Sexual Safety?

Hello Dr. H:

Kudos to you for the time you take to answer the questions from the many anxiety-ridden sexually active folks on here.  

I am a gay man.  32 years old, and sexually active.  The reason I am writing to you is I am trying to assess my HIV risk.  So, I will make it short and sweet.

1.  Anal sex - I rarely participate in this activity - ok, maybe a few times a year.  That said, I ask my partners (always in a "dating situation" never met anyone at bars or bath houses or escorts - I just don't go to those places or hire male escorts).  I do ask my partners their status - HIV/STD wise - and if they say they don't know - I don't "play".   But of course you always run the risk of someone being positive and not knowing it or just wanting to have sex without being turned down because of their status.  So, I use condoms with lots of water based lube - as the insertive partner - I put them on before I even look at their back-side, I hold the rim of the condom during the whole event (to prevent slippage) and pull out right after ejaculation.  I think check the condom (sometime fill it with water to check for breakage - weird I know, but it relaxes my anxiety).  To date, never had a condom break.  If no breaks, can I relax?  Can I really have confidence that the condomw will protect me?

2.  The age old, oral question.  I know you don't answer these questions anymore, but I am curious since this is truly a GREY area for gay men.   It probably is the most asked question or most worrisome act for gay men since their is such conflicting information out there.   I do perform oral sex - not a lot, I take extra care not to let anyone discharge semen in my mouth and would never perform if I had sores or cuts in my mouth.  But I hear the risk is very low.  Again, I ask my partners their status.   In Chicago, the community clinic here classifies oral sex without ejaculation as "minimal" with a very remote chance of catching HIV.   More along the lines of protected vaginal sex.  What's the real deal from your view point?  And, in your clinic, have you had many gay men come in with a reliable account that they got hiv this way?

3.  And finally, Rimming. Another grey area.  Most experts - from my limited reading say this is as close to zero (without any odd circumstances) for HIV.  Yea, their are other things to catch (proud to say I have my hep vacs), but what is the real deal on Rimming?

I just want to sleep better at night with some clarity.  I am quite hypervigilant on reducing my risk to extremely low.  BUT, I also want a satisfying and enjoyable sex life.  So, there is this double edged sword - wanting to enjoy a healthy sex life and wanting to be safe.  I do get check every at every physical.  But, my doctor is very "old school" and thinks oral sex is very high risk (he mentions small invisible cuts in the mouth) and condoms have small holes in them unseen by the eye.  So I am a bit confused.

Signed,

Safety and concerns

[H. Hunter Handsfield, M.D.]

You are being just about as safe as a gay man who dates regularly can be.  The only additional possibility would be to use condoms even for oral sex, expecially when performing fellatio on other men.  But as you say, oral sex is low risk, especially when combined with the other things you are doing--most important, asking your partners about their HIV status and foregoing sex with those who are positive, don't know, or are evasive about answering.  Most prevention experts do not recommend routine condom use for oral sex, although some men do it.  You're right about the gray area of rimming.  To my knowledge, there are no documented cases of HIV transmission by rimming (in either direction).  That doesn't prove it can't happen, but it's a good indicator that such transmission is rare.

Going back to the business about asking HIV status, you are right about the possibility of someone acquiring infection since last tested. But statistically, the odds are strongly in your favor.  You can ice this cake, i.e. increase safety a bit more, by asking a couple more questions.  For example, if your potential partner is, in general, as safe and careful as you are, that's quite reassuring.  In contrast, I would suggest avoiding the meth-using guy who hangs out at the baths and likes glory holes, no matter what he says about his HIV status.  Then there's everybody in between (i.e., most people)--but for the most part your own judgment of them is likely to be pretty good.

Your old school doc is just being cautious and conservative.  We public health types look at the odds--and the transmission risk for oral sex is very much lower than your doc seems to believe.

I hope this helps.  Good luck.  Stay safe--   HHH, MD

[confused516]

I noticed you didnt mention recieving oral sex( which the doctor says is zero risk for hiv.  As far as everything else I would say you are being extremely safe as long as you dont take semen into your mouth and you wear a condom for the anal.

[massguy]

Thanks for your time.  I think I will start using a condom for oral - (hope its not too late - testing at my physical in a month).  I want to take an already very low risk and bring to an extremely low to zero risk.  Like driving a car with your seat belt - but then making sure the car has air bags, too!

[jacobsquestion]

I was just reading through the comments on the website here and was wondering what do you mean by, and am paraphrasing - "condoms for anal sex are good, but know your partners status, even if safe sex is planned or you could become HIV positive one day."   Do you say that because condoms can break or slip off?  I just see your comments a lot in the forum and was just purely wondering.   Sorry for the stupid question - but it just truly got me curious....

If your a dad, Happy father's Day.

[cutie kitty]

like you i want to have sex i love to have sex !! my boy friend and i love having oral sex only because we like seeing each other naked and sucking on each other. then he always rimmes my vigina (vagina) i love it!!! but the best way to have sex with a partner is oral and with a condom