by Steve
Martindale
Here we go again. A recent American study has once again raised the issue of HIV transmission through oral sex, generating controversy in the media, provoking heated debate on the internet and prompting renewed calls for the use of condoms for cocksucking.
Let's stop kidding ourselves: most gay and bisexual men aren't using condoms for oral sex and aren't about to start. As a friend of mine says, if want to suck latex you might as well warm up a dildo in the microwave and slurp on that instead.
But the possibility of getting or spreading HIV through oral sex continues to be a source of anxiety for many of us, and every few years the media feeds that anxiety by issuing dire warnings on the subject.
As reported in the last issue of Xtra West, a recent San Francisco study of 122 newly infected gay men concluded that 6.6% of them were likely infected through oral sex (although this figure was more widely publicized as 8%).
These findings aren't supported by Vancouver data. The Vanguard Project has been collecting HIV test results and detailed questionnaires on over 850 young gay and bisexual men in the Lower Mainland since 1995. If HIV were being commonly spread through oral sex, by now we would have seen unexplained cases of HIV transmission within this cohort.
But we haven't. Everyone who has seroconverted while in the Vanguard Project reported unprotected anal sex and/or injection drug use prior to infection. We do not have a single unexplained case of HIV infection within the study.
And it isn't because Vanguard participants are using condoms for oral sex. Of 790 HIV-negative men in the study, 92% sucked cock in the previous year, and 96% of them did so at least some of the time without condoms. Nevertheless, all of these men have remained HIV-negative.
If Americans seem obsessed with cocksucking and HIV, it may be related to the markedly different approaches taken by public health authorities in our respective countries.
In the early years of the AIDS epidemic, the American Centers for Disease Control (CDC) classified oral sex as a "risky" activity for HIV, despite a lack of supporting evidence.
The British took a different approach, producing education campaigns aimed at gay men in the early '90s that bluntly stated "Sucking is Safe." Even though British sexual health educators knew this wasn't entirely true, they chose to promote oral sex in the hopes that it would steer gay and bisexual men away from higher-risk anal sex.
The Canadian perspective, as usual, fell somewhere in between. Our safer sex guidelines have always maintained that oral sex is a "low risk" activity, meaning that although there are some documented cases of oral transmission, they are rare and generally involved extenuating circumstances, such as recent oral surgery or lesions in the mouth.
Over the years this has enraged some of our neighbours to the south, who would like to see the rest of the world reject the harm reduction model in favour of their "100% safe, 100% of the time," all-or-nothing ideology.
While Canadian sexual health educators have never considered oral sex to be completely risk-free, their approach has been to provide people with the available information, and support them in making informed choices about their sexual practices.
Part of the problem with this whole issue is that many people want black and white answers to questions of sexual safety, and oral sex has always been a grey area. Some gay and bisexual men seem to be looking for permission to have unprotected oral sex. They want to be told that it's completely safe, so they can then be absolved of responsibility for the choices they make.
As another friend is fond of saying, "If you want permission to suck cock, go ask your mother, and if it's absolution you're after, go see a priest."
Amen to that.
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Steve Martindale coordinates the Vanguard Project, an ongoing
study of HIV rates and risk factors in young gay and bisexual
men, run by the BC Centre for Excellence in HIV/AIDS.
For more information, contact:
Bonnie Devlin
Vanguard Project Coordinator
608 - 1081 Burrard Street
Vancouver, BC, Canada, V6Z 1Y6
Tel: (604)806-8306
Fax: (604)806-9044