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David J Malebranche, MD, MPH posted:
There is always alot of discussion about how risky oral sex is when it comes to HIV. To keep it simple, let's keep a few facts in mind:

1. HIV has to get into the bloodstream to establish an infection

In order to begin to reproduce in the human body, HIV MUST get in the bloodstream. So any behavior that can get HIV in the blood easily will be considered "higher risk." That's why IV drug use is the highest risk or transfusions used to be before we started screening blood - putting a needle with HIV directly in your vein or having HIV+ blood transfused into your vein will be the most risky exposures. Right after those would be unprotected anal or vaginal sex, for the person being penetrated. The reason there is that the skin lining the anus is very sensitive and can bleed easily, even if you cannot see blood - so HIV can get into the bloodstream easier that way. The skin lining the vagina doesn't bleed as easily, but can. With oral sex, the mouth is meant for chewing, so the skin inside the mouth is used to trauma, changes in temperature, etc. So even for the person giving oral sex, it would be difficult to contract HIV from that.

2. You have to have sex with someone with HIV to get HIV!

This may sound simple and logical, but HIV doesn't just spontaneously emerge when someone has unprotected sex with another person. In the general population in the United States, less than 1 out of every 1000 people are HIV+. This number may be higher or lower depending on the city you live in, but the point is, the majority of people in the US are HIV negative. If you don't know the status of the sexual partner, find out - and if you can't because it was anonymous and you won't see them again, assume that they may be and get tested and checked out for HIV and STDs about 1 month after the exposure.

Remember also that if you do have sex with someone who is HIV positive - if they are on medication and have their virus under control, it reduces your risk by 96%! So there is a differences between someone who is HIV positive and NOT on meds or in care (they may be more risky to have sex with), and someone who is HIV positive, is in care, on meds and taking care of themselves. Risk with someone who is HIV positive is not all the same.

3. HIV is not an easy disease to catch

The conclusion one can come up with given alot of these facts is that HIV is not an easy disease to catch. It is not airborne, so you can't cough it on someone, and if it was transmitted by oral sex, it would be much more common than it is now. In other words, while I would encourage everyone to get routine HIV testing, at least once a year if you are sexually active (yes, even if you are in a "monogamous" relationship) - I would also suggest that instead of thinking that every rash or symptom IS HIV, think about the more commone things that can cause rashes, fevers and other symptoms. This includes most common STDs, which are all way easier to contract than HIV.

The link below is the CDC's official report on oral sex and HIV. While I don't necessarily agree with all they say (I haven't seen these studies that demonstrate documented cases of HIV from oral sex), the information there is similar to what I am telling you. .

Remember you can never go wrong in getting tested regularly and taking care of yourself, but don't let fear get in the way of logic. Educate yourself, protect yourself and enjoy yourselves as sexual beings. You can't enjoy sex if you are always worried about HIV, so just take precautions and live your life!!!

Happy holidays!

stresstime responded:
Dr. David,

Very informative post. thank you

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