3 min

Condoms & oral sex

Mixed messages surround the risk of HIV infection

RUSSIAN ROULETTE? Robert Remis says there's no such as zero risk. Credit: Jan Becker

How worried should gay men be about getting HIV from unprotected oral sex?

It all depends on who you ask.

The findings of a recent US study say the risk is almost nil, but a top AIDS authority in Toronto says gay men should take any risk seriously.

“I’m not saying that anyone who has oral sex without a condom is crazy or ill-advised,” says Dr Robert Remis, associate professor with Public Health Sciences at the University Of Toronto. “It depends on the risk they’re willing to tolerate.”

But the risks seem very low if you look at the results of a recent study out of San Francisco. Presented this summer at the US National HIV Prevention Conference in Atlanta, the HIV Oral Transmission (or HOT) study cites the probability of acquiring HIV through unprotected oral sex as “very, very low.”

The study involved 198 gay and bisexual men who only engaged in oral sex during the study period. Its main intention was to isolate risk factors like performing oral sex on someone with a sexually transmitted disease, swallowing semen or performing oral sex with open sores in the mouth.

Most studies on HIV infection have not broken down such factors, and there has been a history of misreporting because men are often reluctant to admit many sexual behaviours like anal sex.

As well, Kimberly Page-Shafer, the study’s principal investigator, says it’s difficult to quantify oral transmission because it’s “not easy to find people who have only had oral sex for the past 10 years.”

In preliminary results Page-Shafer reported to Health Scout News, “we did not detect any new infections and we have not been able to identify infection attributed to oral sex…. Statistically, the probability is zero for our study group.”

Mostly noteably, 20 percent of participants reported having unprotect oral sex with a partner they knew to be HIV-positive.

But Remis insists that unprotected oral sex – like a game of Russian roulette – can come with a fatal price tag: “It’s not a theoretical risk, it’s a very real one.”

He maintains that it is possible to get HIV from one of the few sexual acts gay men have believed safe since the onset of the AIDS crisis two decades ago.

Remis puts the risk of transmitting oral sex at one in a thousand.

“Like anything else, a low risk accumulates with exposure,” he says. “It’s a matter of how much you do it. Maybe the odd time you do it with someone you absolutely don’t know is HIV-negative isn’t so crazy, but to assume that there’s nothing there without any consideration for the risk wouldn’t be well advised. It’s dangerous to be having many, many partners.”

Remis says many men believe oral sex is harmless because of public health messages promoting it as a safer alternative to anal sex.

“There’s some concern that by telling people there are too many risks that they’ll get discouraged and give up. So there’s been some sort of reluctance to talk about this openly because of the potential danger of it.”

Page-Shafer and her colleagues say they were able to pinpoint the risk facts for oral HIV transmission using new techniques that allowed researchers to identify HIV infections had been acquired within the last 129 days of observation. That makes it easier to identify people who have exclusively had oral sex during that period, rather than simply relying on conversations with people about their past behaviour.

But even with these optimistic results, Page-Shafer isn’t suggesting everyone abandon condoms for blowjobs.

“I want to emphasize that, while rare, acquiring HIV infection orally is possible and that many other sexually transmitted diseases such as gonorrhea, chlamydia and syphilis are transmitted orally,” she told last year.

She says there’s a lot of misinformation out there.

“I’ve talked to a lot of counselors, and none of them tell patients the same thing. Some say use mouthwash, other say don’t…. Some say don’t floss or brush for an hour before and after, others say for four hours… It’s amazing to me how much supposed knowledge has built up around [oral sex and HIV] when there is actually no scientific data.”