A while ago, a friend of mine, who is around 55 years old and from Europe, sadly looked back on his life during a birthday dinner. He said that none of his (gay) friends from when he was in his twenties and thirties was alive to celebrate his birthday with him. They had all died - most of them, by far, died of AIDS.
He said: "Condoms? Nobody used them at that time. It was true; I had syphilis, gonorrhea and chlamydia several times, but those could be treated easily. That was not it, for sure."
So, what then? He answered: "It is the fact that I HATE anal sex which must have saved my life!"
It is an interesting conclusion, with a lot of truth in it. Anal intercourse is the sexual behaviour which is - by far - most likely to transmit HIV among gay men (and - much less well known - maybe among some heterosexuals, too).
The reasons are simple: the rectum is not naturally lubricated, as is a vagina or a mouth. It is also much narrower, increasing the pressure on the penis during intercourse. This adds to its appeal for many men, but it also increases the chance that sperm (or pre-cum) of the 'penetrator' can come in contact with the blood of the 'receptor', so that the penetrator can transmit HIV to the receptor. Likewise, there is a chance that tiny blood vessels on the inside of the foreskin (if present) and the glans of the penis of the penetrator are broken and that his blood comes in contact with the blood resulting from broken blood vessels inside the rectum of the 'receptor'.
Both can lead to HIV transmission (as well as the transmission of several other sexually transmitted diseases). The fragility and the surface of the inside of the rectum are greater than that of the foreskin and glans penis; hence, the chance for a receptive person to become infected with HIV are bigger than for the 'penetrator'.
How about oral sex then? During oral sex there is plenty of lubrication... Just think about that mouth-watering lollipop, and don't you start to automatically salivate? During oral sex, there is much less pressure and friction between the penis and the mouth, no matter how hard you suck, decreasing the chance for tiny blood vessels in the foreskin or glans of the penis to break. The 'walls' of the mouth are also much better protected against breaking blood vessels. While your mouth can harbour a series of sexually transmitted infections, as my friend had already noted, oral transmission of human immunodeficiency virus (HIV) is considered to be CLOSE to impossible. Even if you 'swallow', the acids in your stomach will deal with possible virus particles effectively.
So why is oral sex not widely recommended as an extremely low-risk activity?
I don't really know. Fact is, there are a few people out there who have HIV and swear that they had only oral sex. Perhaps infection took place after they swallowed and before the cum reached the stomach - i.e. in the pharynx.
Or it may be a matter of timing. During 'acute infection' of HIV - during the first 2-8 weeks of infection - a newly infected person's viral load is skyrocketing, hence he is much more infectious during that time than later in his HIV infection, when the viral load is low(er) (especially if he takes antiretroviral medicines). So, a tiny little cut in someone's mouth that comes in touch with cum that has loads and loads of HIV in it might then just do the trick, just during that period of time. But the chance is considered to be very, very tiny.
Imagine a city with one million gay men who have sex two times a week. Imagine most of that sex is anal sex. Imagine little condoms are used, as was the case in the time my European friend was young. If HIV is introduced in this population, it is likely to spread rapidly. Look, for example, at Bangkok: 17 percent of gay men were infected in 2003, rising to nearly 31 percent in 2007.
But what would happen if all these one million men, as if by magic, discover the Magic of Sucking, and stop having anal sex?
Sure - a tiny, tiny number of cases of transmission could still occur via oral sex (... and were these really caused by oral sex, or by anal sex or - God forbid! - vaginal sex, but was the person too shy to admit it?). But the chance of HIV transmission would be so small that it would not be enough to sustain levels of HIV in the population.
Hence, HIV would stabilise, and over many years it would gradually die out....
So, rather than speaking about 'safe sex' as if all sex has the same risk of HIV transmission, we should educate our sisters and brothers about the virtue of oral sex versus anal sex. If we would all switch from having anal sex to only having oral sex, we would not only be able to walk straighter, but we would turn the HIV epidemic around...
Conclusion: Let's all start sucking around!
Editor’s note: Anyone who has cuts or open wounds in their mouth or throat can still be prone to HIV infection; and risks contracting sexually transmitted infections (STI) such as genital herpes and syphilis when engaging in unprotected oral sex. By using condoms or other barriers between the mouth and genitals, individuals can reduce their risk of contracting HIV or another STD through oral sex. Read more about oral sex and its associated risks: Oral Sex & HIV (TheBody.com).
Jan Wijngaarden has worked, in different functions and roles, on promoting HIV prevention, care and support for men who have sex with men (MSM) since 1994. He is also the moderator of MSM-Asia, an information network on MSM, HIV and human rights, with nearly 600 members from across the region. If you want to become a member of MSM-Asia, or for information requests or comments, pls contact him at jwdlvw@gmail.com.