Oral Sex and HIV
posted: 10/09/2010
The gay men’s sex survey sometimes tells us surprising things, but the news that almost all gay and bisexual men have oral sex - 99% - was no surprise at all. With HIV, what do men need to know?
What about HIV?
How risky is oral sex for men with HIV? How risky is it for positive men’s partners?
There’s a lot of confusion about this – at all our newly diagnosed courses this causes big discussions and lots of questions.
Doctors and researchers aren't sure exactly how many people get HIV from oral sex. Some think hardly anybody ever gets HIV from oral sex, but others think 3 out of every 100 HIV+ people got HIV through oral sex. A review of all the oral sex studies in late 2008 worked out that the risk of getting from oral sex was very low, but the risk isn't zero.
Whatever the oral sex risk, it is always much safer than anal or vaginal sex without a condom.
How risky is oral sex?
The likelihood that HIV is passed on from an HIV-positive person to an HIV-negative person during oral sex depends on
- whether a man with HIV sucks, or gets sucked
- the viral load of the man with HIV
- the dental health of the man sucking
- if the man sucking has a sore mouth, or throat, oral cuts, sores or abrasions
- if either man has a Sexually Transmitted Infection (STI).
Having a high viral load in the blood usually means that the viral load is also high in the semen, and that makes HIV easier to pass on during sex. Although having an undetectable viral load in the blood usually means there is an undetectable viral load in the semen, this isn't always true. And untreated sexually transmitted infections (including infections without symptoms), cause viral load in semen to increase.
But all in all, if you have an undetectable viral load, the chances of passing on HIV are very low in oral sex.
Oral sex is never risk free. It’s also easy to pass on and get some other sexually transmitted infections, such as syphilis, herpes and gonorrhoea.
Oral studies
A number of studies looked at the risks of HIV transmission from oral sex.
- One American study reported that of 122 gay men with HIV, 8% reported oral sex as their only risk activity. But this study is not really trusted. It is based on very few men and some of the men who first of all said oral sex was the only risk they took later on admitted they had anal sex without condoms.
- Another study of over 100 couples didn’t find any cases of oral transmission of HIV over a ten year period, where one partner was HIV-positive and the other HIV-negative.
- Another study from the USA found the risk to be effectively zero, but didn't exclude the possibility of there being a risk.
- Other researchers in 2008 pooled the results from all the oral studies and found that the risk was very low, but not zero.
We are unlikely to ever have an exact answer: the best we can say is low risk, but not no risk.
When is oral sex more risky?
It is important to put oral sex HIV transmission risks in perspective.
If you and your partners are having anal sex without condoms, first do something about reducing your anal sex risks, because the risks of HIV transmission during anal sex are so very much higher than in oral sex. Using condoms during anal sex will make far more difference in reducing the risk of passing on HIV, than trying to reduce the already small risk from oral sex.
Think of oral sex like being a safe car driver – an accident is always possible, but unlikely.
Think of anal sex like speeding and drink driving – an accident is quite likely. To reduce the chance of passing on (or getting HIV), using condoms makes sense, like it makes sense to stop drink driving and speeding. Using condoms reliably during anal sex is what we should really try to do better.
How can you reduce oral risks?
If you do want to cut the HIV risks during oral sex, there are several ways. Some of these are more acceptable than others, so make your own risk decisions. Many of these steps will also cut the risk of other sexually transmitted infections:
- You may decide the risks with oral sex are low enough to carry on as before
- You may prefer not to have oral sex because you do not want to take even a tiny risk
- You may decide to have oral sex with fewer men at a time, and in total
- You may decide to have oral sex using a condom
- Men with HIV may decide only to suck, as this is far less likely to pass on HIV than sucking
- Men who don't have HIV may decide only to be sucked, as being sucked by a positive man is far less likely to pass on HIV
- Men with HIV may decide not to cum in a partner’s mouth. There is a theoretical risk of getting another HIV strain, or drug resistant HIV, if you let another man with HIV come in your mouth.
- You may decide to have less vigorous oral sex, and not to deep throat
- HIV negative men should look after their teeth and mouths. The risk of HIV transmission increases if a HIV negative man sucking has bleeding gums, ulcers, cuts or sores in his mouth. He should not brush his teeth or floss before sucking, because that makes the gums more open to HIV
- Get regular sexual health checks. Sexually transmitted infections raise the risk of passing on HIV to a negative partner. For HIV negative men, sexually transmitted infections raise the risk of getting HIV.
Source 1
Source 2
Permalink
Vote for HIV at Elections
posted: 01/06/2009
The election matters because the tide of public anger with politicians is high, and most people don't normally vote in either county council or European elections. This time abstentions and protest votes for smaller parties like UKIP and BNP, are likely to be far higher than last time.
The risk is serious that parties and candidates will be elected who are hostile to people living with HIV, especially people who are migrants. George House Trust urges everyone to use their vote.
Some migrants with HIV have no right to vote and many others have not registered. This makes it more important that the rest of us do vote, and vote thoughtfully.
Who can vote?
It is too late now to register for this election because you have to register at least 11 working days before an election. Find out here who can register to vote and how to do this in time for the general election which is due before early June 2010 - simply click here or scroll down this page to the line across the page, for the full details and the weblinks.
One or Two Elections?
There are two elections, but most people in the region will only be able to vote in the European one. The council elections are only for County Councils - in the Northwest that means people living in the Lancashire County Council and Cumbria County Council areas. There are no elections this year for unitary councils, like those in Greater Manchester, Merseyside, Blackburn with Darwen, and the two new unitary councils in Cheshire.
European Election Candidates and Parties in Northwest England
The EU Parliament and Commission has some useful powers affecting people living with HIV and it has some influence over migration. That is why voting in the European election is important.
We are a charity and, by law, cannot be party political – we can't tell you who to vote for, or campaign for a party. But we can provide information to help you decide how to use your vote.
In the European elections all of Northwest England is one constituency. Proportional Representation decides which candidates get elected to the 8 seats in the EU Parliament for the NW region.
The UK voting system for the European elections is proportional representation - a regional closed list. This means that political parties put forward names of candidates for each region, in the order they want them elected. You have one vote and put a cross in the box next to the party you want. You can't vote for any individual candidates, except for an independent candidate who is not in a party. (There is one independent standing in the Northwest.)
Who's Standing?
You can check here the full lists of candidates for each party (and the 2004 election results) here
In 2004,
- Conservatives won 4 seats,
- Labour won 3 seats,
- Liberal Democrats won 1 seat,
- UKIP (United Kingdom Independence Party) won 1 seat.
This year the number of seats has been cut across Europe, so the Northwest will have 8 MEPs, not 9 as now.
Please do use your vote
George House Trust asks you to vote in the election on Thursday 4 June, taking into account the impact the party you choose to put a cross next to may have on everyone living with HIV, not just in the UK, but the rest of Europe too, and for the influence the EU can exert in the rest of the world on HIV.
County Council elections in Lancashire and Cumbria
If you have a vote in these elections we urge you to use it - the BNP won seats on Burnley Council at the last election and now hope to win seats on Lancashire County Council.
Who can vote and how do I register?
You can register now to vote for the coming general election, which has to take place by early June 2010, if you are:
• 16 years old or over (but you won't be able to vote until your 18th birthday), AND
• a British citizen, OR
• an Irish, EU, or qualifying Commonwealth citizens.
“Qualifying Commonwealth citizens are those who have leave to enter or remain in the UK, or do not require such leave.”
At the European elections, but not at Council or Parliamentary elections, EU citizens can also vote.
Registering to Vote
You can register to vote online – but you have to print, sign and post the application form to your local council's Electoral Registration Office.
The application form is here. If you enter your postcode in the box (top right) it will tell you the address of your local Electoral Registration Office.
Nationality Question
One question you must answer on the form is about your nationality – simply write in Zimbabwean, or whatever your nationality is – this must be UK, Irish, a Commonwealth country, or another EU country, for you to vote.
The electoral registration form has a simple declaration you must sign which says
“As far as I know, the details on this form are true and accurate. I understand that to provide false information on this form is an offence, punishable on conviction of up to 6 months and/or a fine.
I confirm that I am a British, Irish, European Union or qualifying Commonweath citizen.
Qualifying Commonwealth citizens have leave to enter or remain in the UK, or do not require such leave.”
Normally if you sign this, it is simply accepted. You are not normally asked to show any documents to prove your nationality and leave status.
Am I a 'qualifying Commonwealth Citizen'?
Section B 6 in the Guidance for Electoral Registration Officers explains who can register.
Unfortunately it doesn't explain this in plain English – it refers to the law which is section 4(6) of the Representation of the People Act 1983 and suggests you could check with the Home Office.
The Guidance for Electoral Registration Officers says
Commonwealth citizens - Entitlement to vote
6.14 Qualifying Commonwealth citizens are entitled to register as Parliamentary and as local government electors provided that they also fulfil the age and residence requirements for such registration and are not subject to any other legal incapacity.
Meaning of ‘qualifying Commonwealth citizen’
6.15 A person who is a Commonwealth citizen is a qualifying Commonwealth citizen for registration purposes if they do not require leave to remain in the UK or they do require leave to remain in the UK but have been granted such leave or are treated as having been granted such leave.
6.16 Any type of leave to remain is acceptable, whether indefinite, time limited or conditional.
6.17 Qualifying citizens of the following countries meet the nationality criteria to register in respect of all elections.
Commonwealth countries
Antigua and Barbuda, Australia, The Bahamas, Bangladesh, Barbados, Belize, Botswana, Brunei Darussalam, Cameroon, Canada, Cyprus, Dominica, Fiji Islands, The Gambia, Ghana, Grenada, Guyana, India, Jamaica, Kenya, Kiribati, Lesotho, Malawi, Malaysia, Maldives, Malta, Mauritius, Mozambique, Namibia, Nauru, Nigeria, New Zealand, Pakistan, Papua New Guinea, St Kitts and Nevis, St Lucia, St Vincent and the Grenadines, Samoa, Seychelles, Sierra Leone, Singapore, Solomon Islands, South Africa, Sri Lanka, Swaziland, Tonga, Trinidad and Tobago, Tuvalu, Uganda, United Kingdom, United Republic of Tanzania, Vanuatu, Zambia, Zimbabwe.
Asylum
The Guidance says this about asylum:
6.18 The fact that an applicant or elector has claimed asylum has no connection to their right to be registered as an elector ….. The Electoral Registration Officer can only make enquiries as to nationality and whether a person has any type of leave to remain in the UK.
The Representation of the People Act 1983, Section 4(6) is no real help in deciding who is a qualifying commonwealth citizen.
The George House Trust guide on who can register to vote
This is our understanding of the rules:
If you are a citizen of one of the Commonwealth countries listed above, what matters is
do you
- require leave to enter, or
- have you been granted leave to remain, or
- are you treated as having leave to enter, or
- are you treated as having leave to remain.
If your honest belief, after checking the information below, is that you can truthfully sign the application to register for a vote which states As far as I know, the details on this form are true and accurate, you can apply for a vote.
Leave to enter
Commonwealth citizens always require leave to enter, unless they have the right of abode.
- see Immigration rule 7:
Most Commonwealth citizens with right of abode in the United Kingdom can simply check their passport – a UK stamp in the passport will state if you have the right of abode in the United Kingdom; or you will have a UK certificate of entitlement certifying the right of abode. Official Guidance on Right of Abode
Some other Commonwealth citizens will have the right of abode, even if they don't have this stamp in their passport, or a certificate of entitlement. It is unlikely recent migrants from the Commonwealth will have this. This right of abode depends on your birth, or marriage. South Africans and Pakistani citizens won't be able to claim this. Check the link above for the birth and marriage requirements for this.
Leave to remain
Who has leave to remain is complicated, but people with leave to remain will either have a current, valid stamp in their passport saying you have leave to remain, or will have some other Home Office / Borders and Immigration Agency official document or letter saying this.
The rules about leave to remain are here, and depend on your reason for being here.
Treated as having leave to enter
Commonwealth citizens who have made a valid claim for asylum, or for humanitarian protection, who have not had a final refusal, are treated as having leave to enter.
Treated as having leave to remain
Commonwealth citizens whose claim for asylum or humanitarian protection has been approved, are treated as having leave to remain. Others are also be treated as having leave to remain, for example refused asylum seekers who are receiving ‘section 4 support’.
If you think you should also be treated as having leave to remain, you could check with a Citizens Advice Bureau, or your immigration adviser. We suggest you print this information and take it to them, with your passport, and any official letters, or papers about your immigration / asylum situation.
No right to vote
Other Commonwealth citizens, including people whose
• claims for asylum or humanitarian protection have had a final refusal, or
• who have overstayed their visa, or
• who entered the UK irregularly,
have no right to vote.
You cannot have the right to vote if you are not a citizen of a Commonwealth country, or of an EU country. This means, for example, citizens of the Democratic Republic of the Congo, USA, Brazil, etc. can't ever vote in UK elections, unless they become British, or become a citizen of another EU country.
Register to vote
You can register to vote online – but you have to print, sign and post the application form to the local council's Electoral Registration Office.
The application form is here. If you enter your postcode in the box (top right) it will tell you the address of your local Electoral Registration Office.
George House Trust provides this information in good faith but the responsibility is yours to check you have a right to register. If you are in doubt you could ask your local Citizen's Advice Bureau , or your immigration / asylum adviser.
We suggest you print this information and take it to them, with your passport and any official letters or papers about your immigration or asylum situation.
Permalink
Oral Sex, Tiny HIV Risk
posted: 17/12/2008
For about 20 years we have said oral sex is low-risk, not no-risk for HIV transmission. Now researchers have tried to say how low the risk really is. This is not so easy to check as you might think.
The risk of HIV transmission during oral sex is very low, but not zero, conclude researchers from Imperial College and the London School of Hygiene and Tropical Medicine. They tried to find all the studies, but found that the lack of data meant they still can't make a broad estimate for the transmission risk through oral sex.
They started with a systematic review (an analysis of all the medical research that meets their standards). The studies reviewed include data from heterosexual, lesbian and gay couples, covering both fellatio (oral sex on a man) and cunnilingus (oral sex on a woman).
Only 10 studies count
Only ten studies were judged to be good enough to include in the review. All were from Europe or North America, and only three used data from after HIV combination treatments became widespread.
Problems
The researchers point out the many problems with measuring oral sex risks for HIV.
- Very few people only have oral sex.
- If a person has both unprotected oral sex and unprotected anal or vaginal sex, and acquires HIV, their HIV infection is automatically attributed to the more risky anal or vaginal route, not to oral sex.
- Data on individuals’ self-reported sexual behaviour is hard to collect accurately, especially because people tend to give more socially acceptable answers (i.e. pretending to have been "good" and not "admitting" sex without condoms).
- Studies frequently group all oral sex practices together, without separating out the oral sex acts by who was doing what to whom, which person has HIV, if there is ejaculation in the mouth or not, and if so, the spit or swallow choices.
- Studies of serodiscordant couples (where one person is HIV-positive and the other is not) are likely to include people with well-controlled viral load, meaning that they are much less infectious than during primary infection (the first few weeks after HIV infection when people are the most infectious they will ever be). Oral sex transmission is more likely during primary infection. Oral sex transmission of HIV is also more likely when one or both have certain other sexually transmitted infections (STIs), especially those STIs that have sores.
- Studies which do identify a risk from oral sex are more likely to be published and reported than those which do not, because of the interest and comparative novelty of such a finding.
Estimates of the per-partner transmission risk - zero to 20%!
Five of the studies provided estimates of the risk of multiple oral sex acts during the life of a sero-discordant relationship.Three of these studies gave that estimate as zero – no transmissions were reported.
The fourth study provided a figure of 1% for receptive fellatio.
The fifth study, from Sweden, provided a much higher estimate of 20%. However the sample was very small (ten couples reporting oral sex as their only risk factor), and the review authors comment that the high estimate may be due to under-reporting of higher risk activity, or simply due to chance. Moreover, this is the only reviewed study which identified any HIV transmission among heterosexuals that could be attributed to oral sex.
Estimates of the per-partner incidence, per 100 person years
Three of the studies also reported estimates which calculated the transmission risk of multiple oral sex acts, but with the duration of the relationship stated. In each case, the estimate was zero.
Estimates of the per-study-participant transmission risk
Three further studies followed HIV-negative people who reported unprotected oral sex as their sole risk factor. However the authors note that these studies have additional methodological limitations: the number of sexual partners and their HIV status is not known. This implies that the findings cannot be transferred to other populations where numbers of partners and HIV prevalence are different.
Two American studies gave estimates of 0% and 0.4% respectively, and the more recent Canadian Omega cohort provided a figure of 0.5%. Each study was conducted with gay and bisexual men.
Estimates of the per-act transmission risk
Three studies attempted to calculate the risk of HIV transmission during a single act of oral sex.
Two studies both provided zero estimates – no transmissions were reported.
The third study is Vittinghoff’s often cited paper which used data from American gay or bisexual men who reported multiple risk behaviours. Mathematical models were employed to estimate the risk of different sexual acts, and unprotected receptive oral sex with ejaculation was calculated to have a 0.04% risk of HIV transmission. However the review authors note that this estimate is based on sex with both infected and uninfected men – if the researchers had been able to exclude sex with HIV negative partners, the figure would have been higher.
Conclusions
The authors note the paucity of data to inform this review. Reliable estimates would be important for prevention workers and clinicians advising people on the relative risks. Moreover, because of the low risk of transmission, "large and expensive studies" would be required to provide more precise estimates.
They also comment: "The fact that infected study participants with solely this exposure have remained difficult to identify may suggest that indeed the contribution of orogenital intercourse to HIV incidence remains low."
Nonetheless they do recommend that "individuals should protect themselves using condoms or dental dams to minimise this small risk."
George House Trust comment - STIs and gum disease raise risks
After 20 years we are no nearer answering the oral rex risk question with scientific accuracy. The balance of the evidence is clear - the risk is minimal.
But from other research we know that the risk of HIV (and STI) transmission during oral sex is far higher when people have other STIs (herpes, syphilis, gonorrhoea included) either in their mouth or genitals. It is also higher when people have gum disease and other mouth and throat infections. Both STIs and gum disease increase the risk of transmission during oral sex because they can provide an open pathway into the bloodstream for the HIV virus.
We can reasonably expect that oral sex risks are highest in these situations, especially when people are in the much more infectious primary stage of infection (within the first two months of themselves becoming infected). For people at other times, and especially for those people on treatment with undetectable viral loads, the transmission risk would seem to be very close to zero.
In terms of prevention priorities, fretting about the tiny oral sex risks is a diversion from the things that would really make a difference to the annual numbers becoming infected, including consistent condom use in anal and vaginal sex, reducing the numbers of people with undiagnosed HIV as far as possible, and actions which prevent transmissions during the most infectious first few weeks.
Source and Reference
Permalink