It's happened hundreds of times. A guy gets introduced to me. He asks what I do. I tell him I work at STOP AIDS. He gets that quizzical expression that is so familiar to me.
"Can I ask you a question?" he asks. I guess what's on his mind, and respond before he goes ahead.
"It's a lot less risky than unprotected anal sex," I tell him, "but I can't tell you that there's no risk. There are certainly cases of guys that have gotten infected through oral sex.:"
I've never guessed wrong yet. I also know that I've never told guys anything they didn't know. Other times, they go the calculus route.
"Some people tell me it's less risky than going 65 miles an hour down the freeway," they tell me, "and others tell me it's five times riskier than going down Market street in a convertible."
I never fill in all the numbers for them. But sometimes I'll ask, "If I told you that the risk of going down the freeway was .0025x, and the risk of going down Market Street was .003x, and you knew what x was, would that really help you decide what to do?"
At STOP AIDS workshops, we've repeatedly tried asking some questions that help guys figure out the difference between what they know, and how they make decisions based on that same knowledge. This exercise usually works best for HIV-negative men. I'll get to HIV-positive men's reactions in a moment.
We ask, "How many of you would go down on someone who was HIV-negative?" Most hands fly up.
"How many would go down on someone who's HIV-positive?" we ask. Most hands fly down.
"How many of you would go down on someone whose status you don't know?"
Most of the hands waver for a while. Some go up. More go down. The point seems clear enough. The vast majority of us know that there's some risk. Many of us are comfortable with the risk; some of us aren't.. Some of us only become uncomfortable when we stop to think about what we're doing. Mostly, it drives us nuts that we can't tell exactly how much risk there is. All of us are constantly trying to figure it out. We read every new article that comes out, hoping to read that without a shadow of a doubt, there's no risk to sucking dick. Rumors, anecdotes and facts blur together.
Oral sex serves as a lightning rod for many of our anxieties about the epidemic.
Many HIV-positive men probably make another calculation. One friend of mine responded to being warned about catching gonorrhea or herpes or some other STD with another vehicular metaphor. "What, I've been hit by a Mack Truck, and now I'm supposed to worry about getting hit by a Toyota Tercel?" If you're positive and like to get sucked off, make sure you're making informed decisions about what you're doing with an HIV-negative partner. Or a partner whose status you don't know. Make sure your partner is making an informed decision as well.
In the meantime, however, gay men need to take responsibility making the best decisions they can with the information that we now have. In Boston, they've recently come out with a campaign that says "Oral sex is safer sex." Other cities have as well. They're right. It is safer than unprotected fucking. They're also not saying it's safe.
About to become confused? What DO you do with this information? There are certainly ways to reduce any potential risk. And reducing risk may have the added benefit of reducing anxiety.
If you have a reasonably active sex life, and try to follow the various instructions regarding when to floss and brush, you can end up doing endless calculations. If you're supposed to wait 24 hours after you floss but you're having sex a couple times during the weekend, just when do you get the floss out? Basically, a little routine maintenance will go a long way. Keep your mouth in good health, floss regularly, brush regularly. If you think you're having sex in the immediate future, give your gums a break for a bit.
Meanwhile, when you're sucking, avoid having him pound his dick really hard against the back of your throat. It may irritate the tissues in the back of your throat, making them more absorbent and it easier for the virus to get into your bloodstream.
Wearing a condom is one possibility, although many guys don't like it. (Keep in mind we're not sure how many men have tried it.) They make condoms with various flavors. And if you don't like the flavors, there are unlubed ones that you can flavor with your favorite food. Just watch the Hershey's chocolate syrup and other products that have oil in them. They can dissolve the sturdiest piece of latex.
There's also a basic hygiene question for us all to think about. Would you drink from a perfect stranger's glass? Would you put your mouth around a perfect stranger's dick?
You might, particularly if there are no creepy-crawly things floating in the glass, or oozing from the head of his dick. But if on your partner's penis you see a sore, or a colored ooze, or something that looks like a zit, you might want to pause. Maybe there's something or someone else to do. Remember that HIV isn't the only thing you can catch from sucking dick. There are other sexually transmitted diseases that you can get from sucking, or getting sucked. Many of them are treatable, but they're just plain not good for you.
One useful gauge to help manage this is your own anxiety level. If ten minutes, or ten hours after sucking dick, you're biting your fingernails and tossing and turning in bed, you may want to stop to consider what you're doing. Sex - good, hot, sex, no matter whom it's with - is something that's supposed to feel good. It's most definitely not something that's supposed to make you feel worse afterwards.
No matter what, it's your choice. It's important that you make decisions - whether you're positive or negative - that are healthy and informed for you and your partner. The decisions you make are up to you.
If you want to find out more about how other guys are wrestling with the same concerns that you have, come to a STOP AIDS meeting. Many guys find that trying to make these decisions about sex is difficult. It helps to hear what other people are doing with the same information. If you would like to have a workshop with your own friends, we'll be glad to provide the facilitator; and if you want to come to a workshop with guys you don't know, we can also arrange that.
Call us at (415) 621-7177. Ask for Mike.
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