The Peter Sodann Library
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Oral Sex and Public Health Fear-Mongering


We've all been bombarded with messages about safe sex. Often, these messages are manage to be both hysterical and curiously vague. We are warned that all sex is dangerous, there's no such thing as safe sex, only safer sex, and solemnly enjoined to do ludicrous things like use condoms and dental dams during oral sex. Dental dams!

The patronizing tone of this propaganda always annoyed me. I felt as if I were in a dictatorship, constantly being told what to do, but never why. I remember looking up the actual statistics of HIV transmission in the 1990s and being amazed at how incredibly tiny they were. Over at Salon, Tracy Clark-Flory takes a look at the question of exactly how risky oral sex is:

University of California, San Francisco, study put the per-contact risk of transmission through “receptive” fellatio with an HIV positive partner at 0.04 percent. (For perspective, consider that the same study found a much higher per-contact risk of 0.82 percent for unprotected receptive anal sex.) The researchers calculated the rate of HIV transmission to be 4 out of 10,000 acts of fellatio. Without ejaculation in the mouth, though, some experts have called HIV transmission via performing fellatio “extremely low risk.”

As for the danger of having someone perform unprotected oral sex on you: “The only risk in this scenario would be from bleeding wounds or gums in the HIV positive person’s mouth or on their lips, which may transfer blood onto the mucous membranes of the other person’s genitals or anus, or into any cuts or sores they may have,” according to AVERT.

This more or less conforms to the information I got looking at controlled clinical studies of HIV transmission. The canard that everyone was at equal risk for HIV was just that, a canard. If you are healthy, straight, and don't use IV drugs you can have unprotected oral or vaginal sex with an HIV-positive person literally thousands of times without contracting HIV. And, as Flory reports, pretty much the same goes for other sexually-transmitted diseases and oral sex. Note how the public-health experts she quotes constantly emphasize the risks, but are then forced, almost sheepishly, in the fine print, to admit that actual number of cases of transmission by oral sex is small. And if you use your imagination, you'll probably conclude that most of those transmissions involved the kind of moist, unhygienic frolicking that most sensible people are not going to find tempting.

Obviously, these diseases are unpleasant, people should probably try to have safer sex, etc., etc. But I've always thought the fear-mongering does more harm than good. After all, if you suggest to people that obvious common sense (i.e. that oral sex is less risky than other kinds) is misleading and warn them they must use absurd precautions or they will die, they're going to stop taking you seriously. People wanna have fun. Don't point fingers at them. Explain to them like adults the risks they face, and design a better condom so it's a bit safer for them to do what they're going to do anyway.


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Drink Wawa-beer! The risk of becoming
infected with life threatening bacteria
is only 0.4% each time you drink Wawa-beer!

Don't think about what happens if you
drink Wawa-beer once a week, year after
year! Don't think what happens if many
people drink Wawa-beer! That's fear-


The source of 0.04 percent is here:

The 4 infections out of 10.000 fellatios looks, of course, very low for an individual.

But you have to think further. To think about actual behaviours, and over a longer time.

One doesn't practice fellatio only once, I suppose. So, if, over the years, you have e.g. 100 fellatios with your HIV-infected partner, your risk is at 4% for becoming infected with HIV.

Not so nice, huh?!

Moreover, there's a public health perspective. If for example you observe just 10.000 uninfected subjects, who repeatedly have receptive oral sex with infected partners (100 times over the years, as mentioned above), then this would result in 400 infected subjects.

While I am quite sure that these sex-is-bad messages are neither helpful for prevention nor beneficial for society as a whole, the 0.04% figure does very little to invalidate the claim that oral sex with infected partners must not be taken lightly.

I hope that I mad a mistake in my calculations, otherwise the SALON piece looks like an unpleasant example of zeitgeistiges Schwadronieren about public health issues, without having enough knowledge about the issue.


A little caveat: Being gay does not make one *inherently* more at risk at contracting HIV. It's the anal sex that's the risk factor - and that's true for male-to-female anal sex as well, of course (not female-to-male, though - strapons are totally safe! ;) ). Likewise, if you're a dude sucking another (HIV positive) dude's cock, you're at no higher risk of getting infected than a gal sucking a (HIV positive) dude's cock.


@Damon: You're right in that measuring the risk of HIV transmission involves some unknowns. But there's been plenty of time to study it, and the numbers are pretty well-known. This article cites a number of studies generally showing a 1 in 1250 or higher risk of transmission per sex act. And studying HIV transmission isn't all that difficult -- there were already existing transmission models for tons of other sexually transmitted diseases. A simple Google search will find dozens of peer-reviewed articles on HIV transmission risk. After all, HIV has been one of the most-researched topics in medical history, and how it's transmitted is public health issue #1 in many countries. So there's really not much doubt about it anymore.

@Marmalade: First, why would I listen to a creature that craps in a box? But srlsly, I don't deny that HIV causes AIDS, that's a totally different can of worms. As far as I know, there's no serious reason to doubt that. When scientists do their science stuff in labs, I generally trust them. My beef is with activists and others stirring up a (typical American) moral panic by purposely conflating all sorts of different risk scenarios.

Marmalade Graham

You and Serge Lang.


I don't disagree with your central message. However, I have several questions about the cited numbers (0.04% and 0.82%), and I can't find the study that is referred to in the linked article. My first concern is that this is a mis-citation. Even relatively intelligent people confuse fraction and percent with alarming frequency (i.e. I am worried 0.04 is really 4%). (As a related aside, there's a very amusing conversation from a couple of years ago between a telephone customer and a customer service representative who confused 0.01 with 0.01%.)

Second, what does this number actually mean? For ethical considerations, it cannot possibly have been determined under laboratory conditions. Moreover, I would imagine that most people would learn about someone's HIV positive status only later. It seems unlikely that most people would knowingly have sex with an HIV-positive person even if the risk of contracting HIV were extremely small (most people exaggerate risk--see "Thinking, Fast and Slow" by Kahneman). Calculating a percent chance of contracting HIV per sexual encounter is further complicated by the fact that diagnosing HIV can be difficult in the early stages of infection. So what is this number? Is it the fraction (or percent) of people who have unprotected sex who contract HIV per sexual encounter? Per year? Lifetime accumulated risk?

These numbers are almost comically vague and are potentially misleading. I don't disagree that purposefully exaggerating the risks involved in having unprotected sex would be a terrible practice. However, citing such numbers without context and without directly linking to the study (or review article) is nearly as abd.

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