Safe Sex SucksALTHOUGH FEW AIDS EDUCATORS WILL ADMIT IT, THE SAFE-SEX information with which they have been inundating the gay, lesbian, and bisexual community over the last decade has carried with it a fatal flaw. Even as doctors, researchers, health educators, and activists have argued over what sexual practices do and don't belong on the "safe" list, that is, virtually no one has been willing to talk to sexually active men and women about how to weigh conflicting medical information; evaluate the biases of their information sources; and learn to make sane, reasonable assessments of the personally acceptable risks to which their sexual practices may expose them. Instead, we've settled for a scattershot approach and for slogans like this one: Anyone can get AIDS.
Well, yes, anyone can. But not everyone is equally likely to.
The last year has brought a deluge of new and confusing safe-sex information-this time related to a reassessment of the dangers of cocksucking. As with every debate about safe-sex rules that has come before, people who need to know how to protect themselves from AIDS are getting more of what won't help (a torrent of personal conjecture and "expert" arguments over interpretation) and less of what will (guidance in evaluating the available information and in using it to establish a personal hierarchy of risk).
Part of the problem, as always, is that scientific studies don't lead automatically to clarity about safer sex. In one widely reported piece of research, for example, (i) two men apparently seroconverted after they engaged in cocksucking in which they sometimes did and sometimes didn't take semen into their mouths. Making this study somewhat difficult to interpret, however, is the fact that both men had gingivitis. In other words, they may have taken infected semen into their mouths at a time when their gums were bleeding. Their gum condition, then, provided a more efficient "portal" for HIV and increased the risk-in their personal case-of sucking cock. Yet the study has been used to argue that oral sex presents some greater general risk than experts had previously realized.
Here's another example of the ways in which information about oral-sex risk is typically misused. Canadian M.D. Joss De Wet announced in September 1994 that he had treated seven HIV-antibody-negative patients who had seroconverted-even though their only sexual activity was cocksucking. "Oral sex," Dr. De Wet told reporters, "is not safe."
Unfortunately, there's no news here. No one ever said it was. Rather, the risk involved in cocksucking to orgasm has always been acknowledged, and no information has been discovered recently that throws doubt on our understanding of the degree of that risk.
When it comes to cocksucking without orgasm, meanwhile, two different, small-scale reports have indicated that HIV viral material (though not necessarily infectious HIV) is present in the precum of 43% (ii) to 52% (iii) of HIV-antibody-positive men. So far there has only been only study-not several as some journalists have reported-that suggests the possibility of HIV transmission following unprotected cocksucking without orgasm. In that study, Dr. Michael Samuel (HIV/AIDS Epidemiology Program Manager with the New Mexico Department of Health) looked at pooled data collected between 1984 and 1989 from three San Francisco "cohorts."(iv) Because these data were collected in the years that immediately followed the invention of safer sex, of course, Samuel's study does not-and doesn't pretend to-reflect current safer-sex practices.
Nonetheless, one widely quoted figure from the Samuel study has been an estimate that cocksucking without orgasm carries with it a one-percent risk per partner of contracting HIV. But that simply doesn't reflect Samuel's findings. In fact, Samuel reports no separate figure for cocksucking without orgasm and, in a phone interview, confirmed (a) that his study was not designed to tease out a separate risk for cocksucking with orgasm vs. cocksucking without orgasm and (b) that it provided no proof of actual transmission of HIV via precum.
Rather, the general one-percent infectivity rate for "receptive" cocksucking that Samuel reports is based on a statistical model of the prevalence of HIV infection in a given population (in this case, gay men in San Francisco). His study-and the one-percent estimate-cannot accurately account for the dozens of variables that affect whether HIV may be transmitted between two people engaged in a specific act of cocksucking. Because of the way data were collected, moreover, Samuel could report only per-partner risk estimates, although he and his co-authors acknowledge that, "for personal decision making and for modeling, the per-contact infectivity is of greater relevance than the per-partner infectivity." (v) That only makes logical sense. If you are antibody-negative and your partners are antibody-negative, for instance, the risks of being infected with HIV through unprotected cocksucking-even to the point of taking cum into your mouth-are low. The risk decreases further if you only have one partner and if he, in turn, isn't having sex with anybody besides you (or sharing IV drug needles or receiving blood transfusions).
Obviously, however, if you base your behavior on such beliefs, you make some major assumptions-including the assumption that HIV is the sole cause of AIDS, that HIV-antibody tests are always reliable (they're not), and that your presumably antibody-negative partners are not simply in the midst of a "latency" period (the months after infection before antibodies to the virus show up on tests). Maybe you can live with the degree of doubt inherent in such assumptions and maybe you can't.
If you are already HIV-antibody-positive, on the other hand, you may feel that it no longer matters whether you engage in sex that potentially re-exposes you to HIV. The danger of re-exposure to a new "dose" of HIV or to different strains is also being debated by doctors and researchers. But even leaving that issue aside, exposure to common sexually transmitted bacteria and viruses other than HIV isn't good for anyone-whether or not your immune system is compromised. Nonetheless, these are the kinds of decisions that sexually active HIV-antibody-positive people have to make.
Weighing the Risks
Perhaps even more valuable than understanding the medical information, however, is recognizing the reality that we live in a world that is full of risks-even deadly ones. People who drive to work in rush-hour traffic take a significant risk of being killed in a car accident. (Motor-vehicle fatalities accounted for one in every 50 deaths in 1990.) Cigarette smokers expose themselves to a wide range of debilitating and fatal diseases. (Seven percent of all deaths annually are caused by lung cancer.) Californians live with the threat of devastating earthquakes, midwesterners risk disastrous tornadoes and floods, citizens on the Mexico/Texas border are in increasing danger of encountering swarms of "killer" bees. We weigh and assess such risks as these-and countless others-as we go about our daily lives. And we accept them.More than that, we understand that risk can be managed, moderated, and lived with. There is logic in the assertion that even the tiny risk of being killed in a plane crash (approximately one death per 50,000 passengers) increases if you fly twice weekly rather than only once a year-although we accept the fact that every flight poses some danger.
When it comes to AIDS, however, many people in the United States (including not a few medical professionals) behave as though "zero-risk" can be achieved or should even be expected. We've all heard the news interviews with terrified parents who refuse to let some kid with AIDS into their child's grade school because "even if there's only a one-in-a-billion chance that my son could catch AIDS from him, that's too much." If such parents really believed in protecting their children from anything that posed more than a "one in a billion" risk, they'd never even let them get on the school bus in the morning.
None of this is meant to trivialize the risk of contracting HIV or to encourage anyone to take that risk lightly. But it is essential to view our AIDS risk in the context of the innumerable, non-quantifiable risks that are inherent simply in being alive-and to use that perspective to make rational, information-based decisions about our sexual behavior.
For those who insist on zero AIDS risk, of course, no margin of error is small enough. In the sexual arena, that effectively means no sex, because absolutely safe sex requires avoiding all contact between potentially infectious body fluids and mucus membranes (such as the inside of the mouth or the lining of the rectum) and even the skin. No cum on my chest; I might have scratched the head off a pimple there. No kissing, because HIV has been detected in saliva. (HIV has also been found in breast milk, tears, urine, and vaginal fluid.)
It may also mean giving up our faith in the "safety" of condoms. Although we've put a lot of eggs into that particular basket, research confirms that condom effectiveness varies significantly from brand to brand. One study, in fact, reported that several popular condom brands, when subjected to simulated intercourse in the laboratory, leaked between 0.9% and 22.8% of the time.(vi) Condoms, in other words, pose a risk of HIV transmission even when they are used correctly. Yet AIDS educators continue to behave as though condoms were the Great White Hope of the safe-sex movement.
For those who realize that zero-risk sex (and zero-risk living) don't exist, there's only one completely accurate-if not completely reassuring-answer to the question Is it dangerous to suck cock? And that is: It depends. It depends upon whether the person whose cock you are sucking is HIV-antibody-positive or not. It depends upon how much your gums bleed when you brush your teeth. It depends upon what you make of the limited research that shows the presence of HIV viral material in precum. It depends upon whether your partner even produces precum. (Alfred Kinsey reported that one-third of the men in his research produced no precum at all, regardless of their age or level of arousal.) It depends upon whether you get cum in your mouth or not. And on and on.
Further, despite what you may have read in your local paper, legitimate scientific debates are still taking place over such matters as when and under what conditions semen or precum even contain infectious HIV; whether saliva kills or inhibits HIV; whether the likelihood of transmission of HIV through mouth-penis contact depends upon the virulence of the strain of HIV, upon the amount of HIV transmitted, upon possible changes in an antibody-positive partner's infectivity at different times, upon the number of contacts, upon the condition of the mucus membrane lining the urethra, or upon some combination of all these; and about the way in which transmission is affected by such common dental problems as gingivitis or by the presence of sores or cuts (either visible wounds or microabrasions) in the mouth of the person who sucks cock. How much risk does each of these factors add? That sort of information is simply never going to be quantifiable.
Safe But Sorry?
At a symposium on AIDS in the Media held at the Wexner Center at Columbus, Ohio in 1993, one panel member put safer-sex concerns into this context: "Avoiding HIV is not a sufficient purpose for my life," he said.Although we have some information about the changes people have made in their sexual practices in light of AIDS, we know almost nothing about how individuals come to those decisions. It's conceivable, for example, that some men have elected to stop getting butt-fucked, but have decided that their sex lives would suffer too greatly if they also had to give up cocksucking. So the pact they make with themselves is: "I'll suck cock if I want to, but I won't get cum in my mouth. And no more cocks up my ass."
Indeed, there's evidence that men are weighing their safer-sex options in precisely this way. In his phone interview, for example, Dr. Samuel noted that men were more likely to allow a partner to come in their mouths if that partner was HIV-antibody negative. These men, in other words, understood the danger of ingesting HIV-infected semen and took correct steps to avoid contact with it.
Such men need to be congratulated for having successfully negotiated the minefield of safe-sex information and for having come to decisions they can live with. What usually happens to them instead, however, is that they are made to feel guilty for not having engaged in "completely" safe sex.
Safer-sex campaigns, in fact-particularly those directed toward younger people-trade in such slogans as "No orgasm is worth risking your life for." But the premise behind these educational efforts is false. First, we could just as accurately say "No trip down the street for a Big Mac is worth risking your life for," but that would sound as ludicrous as it is. (Even though you could get run down in the crosswalk on your way there, be shot by a disgruntled postal worker while you're eating, or choke to death on a piece of gristle.)
Far more insidious, however, is the subtle judgment inherent in such slogans: that sex is a shameful and trivial pursuit and that anyone who acknowledges and even elevates the importance of sex in his or her life is pathetic and deluded. If I decide to take up skydiving, for example, people might think I'm crazy. But no one would call me immoral, irresponsible, or decadent. If I choose to take my risks in the sexual arena, on the other hand, I am likely to be called all of those things-or worse.
What safer-sex advocates have largely forgotten is that sex serves an important, even indispensable function in people's lives. It brings with it affection, approval, recreation, relaxation, joy, and lots of other good things that are part of what we might call the life force. For gay men, moreover, the symbolic significance of semen can hardly be overestimated. Not being able to take another man's cum into our bodies is not a trivial loss; and not being able to give our cum to someone else (or to "force" him to take it) wreaks havoc with what can be one of the hottest, most intimate interactions available through sex.
For men into SM, in addition, the power dynamic involved in fucking someone's mouth (or in worshipping your Daddy's dick) is not negligible. If we're going to take activities of such significance away from people, we have to replace them with something. But that is a task that safer-sex advocates have almost entirely abdicated. Rather, the best counsel they have to offer is that we "avoid" this or that activity or that we learn to "eroticize" condoms.
There's no question that making personal decisions about AIDS and sex takes us into territory that most of us find difficult to navigate. Safer-sex decisions always involve the weighing of risks against benefits, the balancing of threats to both physical and emotional health, and at least occasional forays into so-called "gray areas." The degree to which safer-sex advice fails to address these issues is the degree to which the people who need it most are being left to fend for themselves.
Footnotes
(i) Lifson, Alan R., Paul M. O'Malley, Nancy A. Hessol, et al. (1990). HIV Seroconversion in Two Homosexual Men After Receptive Oral Intercourse with Ejaculation: Implications for Counseling Concerning Safe Sexual Practices. American Journal of Public Health, 80(12), 1509-1511.
(ii) Ilaria, Gerard, Jonathan L. Jacobs, Bruce Polsky, et al. (12 December 1992). Detection of HIV-1 DNA sequences in pre-ejaculatory fluid. The Lancet, 340, 1469.
(iii) Pudney, Jeffrey, Monica Oneta, Kenneth Mayer, et al. (12 December 1992). Pre-ejaculatory Fluid as Potential Vector for Sexual Transmission of HIV-1. The Lancet, 340, 1470.
(iv) Samuel, Michael C., Nancy Hessol, Steve Shibokoshi, et al. (1993). Factors Associated with Human Immunodeficiency Virus Seroconversion in Homosexal Men in Three San Francisco Cohort Studies, 1984-1989. Journal of Acquired Immune Deficiency Syndromes, 6, 303-312.
(v) Samuel, Michael C., Michael S. Mohr, Terence P. Speed, and Warren Winkelstein, Jr. (1994). Infectivity of HIV by Anal and Oral Intercourse Among Homosexual Men: Estimates from a Prospective Study in San Francisco. In Modeling the AIDS Epidemic: Planning, Policy, and Prediction, pp. 423-438. New York: Raven Press, p. 434.
(vi) Voeller, Bruce, Jerry Nelson, & Craig Day (1994). Viral leakage risk differences in latex condoms. AIDS Research and Human Retroviruses, 10(6), pp. 701-710.