Oral Sex Information for Counselors from the California Office of AIDS

See also Oral Sex: Risk Factors for HIV Infection by Paul O'Malley, SF Department of Health Oral Sex: Using Your Head from SF Dept. of Health, STD Division Oral Sex & HIV Transmission: a briefing for workers by Keith Alcorn for the Terrence Higgins Trust Oral Sex: It's Up to You by Dan Wohlfeiler, STOP AIDS Project Is Oral Sex Safe? by Chuck Polisher (9/15/93) How Safe is Oral Sex? adapted by Nicolas Sheon from a pamphlet by STOP AIDS Project "HIV Counselor Perspectives" Issue on Oral Sex Risk (March 1991) discusses mostly anecdotal cases How Safe is Kissing? "Transmission of HIV Possibly Associated with Exposure of Mucous Membrane to Contaminated Blood" from MMWR (7/11/97) Where to get latex dams and harnesses (for cunnilingus or rimming)

The following guidelines for HIV test counseling messages around the risk of oral sex were taken from the Counselor Manual developed by the California Department of Health Services, Office of Testing and Counseling.

ORAL SEX AND HIV TRANSMISSION

The risk of HIV infection from oral sex behaviors has been a topic of debate since the beginning of the HIV/AIDS epidemic. Since semen (including pre-cum) and vaginal secretions are known to contain varying amounts of HIV particles, and oral sex risk for other STDs (herpes, ghonorrhea) exists it seems logical that oral sex would be a possible mode of HIV transmission. Oral sex is a common sexual practice among heterosexual, gay, and lesbian partners. Because barrier protetion is often not used, the risk of HIV infection from oral sex is importan t to explore.

THE LITERATURE

Virtually all of the studies in the medical literature strongly suggest that oral sex transmission of HIV is an exfremely rare event. Special circumstances, such as infectious partners (with high viral loads) lengthy duration of exposure, immunosuppression of the exposed partner, substance use, lesions, blood exchange, breaks in the skin of exposed tissue, and large numbers of partners are associated with a handful of documented cases. No study has provided convincing evidence that oral sex HIV transmission is common.

COUNSELING MESSAGE

There is some risk of HIV transmission from unprotected oral sex. From all available evidence, this risk appears to be extremely small and far less than unprotected anal receptive sex, unprotected anal insertive sex, or unprotected vaginal sex. Although tbe risk is small, oral sex HIV transmission has been reporta and can be further reduced by: using a barrier over the external genital area of the male or female recipient, not allowing a partner to ejaculate into the mouth, or having the male insertive partner wear a condom. Another option is to switch to other, less rislcy, sexual bebaviors (masturbation, massage).

COUNSELOR STRATEGIES

• Clarify your own attitudes toward oral sex in order to leave judgements out of the counseling session. Counselors who are uncomfortable with the message of low oral sex risk should explore their own reluctance to accept the prevailing evidence.
• Consider what oral sex might mean to the client. The exchange of bodily fluids might be extremely important to him or her.
• As appropriate, assist clients in clarifying their own attitudes toward oral sex.

THE RISK OF HIV INFECTION FROM ORAL SEX

• For one to become infected with HIV, the sex partner must be already infected.
• HIV transmission from deep kissing or oral- anal contact has never been documented.
• Cunnilingus (oral sex on a woman's vagina) is an ectremely low risk activity for either partner unless blood is present.
• Fellatio (oral sex on a man' s penis) creates a different level of risk for giving and receiving partners and in both cases is extremely low.
• The giving partner (mouth partner) is at more risk, especially if he/she has gum disease or sores in the mouth.

OBSTACLES TO BARRIER PROTECTION

• While it is prudent to suggest barrier protection for oral sex, it is critical to know that, for some people, barriers represent a loss of intimacy that is not negotiable.
• Comselors must also consider cultural and religious norms and messages when discussing barrier use with clients.
• Discussions about taste, texture, inconvemence, and interrupting the moment may assist counselors and clients in identifying client values and developing realistic harm reduction plans.

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