By Andy GibsonLong before AIDS made an entry into our dictionaries and our daily paranoias, there were other sexual scares: syphilis, gonorrhea, chlamydia and genital warts, to name a few. But no one really talked those days about safe sex (although some of these other sexually-transmitted infections could also eventually cost victims their lives). In stopping sexual permissiveness dead in its tracks, AIDS may well have done us a favour: because, the careful sexual behaviour that is our best security against AIDS also constitutes our best protection against other Sexually Transmitted Diseases (STDs).
The essence of safe sex is avoiding high-risk partners and practices, and using condom-management strategies. But when it comes down to the specifics, many questions arise:
Who are the high-risk sexual partners?
The high-risk groups are homosexuals, bi-sexuals, prostitutes, intravenous drug abusers; heterosexuals from Central Africa where AIDS is common; those who have had multiple blood transfusions in areas where AIDS is rampant. Sexual episodes with high-risk partners are the most common way the infection is passed on.
The risk of acquiring AIDS from one penis-vaginal intercourse episode with someone from a high-risk group has been estimated to be: (with condom) - 1 in 100,000 to 1 in 10,000; (without condom) - 1 in 10,000 to 1 in 1000. (The wide range of odds is because of different rates of infection among high-risk groups).
Of course, someone who's not a high-risk partner is not necessarily a no-risk partner. When two people sleep together, it's essentially group sex: they are in effect sleeping with everyone each of them has slept with in the past five to ten years.
How many sexual encounters with a high-risk partner would it take for the virus to be transmitted?
The virus can be transmitted through just one sexual encounter with an infected person. But the chances are less than in the case of multiple encounters with high-risk persons. In one study at the University of California, less than 10 out of 100 persons were found to have contracted the virus through a single sexual encounter with an infected person. But another study found that the odds got steadily worse with continuous sexual activity with an infected partner over a two-year periods - 12 out of 14 people ended up infected.
That is why another cardinal commandment of safe sex: avoid multiple sexual partners. Especially if they are unknown, casual partners, you have no way of knowing which of them is infected, and with every encounter, the laws of probability favour you less and less. Sex with a single, known, trustworthy partner is one of your best armour devices against serious infection. So, if you've tried the rest, now try the best: monogamy!
Is a man more likely to give the infection to a woman than the other way round?
Sperm does appear to contain a higher concentration of the virus then vaginal secretions and the virus does appear to be more efficiently transmitted from men to women then from women to men. But men shouldn't get too smug about this. In Africa, where the disease has had more time to do its work, there's a one-to-one infection ratio between men and women.
Which is the most risky sexual practice?
Without question, anal intercourse without a condom. The walls of the rectum are thinner than the vaginal walls and therefore more prone to abrasions and tears. So, the AIDS virus from an infected partner's semen is absorbed more easily during anal sex.
Other high-risk practices (with an infected partner) are condomless vaginal intercourse fellatio, cunnilingus, the sharing of insertive sex toys and anything that would involve blood contact.
Moderate-risk practices are French kissing, oral sex using condoms, vaginal sex using condoms and spermicide, and anal intercourse using condoms and spermicide.
How safe is kissing?
The AIDS virus is carried by bodily fluids - apart from semen and blood, that includes urine, vaginal secretions, tears, saliva and even faeces.
Does that make practices like oral sex and 'tongue kissing' unsafe? The virus is found only rarely in saliva. In a study of 83 patients (reported in The New England Journal of Medicine), the virus was detected in the saliva of only one.
In another study reported in the same journal, in families where an AIDS -infected member shared food, drink, cutlery and crockery with the others, not a single non-infected person caught the virus.
In these same households, members kissed each other without spreading AIDS. Kissing on the cheeks and lips appears to be perfectly safe. And, to date, there's no evidence that saliva transmits the virus.
Still, since the virus has been isolated in saliva (although in rare cases), caution is the better part of l'amour, especially where deep kissing or French kissing - the kind that curls your toes - is concerned. In the U.S., the Surgeon-General has advised against it. While there has been no documented case of the spread of AIDS in this way, it would be difficult to document because people who start with this kind of kissing often don't stop there. Although most researchers feel that transmission is unlikely even from erotic kissing because there probably wouldn't be an adequate amount of virus in the saliva or a sufficient amount of saliva exchanged, the fact remains that it's theoretically possible.
How risky is oral sex?
So far, researchers haven't confirmed a single case - in either homosexuals or heterosexuals - attributable to it. But, as with deep kissing, it's difficult to document because oral sex so often goes along with other sexual activities. Therefore, the experts advise against letting semen enter the mouth. The risk is lowered if the man wears a condom or doesn't ejaculate in his partner's mouth. But both need to remember that a small amount of the virus may be present in the pre-ejaculatory fluid.
Oral sex is less risky for a heterosexual man, because he usually comes in contact with less fluids. Still, the virus can exist in small concentration in vaginal fluids.
What are the safe-sex activities you can indulge in with a partner of doubtful credentials?
There are several such activities you can enjoy short of intercourse: dry kissing, hugging and caressing, massage and mutual masturbation (provided the man does not ejaculate near the woman's vagina; and provided vaginal secretion do not come in contact with broken skin).
Don't condoms offer foolproof protection against STDs?
Condoms have been shown to be laboratory-effective in blocking the transmission of gonorrhea, syphilis and herpes. The most efficient are latex condoms which have been studied under the electron microscope - neither bacteria nor viruses have been able to penetrate them. That includes the AIDS virus, which is about 25 times smaller than a sperm.
Some experts however have their doubts about the efficacy of condoms made from natural skin, such as lambskin, in blocking transmission of the microscopic AIDS virus. These condoms are made of hundreds of layers of porous collagen. Although the chances of a virus navigating through them are slim, lab tests have shown it's possible.
However: Even with latex condoms, when it comes down to actual practice, they have never been anywhere near 100 per cent reliable. They slip, they break, and people often don't use them soon enough, or withdraw them carefully enough. Consider this noteworthy statistic: one out of 10 women who rely on condoms as contraception still get pregnant each year - although contraception can occur only a few days each month. In contrast, you are susceptible to the AIDS virus 365 days a year.
Here's how condoms fared in one real-life study of couples, one of whom was infected and relied on condoms to prevent the spread of the virus to the non-infected partner. After using condoms for between one to three years, three of the 18 spouses contracted the virus, a failure rate of 17 per cent. Says the study's chief researcher, Margaret Fischl of the University Of Miami School Of Medicine, "Our study shows that using condoms decreases the risk, but clearly it's not a foolproof system". Evidently, there is still no such thing as 'safe sex' with an infected partner - only degrees of risk.
How can you improve your margin of safety using condoms?
- One of the best ways is to use them in tandem with s spermicide which contains the active ingredient nonoxynol-9. This ingredient has been shown to kill the herpes and AIDS viruses (at least under lab conditions).
- Choose latex condoms over those made of animal membrane such as lambskin. Latex is less porous.
- Choose the well-known brands. They are more likely to have undergone thorough testing and less likely to have undetected holes.
- As a general rule, the thicker the condom the greater your margin of safety. (That again makes latex your best bet).
- Check that the condom you use has a reservoir or receptacle at the end so that semen can't spill over the sides during ejaculation. By catching semen in its reservoir, this kind of condom also lowers rupture risks to near-zero.
- Never use petroleum-based lubricants such as petroleum jelly with a latex condom - they will cause the latex to disintegrate. But, lubrication does help prevent condom from tearing. Use K-Y jelly, water or - best of all - a spermicide containing nonoxynol-9. (Do not use saliva).
- Put on the condom as soon as erection occurs, don't wait until ejaculation is imminent - some viruses may escape in the pre-ejaculatory fluid.
- When you remove the condom from its wrapper and place it over the tip of your penis, make sure it doesn't catch on a ring or fingernail.
- The condom should seal tightly to your skin. A condom that makes hasty withdrawal necessary, and semen spillage possible, is injurious to your partner's health!
- Withdraw right after ejaculation, because if the erection is lost the condom may slip off, allowing semen to escape. Hold on to the rim of the condom as the penis is being withdrawn.
- Dispose of the condom safely so that no one (a child, for example) could accidentally come in contact with semen.
- Don't 'store' a pare condom in your wallet or the glove compartment of your car. Heat damages latex. Condoms should be stored in a cool, dry place like a bedside drawer.
Sexually transmitted diseases, particularly syphilis and chancroid, are associated with genital ulcers, which allow the HIV virus easy access to the bloodstream.
Isn't there any foolproof protection against AIDS?
There are two. One is to stay celibate: an answer which, for most of us, is of course a non-answer.
The second is to have sex only with a partner who has been tested for AIDS. But this is not an easy, or practical, as it sounds. It arises from the fact that the so-called "AIDS test" is not really a test for AIDS at all. It is a blood test that detects the presence of antibodies produced by the body to fight the invading virus - called the Human Immunodeficiency Virus. (It's therefore called the HIV test). If the test detects these antibodies, what it means is that, at some point of time, the person was infected by the virus.
However - and this is where the main snag arises - it takes anything from a fortnight to six months for the body to produce the HIV antibodies. This is the so-called "window phase" - the period during which the infection, while already present, may not be signaled by the test because the antibodies haven't yet been produced. What this means is that a negative result on the HIV test (no antibodies) is valid only if the test has been done at least six months after the last sexual exposure.
On the other hand, there have also been problems with the use of the ELISA test to detect HIV antibodies - quite commonly, especially in the case of heterosexuals, ELISA has shown false positives! To exclude the possibility of error, a positive result with ELISA must be confirmed with the so-called Western Blot test. If the results are confirmed, that's bad news, but both tests should be repeated a few weeks later to ensure that there was no mix-up in blood samples in the lab.
However, even if a potential sexual partner has been certified as HIV-negative, remember that sex with such a partner is 'safe' only until his/her next sexual encounter. After that, as they say, all bets are off. (Unless, of course, you and this partner enter into a mutually monogamous relationship - after you too have tested negative!)
What's the bottomline in safe sex?
It's that, where safe sex is concerned, it's better to be a believer in healthy overreaction than to go by the no-case-yet norm. As late as 1984, the medical world was saying we have 'no case yet' of the heterosexual spread of AIDS. One year later, oops, we'd got one. Since AIDS may have a few other unhealthy surprises in store, it's better to err on the side of caution.
One morsel of good news: while some people acquire the virus after just a single exposure, others don't acquire it after repeated exposures. What this means is that, even if you've been having unprotected sex for years, it's conceivably not yet too late to start protecting yourself.
Use condoms, use caution, use commonsense - remember, the AIDS virus cannot get you without your active co-operation!