Advice on Safer Sex (Including Oral Sex)


This document is reprinted from the original at http://www.gay.com/pages/health/safe.html, which you may wish to visit if you are interested in this topic.
If you have further interest in this topic, you may also wish to browse one or more of these related sites: http://www.stopaids.org/AIDSpre.html

THE SAFE SEX GUIDELINES (including information on oral sex - see below)

SAFE SEX - This is What we Know:

About HIV

HIV is the virus that causes AIDS. HIV is spread when semen or blood passes from an HIV+ person into the bloodstream of another person. To enter the bloodstream, the virus must enter through a break in the skin or tissue in the mouth, or pass through the lining of the rectum or enter the tip of the penis. Tops and bottoms are both at risk.

About Drugs and Alcohol

Most drugs affect our inhibitions about sex. They can also affect our judgement. The most important thing to remember when mixing sex and any drug is to plan ahead. Always have condoms and water-based lube anywhere you may be having sex.

About Oral Sex

Oral sex is considered to be much less risky than anal sex. There are ways to make it safer. You can choose to use a condom. Avoid getting cum in your mouth. By not brushing or flossing your teeth just before oral sex, you can reduce the risk of bleeding. Avoid vigorous throat-fucking. You can make rimming safer by using a dental dam, saran wrap, or another barrier. It's your choice.

A Word about Lube

Always use water-based lube with condoms. Do not use Crisco, Vaseline, olive oil, chocolate syrup or anything else with oil in it. Oil causes latex condoms to break down resulting in holes, tears and breaking. Look for the words "water-based" on the label. Happy shopping! 

Silence Still Equals Death

- Dan Wohlfeiler, Education Director

"I was madly in love."

"He got me sooooo hot."

"I was drunk."

"I assumed he had the same HIV-status, since he was willing to do it without rubbers."

"I've lost everyone who was close to me, and I can't go on."

"I took a calculated risk."

"It feels better without a rubber."

We've all heard, or given, these reasons for unsafe sex. New ones get invented over the years, although mostly they stay remarkably the same. Unsafe sex continues -- over a quarter of gay and bisexual men in our city report having had unprotected anal sex in the last year. Too many of us are becoming infected. Too many of us are dying for us to accept this level of unsafe sex. We have to change how we respond to unsafe sex, and how we communicate to each other about sex. It's our responsibility as individuals and as a community. It's what's needed to assure our future.

When you're tempted to have unsafe sex, you can make a choice. You can say yes or no. Unprotected fucking may feel better, but there may be tremendous risks to one or both of you. Staying safe helps you avoid the anxiety of wondering whether HIV was transmitted between the two of you, and saves you from looking for one of the excuses listed above.

If a friend tells you that he fucked the night before without a rubber, there are lots of valid responses. Ask yourself what you would want to hear if you were in his place. Caring confrontation, where you communicate your concern to the person who's engaged in risky behavior, is your responsibility.

Maybe the response is "What the hell did you do that for'?" Maybe it's "Do you know what the risks are?" Maybe it's "Call the hotline, or go to a STOP AIDS meeting.*" Maybe it's "I care about you too much for you to take that kind of risk." The only inappropriate response is silence: silence equals death.

In addition to our individual responsibility, we Have a community responsibility to stop transmitting HIV to one another.

In the beginning of the epidemic, our community did take that responsibility. We made history by quickly reducing the most intimate and riskiest behavior -- unprotected fucking -- on a larger scale than anybody had ever seen before in the history of public health. And part of our response was to create our own organizations which could help educate, motivate, and maintain those successes.

But AIDS prevention agencies can't do it alone. They can only catalyze what the rest of us need to do for ourselves. We all need to confront what we're doing, seek help if we need it, and explicitly encourage one another to do the same.

You can go home tonight and spend five minutes thinking about your own level of risk. You can talk to three of your friends about how safe they're being. And if you're going to fuck tonight, use a rubber.

As a community, we have rallied against profiteering drug companies and unresponsive governments. We also have the responsibility to rally ourselves to change the way we have sex. We've made huge successes when it comes to confronting external obstacles; we've been more timid at confronting ourselves and one another.

We need to unite. We need to talk openly. We don't need to go back and reinvent prevention; we need to strengthen it. We need to reorganize ourselves, think through our priorities, and most importantly, reinvent hope. Hope is what it will take to encourage HIV-positive men and HIV-negative men, both overwhelmed by taking care of themselves and one another, to stay safe.

In the 25 years since Stonewall, our community has made astonishing progress. By having safe sex today, you're helping build the foundation for our community's success during the next 25 years, and the 25 after that.

*Call STOP AIDS at (415) 621-7177. The San Francisco AIDS Foundation Hotline number is (415) 863-AIDS. Both can help, and both can refer you to other agencies to serve your specific needs. If you're having trouble staying safe, or if you want to be a part of the community response, call.

Oral Sex: How Safe is It? Has anyone gotten HIV through oral sex?

The San Francisco Department of Public Health has recorded at least three cases of men who have become infected with HIV through oral sex. This isn't very many, considering how many men have oral sex. Other cases have been reported elsewhere.

Unfortunately, we can't tell you "just do it," and we can't tell you "just say no." We can give you facts to help you make the choice that's right for you.

Unprotected oral sex is certainly much safer than unprotected anal sex. Why?

Receptive oral sex - sucking dick, or going down on someone - is certainly riskier than having someone suck you.

HIV is in pre-cum, as well as in semen. But there's usually less pre-cum than semen during any one sexual act. It's unlikely that pre-cum by itself can transmit HIV, but it's possible.

The length and intensity of the sexual act may affect transmission. If his dick is pounding against the back of your throat, your tissues may become irritated, becoming more permeable and increasing the likelihood of infection.

Other health factors may affect risk.

What can you do?
Oral Sex: Its Up to You

- Dan Wohlfeiler, Education Director

It's happened hundreds of times. A guy gets introduced to me. He asks what I do. I tell him I work at STOP AIDS. He gets that quizzical expression that is so familiar to me.

"Can I ask you a question?" he asks. I guess what's on his mind, and respond before he goes ahead.

"It's a lot less risky than unprotected anal sex," I tell him, "but I can't tell you that there's no risk. There are certainly cases of guys that have gotten infected through oral sex.:"

I've never guessed wrong yet. I also know that I've never told guys anything they didn't know. Other times, they go the calculus route.

"Some people tell me it's less risky than going 65 miles an hour down the freeway," they tell me, "and others tell me it's five times riskier than going down Market street in a convertible."

I never fill in all the numbers for them. But sometimes I'll ask, "If I told you that the risk of going down the freeway was .0025x, and the risk of going down Market Street was .003x, and you knew what x was, would that really help you decide what to do?"

At STOP AIDS workshops, we've repeatedly tried asking some questions that help guys figure out the difference between what they know, and how they make decisions based on that same knowledge. This exercise usually works best for HIV-negative men. I'll get to HIV-positive men's reactions in a moment.

We ask, "How many of you would go down on someone who was HIV-negative?" Most hands fly up.

"How many would go down on someone who's HIV-positive?" we ask. Most hands fly down.

"How many of you would go down on someone whose status you don't know?"

Most of the hands waver for a while. Some go up. More go down. The point seems clear enough. The vast majority of us know that there's some risk. Many of us are comfortable with the risk; some of us aren't.. Some of us only become uncomfortable when we stop to think about what we're doing. Mostly, it drives us nuts that we can't tell exactly how much risk there is. All of us are constantly trying to figure it out. We read every new article that comes out, hoping to read that without a shadow of a doubt, there's no risk to sucking dick. Rumors, anecdotes and facts blur together.

Oral sex serves as a lightning rod for many of our anxieties about the epidemic.

Many HIV-positive men probably make another calculation. One friend of mine responded to being warned about catching gonorrhea or herpes or some other STD with another vehicular metaphor. "What, I've been hit by a Mack Truck, and now I'm supposed to worry about getting hit by a Toyota Tercel?" If you're positive and like to get sucked off, make sure you're making informed decisions about what you're doing with an HIV-negative partner. Or a partner whose status you don't know. Make sure your partner is making an informed decision as well.

In the meantime, however, gay men need to take responsibility making the best decisions they can with the information that we now have. In Boston, they've recently come out with a campaign that says "Oral sex is safer sex." Other cities have as well. They're right. It is safer than unprotected fucking. They're also not saying it's safe.

About to become confused? What DO you do with this information? There are certainly ways to reduce any potential risk. And reducing risk may have the added benefit of reducing anxiety.

If you have a reasonably active sex life, and try to follow the various instructions regarding when to floss and brush, you can end up doing endless calculations. If you're supposed to wait 24 hours after you floss but you're having sex a couple times during the weekend, just when do you get the floss out? Basically, a little routine maintenance will go a long way. Keep your mouth in good health, floss regularly, brush regularly. If you think you're having sex in the immediate future, give your gums a break for a bit.

Meanwhile, when you're sucking, avoid having him pound his dick really hard against the back of your throat. It may irritate the tissues in the back of your throat, making them more absorbent and it easier for the virus to get into your bloodstream.

Wearing a condom is one possibility, although many guys don't like it. (Keep in mind we're not sure how many men have tried it.) They make condoms with various flavors. And if you don't like the flavors, there are unlubed ones that you can flavor with your favorite food. Just watch the Hershey's chocolate syrup and other products that have oil in them. They can dissolve the sturdiest piece of latex.

There's also a basic hygiene question for us all to think about. Would you drink from a perfect stranger's glass? Would you put your mouth around a perfect stranger's dick?

You might, particularly if there are no creepy-crawly things floating in the glass, or oozing from the head of his dick. But if on your partner's penis you see a sore, or a colored ooze, or something that looks like a zit, you might want to pause. Maybe there's something or someone else to do. Remember that HIV isn't the only thing you can catch from sucking dick. There are other sexually transmitted diseases that you can get from sucking, or getting sucked. Many of them are treatable, but they're just plain not good for you.

One useful gauge to help manage this is your own anxiety level. If ten minutes, or ten hours after sucking dick, you're biting your fingernails and tossing and turning in bed, you may want to stop to consider what you're doing. Sex - good, hot, sex, no matter whom it's with - is something that's supposed to feel good. It's most definitely not something that's supposed to make you feel worse afterwards.

No matter what, it's your choice. It's important that you make decisions - whether you're positive or negative - that are healthy and informed for you and your partner. The decisions you make are up to you.

If you want to find out more about how other guys are wrestling with the same concerns that you have, come to a STOP AIDS meeting. Many guys find that trying to make these decisions about sex is difficult. It helps to hear what other people are doing with the same information. If you would like to have a workshop with your own friends, we'll be glad to provide the facilitator; and if you want to come to a workshop with guys you don't know, we can also arrange that.

Call us at 621-7177. Ask for Mike. 

What's Your Pleasure?

Avanti:

This is the first commercial polyurethane male condom on the market. It is made of plastic rather than latex. It is thinner than latex condoms, stronger, and won't be damaged by oil-based lubricants. (Caution: oil-based lubricants will damage latex condoms.) The thinness of this condom is designed to increase sensitivity. Laboratory tests have shown that particles, even as small as sperm and viruses like HIV cannot pass through the polyurethane material. Available lubricated in 3 and 6 packs.

Maxx:

The first of the larger sized condoms, this condom measures in at 7 1/4" x 2". The thinner, high quality latex makes this one of the more sensitive larger sized condoms. Its design adds extra length as well as extra head room. If you're looking for a condom with greater width, try either the Trojan Magnum or Trojan-Enz Large. Maxx is available lubricated with or without Nonoxynol-9 in 3 or 12 packs.

Lifestyles Extra-Strength:

For those who play a little rougher or who have marathon sessions, this condom might be a good option. Extra-strength condoms are thicker but can break too if misused. Make certain to use a water-based lubricant and check occasionally to make sure the condom doesn't start to dry out and get sticky. The thickness of extra-strength condoms can decrease sensitivity. Available lubricated in 3 and 12 packs.

Lifestyles Snugger Fit:

This contoured condom is ideal for a man with a slimmer penis. Men who have had a problem with condoms sliding off or who prefer a tighter fitting condom may want to try this one. Other contoured condoms include Prime Snugger Fit and Exotica brands. Lifestyles Snugger Fit condoms are available lubricated in 3 and 12 packs.

Pleasure Plus:

The Pleasure Plus condom has a unique design. It has an extra pouch of latex at the end of the condom designed to roll back and forth over the underside of the head during intercourse. The folding action is designed to stimulate the nerve endings in the glans. Despite its somewhat awkward appearance, it has become a very popular condom. (A helpful hint: the thicker side of the rolled condom is the pouch. Place this side on the underside of the head and roll the condom down the shaft.) Available lubricated in 3, 6 and 12 packs.

Rough Rider:

This studded condom has hundreds of raised dots on the exterior along the shaft designed to increase stimulation. For those looking for a condom with a little extra something, this may be the condom for you. The raised dots increase the thickness of the condom which may decrease its sensitivity. Available lubricated in 3 packs.

Glyde "Lollyes" Dams:

Finally, no more mini-trampoline dams or plastic wraps that cling to themselves! The "Lollyes" dams are a latex barrier designed for oral sex. These dams are 6" x 8" and are powdered lightly with corn starch rather than talc powder. Make certain to cover the entire orifice that you're licking. Do not share or reuse dams. "Lollyes" dams are sold individually at Good Vibrations.

Kimono Micro Thin:

The Kimono Micro Thin condom is almost 40% thinner than regular condoms. The thinness of the condom increases sensitivity while still offering strength and safety. Its thinness and light lubrication make it an option for oral sex too. (Condoms lubricated with Nonoxynol-9 have a bitter taste.) Other condoms from this manufacturer include: Kimono, Kimono Sensation and a larger sized condom, Maxx. Available lubricated with and without Nonoxynol-9 in 3 and 12 packs.

Condoms come in a variety of shapes, sizes, textures, flavors and colors. The STOP AIDS Project encourages you to try these or other styles until you find the one(s) that work best for you.

Have some fun, experiment, play around!

How to Use Condoms
  1. Be sure to have condoms ready for use, wherever you use them.
  2. Carefully tear open the package.
  3. Be careful not to damage the condom with a fingernail or other sharp object.
  4. Do not unroll the condom before there's a dick to put it on. Do not inflate it. This will make it unreliable.
  5. Squeeze tip of the condom between thumb and forefinger to expel air.
  6. Put on the condom when the dick is fully erect.
  7. Place a rolled up condom on the dick, if uncut, draw back the foreskin.
  8. Roll the condom down over the whole length of the dick. Get rid of air bubbles.
  9. Use extra water-based lube if necessary. Oil-based lube will break down latex.
  10. Hold the base of the condom, withdraw while the dick is still stiff.
  11. Use each condom only once. (Have some extras available!)
  12. Tie up the condom and dispose of it. Do not put it in the toilet.
HIV Antibody Testing in San Francisco

The AIDS antibody test is a test to see if you have antibodies to HIV in your blood. Having antibodies to HIV only shows that you are infected. Being infected is not the same as having AIDS.

If you test negative and haven't put yourself at risk during the six months prior to the test, that means antibodies to HIV were not found in your blood. A negative test will not change over time unless you allow the virus into your body. This is a good time to review your own safe sex guidelines.

If you test positive, antibodies to HIV were found in your blood. Early intervention can keep you healthier longer. Don't risk infecting someone else, or reinfecting yourself with another strain of HIV. This is a good time to review your own safe sex guidelines.

Anonymous testing means you never give your name. No one - except you - knows the results.

Confidential testing means the test results are connected to your name. Other people may be able to get those results.

This is where you can be tested

ANTIBODY TEST SITES
415-554-9888 

     (Multilingual translators,TTY Available)
     Anonymous testing and counseling at several locations.
     Day, evening and Saturday appointments available.
     Free
CITY CLINIC
487-5500
356 7th Street 
     English and Spanish.
     Wheelchair accessible.
     Provides anonymous and confidential testing and counseling.
     $10 donations requested.
CALIFORNIA PACIFIC MEDICAL CENTER
3700 California Street
750-6481 
     Anonymous antibody testing, pre-test and post-test counseling. Test
     done within 1 or 2 days, results in 7 days.
     $75
Need help staying safe? - Call one of these agencies:

 TRILINGUAL HOTLINE
415-863-2437 (800-367-2437) 

     (English, Spanish, Filipino)
     Up-to-date information on all aspects of safe sex, HIV and AIDS,
     medical and psychological referrals.
BAY POSITIVES
518 Waller Street
415-487-1616 
     Offers support groups, counseling, health care and social services
     for anyone 26 or younger with HIV.
BROTHERS NETWORK
625 O'Farrell Street
415-749-6714 
     Offers multicultural and multi-ethnic support groups, peer
     counseling and advocacy for people with HIV.
AIDS HEALTH PROJECT
476-6430 Main switchboard
476-3902 Support groups 
     Offers mental health counseling and support services to positive
     and negative men affected by the epidemic.
18TH STREET SERVICES
217 Church Street
415-861-4898 English
415-861-8803 Spanish 
     Offers outpatient substance abuse treatment, group and individual
     counseling
PROJECTO CONTRA SIDA POR VIDA
3690 18th St. 415-864-7278 
     Offers advocacy, support and referrals for Latino/as with HIV
     infection.
AIDS INFO BBS
Worldwide 415-626-1246 
     Free computer bulletin board service with current information on
     HIV and AIDS.
COMPASS PROJECT
San Francisco AIDS Foundation
25 Van Ness Street
415-864-0968 
     Offers one-on-one peer support for HIV+ and HIV- men concerning
     safe sex and related issues.
GAY ASIAN PACIFIC ALLIANCE
1841 Market Street
415-575-3939 
     Offers emotional and practical support, counseling and case
     management for Asians and Pacific Islanders.
KAIROS HOUSE
114 Douglas Street
415-861-0877 
     Offers support groups, counseling and workshops for caregivers of
     HIV infected persons.

AIDS IN SAN FRANCISCO AS OF March 31, 1996

THE POPULATION:

THE DISEASE AND ITS TOLL: BEHAVIOR CHANGE: CHRONOLOGY OF THE STOP AIDS PROJECT: SOURCES OF INFORMATION

 Infection rates, number of cases and deaths: San Francisco Dept. of Public Health AIDS Office and CDC. Percentage of gay men: 1989 survey for SFDPH by Communication Technologies.

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