(Ed. note: As part of our continuing series on health issues associated with AIDS, we are presenting an article which deals with sexual information in an honest and often explicit fashion. Rather than censor what we feel to be important and potentially life-saving educational infor- mation, we leave our readers to exercise their own judgment in reading this piece.) Is oral sex safe? Most gay men are acting as if it is, at least according to studies being done. Eighty percent of the gay men in one survey reported unprotected oral sex, results which are reflected in other studies and the informal observations of those who work in AIDS-related fields. But is it really safe, or are we just kidding ourselves because we're not will- ing to give up something that has long been our most common form of sexual expres- sion? Statistically speaking... Among those working with AIDS, discussion of oral sex can set off heated and angry debate between divergent points of view. And while it may be amusing to think of research scientists, epidemiologists, and public health officials all yelling over the relative merits of the blowjob, the implica- tions for our lives are quite serious. There is, unfortunately, no definitive answer to the question of whether HIV is transmitted through oral sex or not. Impor- tant evidence is cited by both sides of the argument. The case that HIV can be transmitted orally was bolstered recently by a report from San Francisco claiming that two gay men enrolled in a long—term study were infected with HIV when their only risk was unprotected oral sex. This report is the best documented of a small handful of cases (under ten) published in the medical litera- ture which suggests oral sex as the route of acquiring IHV. Even though these cases have surfaced, they all rely on the same thing: self-reporting of behavior by the person infected with HIV, which is, by nature, completely impossible to verify. Those who argue against the likeli- hood of oral transmission point out that (with the exception of the two recently reported cases from San Francisco) no evidence of it has emerged from the ongo- mg large-scale epidemiological studies of Oral Sex: Is It Safe? gay men's sexual activity. In these studies, men who report having oral but no anal intercourse have not tested positive. Since these studies involve thousands and thou- sands of gay men over extended periods of time, they argue that some transmission would show up if it happened. But critics of that point of view note that relatively few people (particularly in the pre-AIDS period) have a history of participating in only oral sex or only anal sex. There is no way of knowing for certain that HIV positive men who have had both forms of sex didn't actually get the virus through an oral route, instead of the anal route assumed by researchers. While population studies have defini- tively implicated unprotected anal and vaginal intercourse in HIV transmission, at this point they cannot report with the same degree of certainty about oral sex. Biologically speaking... Biologically, oral sex seems to present less of a risk than anal sex. The mucous membrane of the rectum appears to be far more likely to absorb HIV into the blood- stream than does the mouth; the rectal wall lining is both more porous and more likely to tear during sex than is the lining of the mouth. Yet there is always the possibility of cuts, tears, and abrasions in the mouth, meaning that infected semen or pre-cum could find access to the bloodstream. While such a route appears unlikely, it is not impossible. The risk is relatively one-way, with little risk for the partner whose penis is being put in the mouth, and higher risk for the partner whose mouth is being entered. In the final analysis, oral sex falls into a grey area of uncertain risk, and everyone must decide how much risk they are will- ing to take. Mathematically speaking... That decision-making, like all deci- sions about safer sex, involves a compli- cated calculus, and the answer will not be the same for everyone. The seronegative partner of a person known to be HIV posi- tive may decide that the risks involved in unprotected oral sex are greater than those which they are willing to take together, while partners who are both negative or both positive may decide that they are acceptable for them. Those who do not January 1991 know the HIV status of their partner or partners (or their own status) face an en- tirely different set of issues and equations in weighing risk. Likewise, someone who decides to participate in oral sex may choose different ways to reduce their risk. For some, using a condom is a possibility — although for many people, the taste of latex is too unpleasant to consider. (That can be helped somewhat by flavored condoms and lubricants.) Others may engage in oral sex without taking the tip of the penis entirely in the mouth, using tongue, lips, and teeth to (continued on next page) Forconfidenfial AIDS Information Call 1-800-882-AIDS O.