There is risk inherent in any contact between two people. As human beings, we suffer from occasional infections, we become infected with viruses, and we cough and sneeze and touch in ways that transmit our afflictions to others.
Some forms of human contact are riskier than others, and they happen to be the most desirable and delightful. They fall under the heading of sex, an activity that comes in many forms, but in essence involves one person coming into contact in some way with the most vulnerable parts of another.
Those vulnerable parts are what doctors called the “mucous membrane,” that soft and wet tissue that lines the bodily cavities and canals that connect the inside of your body with the outer world. It’s the inside of your mouth, the inside of your vagina (if you’re a woman), the inside of your anus, the channel called the urethra through which you urinate if you’re a man.
Smart sex is all about minimizing the risk of intimate contact between two people while maximizing the pleasure. The ultimate form of risk reduction is using some form of a condom — a barrier (typically latex) that keeps one person’s mucous membranes or bodily fluids from coming into contact with those of another. Whether you use a condom is for you to decide. But you can’t make a smart decision without knowing the facts.
MINIMIZING RISK
What can you do, besides insisting that your partner use a condom, to minimize the risk of contracting a disease through sex? Let’s start with what you can’t do. You can’t rely on someone telling you that he has been tested and isn’t infected with HIV or any other sexually transmitted disease.
Your sexual partner might even think he’s telling the truth and have the doctor’s report to show you. But in reality, if one is tested on a Monday and gets the results back on Friday and has had unsafe sex on the Wednesday in the middle of that week, he may be infected. It typically takes several days to get such results back, so unless you’ve had your sexual partner locked away in solitude during that period, relying on someone’s HIV or sexual disease test isn’t a good idea.
A latex condom is indisputably the best way to reduce the risk of infection (condoms made of other rare materials such as lambskin — really the intestine of a lamb — won’t protect you because, while they will block sperm and prevent pregnancy, they won’t block a virus or bacteria). Some people are allergic to latex. For them there are condoms made of polyisoprene and marketed by LifeStyles under the SKYN brand and Durex under the Avanti Bare label.
You also can take medicine to reduce your risk of infection. There’s a growing movement to promote PreP, which stands for “pre-exposure prophylaxis” (a Latin word meaning “prevention of disease”). With PreP you must take every day a dose of a drug called Truvada (tenofovir disoproxil fumarate and emtricitabine). A study by the National Institutes of Health found a 90 percent reduction in the risk of HIV infection among men who rigorously adhered to the PreP regimen. But, of course, 10 percent of men on the PreP plan did not have their risk reduced. Also PreP does not reduce the risk of other sexually transmitted diseases. Given that it’s new, it isn’t yet clear what the long-term consequences to your health are of taking this medication.
If you are HIV positive, you can dramatically reduce your chance of infecting someone else with HIV if you take your anti-HIV medicine as prescribed and are able to lower the measurable amount of the virus in your blood stream to fewer than 200 units per millimeter of blood. (Something that only your doctor can tell you). If you’re in that situation, you’re considered “undetectable.” Understand, “undetectable” doesn’t mean you don’t have the HIV virus. It just means that it is present at a very low level.
If you are HIV negative, is it really safe to have unprotected sex with someone who is HIV positive and “undetectable”? A recent study found that the risk of transmission is one percent if you are the bottom and the top doesn’t ejaculate in you, and four percent if he does. Taking into account various margins of error, the researchers said the risk is close to zero.
But the real question is: “How do you know someone is ‘undetectable’?” A guy may tell you that he is, and he might be right. He also might be wrong. He might even think he’s telling the truth but actually finds out on his next visit to the doctor that his viral load is higher than 200. Whether to have unprotected sex with someone who is undetectable is a tough decision. If it’s someone you’ve come to know and trust, obviously the risk is reduced. If it’s someone you’ve met online or in a bar or are just getting to know, the risk is much higher.
The pages that follow list various sexual activities with an assessment of the risk involved in each.
Page 2: Anal Sex
Page 3: Bondage and Discipline
Page 4: Fisting
Page 5: Kissing
Page 6: Masturbation
Page 7: Mutual Masturbation
Page 8: Oral Sex
Page 9: Rimming
Page 10: Sounding
Page 11: Watersports
HIV cannot always be isolated in urine, and if it is, HIV concentrations are too small to pose a threat of infection. The HIV risk from drinking urine is negligible. Some conditions contribute to blood being present in a person’s urine, which would contribute to a risk of HIV transmission if your partner was infected. Urine is fine on the outside of intact skin. If there are any breaks on the outside of the skin, don’t urinate (piss) near the break(s). Remember that a pimple or shaving cut is also a break. Cytomegalovirus (CMV) is a virus that can be… Read more »