands of condoms designed explicitly for men who have a large
penis. Interestingly, few if any men say that their penises are too
small for a condom.
Using "Male" Condoms
Pick up the condom by grabbing the
"nose" (the reservoir tip) between your thumb and forefinger (to ensure that
no air bubble gets trapped in the tip, which may cause breakage during
intercourse).
With both hands place the condom on the
head of a fully erect penis (remember, you are holding the "nose" in one
hand; you roll the condom down onto the penis with the other hand).
Unroll the condom completely, all the way
down to the base of the penis. Having used both hands and held onto the
reservoir tip, you have just ensured that no air is trapped inside the
condom. Not only does this prevent air bubbles popping the condom during
the friction of intercourse, but it also creates a vacuum, which helps
to keep the condom in place.
Use plenty of water-based lubricant (some
people use a single drop inside the tip to keep the air out).
When pulling out, the man or his partner
should hold the condom between the fingers so that it does not slip off
and spill any semen inside the body.
Preventing Condom Breakage
The main reason for condom breakage is
user failure. Although condoms are very resilient, they may become
weaker when affected by several factors:
Heat
Condoms should never be left in places
where they will be exposed to heat, such as glove compartments, under
direct sunlight or in pockets of tight jeans.
Age Condoms should be
fresh when used. We recommend not keeping condoms longer than a year. If
there is any uncertainty about how old a condom is, it should be thrown
out. Most condoms will have expiration dates on the package.
Insufficient lubrication It is
important to use a lubricant (such as saliva or a commercial lubricant
like KY jelly or another product) to reduce friction on the outside of
the condom during sexual intercourse. When in doubt, more lubrication
should be added.
Use of oil-based lubricant
Oil-based lubricants affect the latex and make it break.
Lubricants that should never
be used include: Vaseline, baby oil, Crisco, hand lotion, massage oil,
face cream, etc. Just look on the label for ingredients: water
should be the first ingredient.
Air bubbles The main
reason condoms break during sex is because air bubbles get trapped
inside them, which make them break due to the motions of intercourse.
The air must be pinched out of the condom's tip before putting it on.
Using Condoms During Oral Sex
If you wish to perform safer oral sex on
a man, you have the option of using non-lubricated condoms and also poly
urethane condoms. Lubricated condoms do not taste good to most people
and if there is nonoxynol-9 on the condom, it may cause numbness of the
lips lasting several hours. (see “Lubricant” above for more information
on nonoxynol-9 and some concerns regarding it). Some people don't like
the white powder that covers non-lubricated condoms. That white powder
is cornstarch and can be easily wiped off with a wet washcloth.
Condom Availability
Condoms are, in general, very easy to
find. Most drugstores carry them. However, in some places people have to
ask the clerk for them, which can be embarrassing.
Condoms are usually inexpensive.
Some stores have an arrangement of selling them at cost (that is,
they charge only what the manufacturer charges them) to make them
even more accessible. Some health departments and STD clinics, and
nonprofit HIV/AIDS service organizations have condoms available for
free.
We encourage you to keep a good
supply of condoms available at home or at any place where you are
likely to have sex. Having condoms readily available increases the
probability of their being used.
Using Dental Dams And Plastic Wrap For
Oral Sex
The dam or plastic wrap can be placed
between the mouth and the vagina or anus during oral sex to reduce risk
of sexually transmitted diseases. It is very important that you use a
different dam or piece of plastic wrap every time that you perform oral
sex. It is not a good idea to set the barrier aside and use it again
because it's too easy to flip it over and forget what side touched the
vagina or anus.
Dental dams are not as readily available
as plastic wrap. They can be bought from medical supply stores, and from
some sex shops and drugstores. They can also be ordered by phone.
How to clean
up Blood or other potentially dangerous body fluids. (Back
to top)
Always wear waterproof gloves to
prevent direct contact with potentially contaminated fluids.
Bleach and water mixed in a 1:10 ratio
should be used to wipe up the spill. A solution containing bleach kills the
virus but water alone does not.
HIV/AIDS
Information