SAFER SEXLiz A. Highleyman Acquired Immune Deficiency Syndrome (AIDS) is believed to be caused by a virus called HIV, which weakens the immune system and makes the body less able to fight infection. A person who is HIV+ (tests positive for HIV antibodies) may have no symptoms, or may have opportunistic infections such as certain cancers or pneumonia. There is currently no cure for AIDS, but it can often be controlled with drugs. HIV+ people may be symptom-free for years, and people with AIDS (PWAs) may live for years with the disease. In the age of AIDS, everyone should know about safer sex. HIV can infect anyone, regardless of sexual orientation, sex, age, race, or economic class. While the incidence of AIDS is much higher in some populations than in others, it is not who you are that can give you AIDS, but what you do. Only you can decide what kind of sex is right for you and what risks you will take. Some people take all possible precautions with every partner for their own peace of mind and so they do not have to rely on others for their safety. Others choose to forgo some or all precautions depending on their relationships and lifestyle. This brochure talks about various risk factors and offers suggestions for making sex as enjoyable and risk-free as possible. THINKING ABOUT RISK: A CONTINUUMSafer sex recommendations vary greatly. Many AIDS organizations and public health departments promote stringent guidelines. People rely on this advice to make life-and-death decisions, and it seems better to err on the side of too much rather than too little caution. Other people (especially those in groups with a low incidence of AIDS) figure that statistically most people have less chance of getting AIDS than of being struck by lightning. They are unwilling to restrict their sexual options in the face of such low odds, especially since this plays into the anti-sex agenda of moral conservatives. When people are told to restrict most of their favorite activities, they may ignore safer sex advice altogether. Given the low or indeterminate risk of certain activities (such as unprotected oral sex), some AIDS organizations and activists put an emphasis on avoiding the most risky ones (such as unprotected anal or vaginal intercourse). SOME COMMENTS ABOUT RISK``Low Risk'' MythsYou cannot tell whether someone is infected by their appearance or lifestyle. Most HIV+ people do not look sick and may pass on the virus unintentionally. ``Nice people'' can and do get AIDS. Marriage, long-term relationships, and monogamy are no guarantee against AIDS if one partner has been previously infected. AIDS was recognized in 1981; the virus has been around even longer. A common rule of thumb is that a negative HIV test is not reliable unless the person was tested at least six months after he or she had engaged in any unsafe activity. One unprotected encounter with an infected person is enough to transmit the virus. Sexual OrientationMen who have sex with men account for most U.S. AIDS cases. People who have sex with members of the opposite sex make up a growing proportion, especially among women, urban populations, and IV drug users; in several countries heterosexual sex is the primary means of AIDS transmission. Women who have sex with women account for a small number of cases. The labels gay, lesbian, heterosexual, and bisexual are not reliable indicators of sexual behavior. Some gay men and lesbians have sex with the opposite sex, some heterosexuals have sex with the same sex, and bisexuals may have sex with either, both or neither sex. Current self-identification does not indicate past sexual activity. ``Unusual'' ActivitiesSome sources recommend against unusual and stigmatized sexual practices such as s/m (sadomasochism), sex with multiple partners, fisting, and sex for money. With knowledge and precautions, these can be done with minimal risk of AIDS. Such warnings are based on moralism not medicine.Drugs and AlcoholDrugs, ``poppers,'' and alcohol may impair your judgement, leading you to take risks that you would not otherwise take. They can also weaken your immune system, making you more susceptible to infection with HIV and other illnesses.If you're HIV+Practice safe sex even with partners who are also positive. This can prevent infection with new strains of HIV (which could make you more ill), as well as other diseases which can be especially dangerous for a person with a weakened immune system.HonestyCommunication is important, but consider carefully the wisdom of relying on honesty. It is possible that a partner might fail to remember or neglect to mention a risky activity, especially one that happened a long time ago or one that is stigmatized (such as same-sex sexual activity or needle use).WHAT ACTIVITIES ARE RISKY?The highest amounts of HIV are found in blood and semen. HIV is present in smaller amounts in vaginal and cervical fluid (especially if a woman has a vaginal or cervical infection). Recent studies show that pre-cum does contain HIV, although it is debated whether it is enough to transmit AIDS. There are no studies of the amount of HIV in female ejaculate. Very little HIV is present in saliva, sweat, and tears; these almost certainly cannot transmit AIDS. Anal and vaginal intercourse account for most documented cases of sexually transmitted AIDS, while oral sex accounts for a few cases. Other activities have not been shown to cause AIDS, but theoretically could present some risk because they can allow HIV-containing body fluids to get from one person to another. Studies show that HIV may be absorbed directly by cells in the mucous membranes. The safest activities are those that avoid any way in which HIV-infected blood, semen or vaginal fluid can get from one person's body to another person's mucous membranes or bloodstream.
HIGH RISK
/\ Unprotected anal intercourse
/ \ Unprotected vaginal intercourseS
/ \ Sharing needles (for drugs, piercing)
-+ +- Sharing implements that draw blood (whips, knives)
| | Unprotected oral sex on a menstruating woman
| | Unprotected oral sex on a man with ejaculation
| | Unprotected oral-anal contact
| | Getting urine or feces in mouth, vagina, ass
| | Unprotected fisting or finger fucking
| | Unprotected oral sex on a man without ejaculation
| | Unprotected oral sex on a non-menstruating woman
| | Sharing uncovered sex toys
| | Anal intercourse with a condom
| | Vaginal intercourse with a condom
| | Oral sex on a man using a condom
| | Oral sex on a woman using a latex barrier
| | Oral-anal contact using a latex barrier
| | Fisting or finger fucking using a glove
| | Petting, manual-genital contact
| | Deep (French) kissing
| | Spanking, whipping that does not break the skin
| | Bonadge and discipline play
-+ +- Masturbation (alone or with partner)
\ / Hugging, touching
\ / Massage
\/ Talking dirty, phone or net sex, fantasy
NO RISK
Sexual activities fall on a continuum from high risk to risk-free. Activities at the top carry a high risk of HIV transmission (especially for the receptive partner). Upper-middle range activities carry a minimal or indeterminate risk. Lower-middle range activities carry a theoretical risk. Activities at the bottom are completely safe. SAFER SEX TIPSUse latex condoms for vaginal and anal intercourse. Use a water-based lubricant (K-Y, Astroglide, Probe); oil-containing products (Crisco, Vaseline, baby oil, lotion, whipped cream) can destroy latex. A drop of lube inside the condom may increase sensitivity. Don't use saliva as a lubricant. Other contraceptive devices do not protect against AIDS. Products containing Nonoxynol-9 (a spermicide) can kill HIV and may provide extra protection, but should not be relied on alone. Some studies show that Nonoxynol-9 can cause genital irritation that may promote HIV infection, especially with very frequent intercourse. The effects of ingesting Nonoxynol-9 are unstudied. Blood-to-blood contact is the most direct route of HIV transmission. Sharing needles (for drugs, steroids, piercing or tattooing), razors, or any implement that draws blood is dangerous since blood may be left on used implements. Clean needles by rinsing several times with bleach then with water. Avoid contact with blood in s/m scenes. Whips or knives that break the skin should not be used on another person until disinfected with bleach or a cleaning solution. Use an unlubricated condom for oral sex if a man will come in your mouth. For oral sex on a woman or oral-anal sex (rimming), use a dental dam (latex square), a condom or latex glove cut to produce a flat sheet, or non-microwaveable food wrap. Rinse powder off dams before use. Use all barriers only once and only on one person. Oral sex on a man without ejaculation or on a non-menstruating woman is thought to be a low risk activity. There is a risk that HIV could enter through small cuts or openings in the mouth, gums or throat; avoid brushing your teeth two hours before or after oral sex to minimize abrasions. If you share sex toys like dildoes or vibrators, put on a fresh condom for each user (and when going from anus to vagina), or clean with bleach, alcohol, or soap and water. Use latex gloves for finger fucking or fisting to guard the wearer against infection through cuts on the hand or arm, and to guard the partner against injury from fingernails. Touching and kissing are safe. It is safe to get cum, vaginal fluid or piss on unbroken skin. No AIDS cases have been traced to kissing, including deep (French) kissing. Precautions against AIDS can protect you from other sexually transmitted diseases such as gonorrhea, syphilis, chlamydia, herpes, yeast infections, amoebiasis, and hepatitis B. Preventing other STDs can in turn minimize your chances of getting AIDS, since many STDs cause sores in the genital or anal area or around the mouth which can provide a path for HIV transmission. RESOURCES:
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