Will that be low risk or high?

One of our favourite online information sources is The Body – The Complete HIV/AIDS Resource.  They have an excellent high-traffic Ask the Experts forum where twelve HIV specialists (many of them doctors) answer the public’s questions.  A recent thread got me thinking about the notion of risk.  Dr. Robert Frascino (Dr. Bob) calls it the QTND – question that never dies – what’s the risk of getting or passing on HIV by giving or receiving oral sex?  “Sometimes I wish there were a universal factsheet” writes Confused London Boy, “[…] saying when and in what situation a condom should be used”.  “Where is the line?”

Dr. Bob responds to CLB the same way we always respond, reiterating that the risk of HIV transmission via oral sex is very low, but not completely non-existent.  He also clearly outlines a few of the other risk factors, which can increase the risk of transmission: the presence of other STIs, oral trauma or gingivitis, the viral load of the HIV positive partner and whether they are on treatment, etc.  There is no line; “in reality what exists is more of a zone”.  Some people choose to take a “no avoidable risk” approach and always use a condom or dental dam for oral sex with an HIV positive partner.  Some don’t.

One angry answer-seeker had written to Dr. Bob on Christmas day, claiming that he contracted HIV from oral sex and demanding that Dr. Bob retract his assertion that oral sex is a low risk activity “and take a more strident stance that Oral Sex [sic] is a significant risk”.  (It turns out this man actually hasn’t taken an HIV test “yet”, but he’s pretty sure the scratchy throat he’s feeling is caused by HIV …)  Dr. Bob basically says, no, because that would be lying, and defends himself for consistently presenting the risk as it stands statistically (very low), providing as much information as possible about risk factors, considerations, etc.  But he considers it a decision for each individual to make with their sex partners.

There have been a handful of studies on this issue, summarized in 2007 by researchers from Imperial College in London. (Dr. Bob describes these studies here.)  The results all indicate very low risk (with six out of ten studies reporting no HIV transmission via oral sex), but the researchers agree that it is extremely difficult to tell whether somebody really did get HIV from oral sex, because most people don’t engage in oral sex only.  Among the handful of people who make the on-line claim that they contracted HIV from oral sex, it is completely possible that some of them really did.  These people might be one in a million, making up that tiny little statistical probability that makes us say “very low risk”.  For them though, becoming infected with HIV is not “one in a million” … it’s 100%.  You either have HIV or you don’t and if you do it’s a big thing to live and deal with.  But this is exactly the dilemma that intrigues me about statistical probabilities and the notion of risk.  Statistical probability is a scientific measurement of risk, but it is definitely not an adequate indicator of personal impact.

We take risks every day, some smaller, some greater—driving a car, crossing the street, skiing, eating in a restaurant.  The trick is to be informed, avoid unnecessary risks and take precautions when it makes sense.  This navigating of risks is something that each person must do for herself.  As professionals, we can inform you of the facts—the statistical risk and other factors—and we can even strongly caution you against high risk activities, such as sharing needles and having unprotected vaginal or anal sex with somebody you cannot guarantee is STI-free.  But ultimately, you decide what your risk threshold is.  Of course, it’s also important to consider whether something is putting other people at risk …

To make your own decision about oral sex, definitely take a look at The Body’s oral sex chapter and search for “oral sex” on our You Should Know website, dedicated to the sexual health of women after 40.  And remember that there are other, more common STIs that are transmitted by oral sex, including Chlamydia, Gonorrhea, both types of Herpes and Syphilis.  The risk of getting or passing on one of these diseases is greatly reduced by using a condom or dental dam when giving or receiving oral sex.

-Miriam

This blog represents the ideas of individual writers, and does not necessarily reflect any formal stance taken by Positive Women’s Network.

This was posted on Friday, January 8th, 2010 at 10:00 am and is filed under Body Health, HIV Prevention, News . Feel free to respond, or trackback. Read our comments policy.

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