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Risk of hiv transmission via precum in oral sex

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LiveWithIt:
There has never been a documented case of oral transmission of HIV, and I"m sure out of the millions who have engaged in this that some of them have had lesions or abrasions  in their mouths and still no documented case. 

Giancarlo:

--- Quote from: LiveWithIt on November 07, 2013, 10:21:03 AM ---There has never been a documented case of oral transmission of HIV
--- End quote ---

How can you say that?
And how is that possible that no one has reacted yet after one week???
I was infected orally, and from what I read in many forums, I am far from being an isolated case. In fact, a French team found in a recent study that 25% of the patients enrolled in their study reported an oral transmission. I don't see any reason why they would be wrong. (The assumption that they would lie because they are too ashamed to acknowledge that they have had unprotected anal sex is really not convincing.)
http://journals.lww.com/jaids/Citation/2013/08150/Increasing_Frequency_of_Self_Reported_Orogenital.23.aspx

You call for "documented cases of oral transmission of HIV", but what would that be anyway? You put a guy in a room and make him suck poz guys for a few months without letting him go out of the room, and then test him?

jkinatl2:
Yeah, once you move past the patient report (which is notoriously unreliable) the amount of HIV transmission documented from performing fellatio becomes less than negligible.

Which is why, in AM I INFECTED, we present performing fellatio as being a form of safer sex in all but the most outrageous circumstances (insertive partner with a huge viral load, receptive partner with "meth mouth" or similar slaiva-inhibiting situations not found in everyday life).

That, and the three serodiscordant couples' studies are the basis of the science we use to determine HIV risk on this controversial topic.


*edited to add: Yay! Shitstorm!

Ann:
It's also very telling that there has never been a documented case of a woman who claimed to have been infected through a blowjob. There has also never been a case of a woman claiming a blowjob as their transmission route in patient disclosure studies.

Given that there are more women in the world who give blowjobs than there are men, and there are more women world-wide living with hiv than men, it makes men's claims of the blowjob route rather dubious.

"Documented case" means that the virus has been verified to have come from the claimed source.

Giancarlo:
Well, I have to admit, all the things that you say are exactly the kind of arguments that really convinced me that I was playing safe in the last 10 years, even when I was frequently performing blowjobs to casual partners.
And now here I am, on a poz forum... :-\

Telling a girl, who is panicking after doing a single blowjob to a single heterosexual guy, that she is most probably safe, is one thing.
Telling an homosexual guy that he will never get into any kind of troubles if he gives blowjobs to many casual partners on a regular basis during 10 years or more, is another thing.
The first thing is true, the second is not. Stating that there has never been any documented case of oral transmission of HIV is misleading! I don't claim that the risk of oral transmission is as high as the risk of unprotected anal transmission. But I am sure that it is not negligible in a context of long-term frequent exposure. And I think that you don't need meth-mouth or open sores in your mouth or whatever for the oral transmission to occur, you just need a partner during his primary infection, or any untreated partner with a high viral load. I also believe that the risk of transmission is also increased by the presence of a pharyngeal infection (such as chlamydia or gonorrhea, or even a simple tonsillitis).
A partner during his primary infection is maybe "not found in everyday life", but it definitely can be found a few times in 10 years of a sexually active gay guy's life.

From what I have understood, oral transmission of HIV is not uncommon at all in MSM (at least it is very often reported), while it seems to be very rare (or very rarely reported) in heterosexual women. In any case, we have to understand why: why oral transmission is effectively more frequent in MSM, or why is it frequently (wrongly) reported in MSM and never (wrongly) reported in heterosexual women.
I can think of many reasons why oral transmission could be more frequent in MSM, but I don't see any reason why women would be less prone to wrong reporting of oral transmission than MSM.
Before going into more details, could you please give me the references of the 3 serodiscordant couples' studies that you refer to?

Now a few hints of why I think that oral transmission is not negligible in the MSM community (while it is negligible in the heterosexual community).
MSM statistically have more partners and the prevalence of HIV is higher. They also tend to do deeper blowjobs (deep throat) and the prevalence of other STI is also higher (for example pharyngeal chlamydia, which is increasingly common), which increases the risk of HIV transmission. It is also common practice in the MSM community to always use condoms for anal intercourse while never using any protection for blowjobs, so for many people it is quite easy to come to the conclusion that they were infected while doing a blowjob. In the heterosexual community, the occurrence of unprotected vaginal or anal sex is usually high so it is more difficult to rule out any other transmission route than oral sex. The effect of oral transmission is masked out because when both unprotected vaginal/anal and oral sex are reported, it is always assumed that the transmission was caused by the vaginal/anal sex.


--- Quote from: Ann on November 16, 2013, 03:40:26 AM ---Given that there are more women in the world who give blowjobs than there are men
--- End quote ---
This is true in the western world, where HIV prevalence is very low in the heterosexual community.


--- Quote from: Ann on November 16, 2013, 03:40:26 AM ---and there are more women world-wide living with hiv than men
--- End quote ---
This is true in the rest of the world. I am not convinced that blowjobs are a common sexual practice in, say, rural Africa, where the prevalence of HIV is very high in the heterosexual community. (Actually I have no idea, I don't mean to be offending here.)


--- Quote from: Ann on November 16, 2013, 03:40:26 AM ---"Documented case" means that the virus has been verified to have come from the claimed source.
--- End quote ---
Yes you can verify that the transmission occurred from patient A to patient B. But how can you verify that it was an oral transmission? You can only rely on self-reporting for that.

Hope to keep exchanging on this topic.
More on that later (when I have read the three studies that you mention).

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