How Safe Is Your Oral Sex?
Scientists and Community Groups Take Sides in a Debate About HIV
By Ann Giudici Fettner
How safe is unportected oral sex? It depends on whom you ask. The U.S. Centers for
Disease Control (CDC) continues to classify it as high-risk behavior, saying that HIV, the
suspected AIDS virus, can be passed that way. But many community-based groups that
disseminate safe-sex information are in the process of modifying their guidelines, and a
number of them contend that oral sex is an extremely low-risk activity. So how does one
make a personal decision?
INHIBITORY FACTOR IN SALIVA
An article in the Journal of the American Dental Association (Vol. 118, June 1989)
concludes that "saliva from healthy men, women, and children contained a factor that
inhibits HIV-1 infection of lymphocytes [white blood cells]. This finding is consistent
with the documented low risk of oral transmission of this virus and the infrequent
isolation of HIV-1 from human oral fluids."
In their study, researchers took samples of saliva from uninfected people - nine women,
nine men, and seven children - and from nine HIV-positive men. Each sample of saliva was
incubated with concentrated HIV-1 for one hour, after which time lymphocytes were added to
the saliva-virus mixture for another hour. The researchers then tested the mixtures three
times, starting on the eighth day, looking for signs that the virus was replicating.
The saliva from all the women and children and from the majority of men completely
protected the lymphocytes against infection with the virus. Three uninfected and two
HIV-positive men had "substantial, partial inhibitory activity." Even when the
saliva was diluted by a factor of 20 to 1, 50% of its inhibitory activity remained.
Among the authors' conclusions is a statement that has major implications for therapy:
"The inhibitory activity displays an important characteristic of a pharmacological
agent." This suggests that the as-yet unknown protective factor - probably a large
protein molecule - may offer an important clue to the identification of a "natural,
nontoxic [antiviral] product."
If identified, such a molecule could form the basis of an agent capable of protecting
cells against HIV, and it would offer some insight into the mechanism by which the virus
is neutralized, says Dr. Phillip Fox, chief of the clinical investigative section that
conducted the research. To that end, four studies have been funded to continue the work.
"Based on what we've seen and the number of years of experience, there is enough
background to see that [oral activity] isn't a route of transmission," Fox says.
"To my mind it makes sense that this fluid - saliva - which definately contains the
virus, is not transmitting it."
Because semen, saliva, and breast milk have all been shown to contain inconsistent, low
levels of HIV, it seems sensible to look at the more clear-cut instance of uninfected
babies being nursed by HIV-positive mothers, where the only risk factor was the baby's
Pediatric immunologist James Oleske of Newark, N.J., who was one of the first to
identify AIDS in children, has criticized the CDC's recommentation that HIV-positive women
not breast-feed their infants. "This is a typical overresponse," he says.
"Yes, factors in saliva seem to inhibit HIV, which is just one more bit of evidence
that you don't get AIDS through oral exposure very frequently."
Oleske knows of two European cases in which babies who became infected by transfusion
after birth and were being breast-fed have infected their mothers. In both instances the
children were teething and the mothers' nipples were cracked, creating a blood-blood
rather than simply oral route of transmission.
DEFINING WHAT IS "LOW RISK"
On the basis of scientific evidence such as that presented above, some social-service
organizations are now issuing guidelines that place oral sex in a low-risk category. One
of these groups is the AIDS Commision of Toronto, Canada. Ed Johnson, director of
education for the commission, says, "Because different organizations are saying
different things - and there is often great discrepancy between them - we took every study
available into consideration and, through the Canadian AIDS Social Coalition, came out
with a statement that anal and oral sex cannot be considered of equal risk."
Johnson's group then developed three catetories of risk, placing oral sex in the
"minimal/theoretical" risk category. Unprotected anal or vaginal sex is in the
high risk category; abstinence is listed as no risk.
Wayne Blankenship of the Tuscon AIDS Project, which is following Canada's lead, says
that in the United States "We're so invested in having to see transmission in either
black or white terms that we've painted ourselves into a corner. A real issue is that
there is nothing positive said officially about any form of sex between men. This is a
disservice to those trying to make rational choices."
While admitting that "no one would say that there's a 100% guarantee that oral sex
won't transmit the virus," Blankenship says critics have sensationalized his group's
guidelines as "advocating that people should be having oral sex without a condom. But
that's not what our information is about. It's about the relative risk."
According to Kevin Armington, coordinatior of medical information for Gay Men's Health
Crisis (GMHC) in New York City, the group's "safer sex" guidelines emphasize
"safe, creative sexual activities." GMHC educational materials recommend either
using a condom during oral sex or; if no condom is used, refraining from ejaculating in a
partner's mouth. The group's concern over possible transmission through oral sex is based
on several letters in the mid 1980s in the British medical journal The Lancet, which
reported that a few people who claimed that they had participated in no other sexual
activities than oral sex nonetheless became infected. Several I.V. drug-using lesbians
have reportedly passed the virus to their partners through oral sex. This, GMHC argues,
indicates that oral sex is not in a no-risk category.
Marcus Conant, a physician in San Francisco who sees a large population of AIDS
patients, emphasizes, "You have to ask what is meant by 'low risk' - which does not
mean 'no risk'. If you mean low, you have to decide what risks you are willing to
take." Conant draws on the analogy of risks that people take every day: "On a
California freeway you have a 1-in-4,000 chance of being killed; in a lightning storm, a
1-in-12,000 chance of being struck. A pregnant woman has about a 1-in-8,000 chance that
her baby will have a severe birth defect. The risk of getting HIV from oral sex is clearly
lower than 1 in 4,000 but whether it's lower than 1 in 12,000, I don't know.
"People are caught back in a 1983 frame of mind and haven't [stopped to think],
Now anyone can get tested," Conant continues. "I wouldn't [advise people] to
have rectal sex with anyone without a condom, but they might engage in something that has
a low risk - if both were negative and being tested periodically."
PLAYING THE ODDS
In science, it's impossible to prove that something never happens. While Conant and
other researchers suggest that the likelihood of becoming infected through oral sex is
extremely small, there are no guarantees. It seems reasonable for people who are concerned
about this to make sure that they and/or their partners are protected.
Toronto's Johnson says his group has been criticized for not pointing out that those
who are already HIV-positive may risk contracting additional infections during unprotected
oral sex. Conant, however, says this is farfetched. "They ride the subways and come
in contact with people with a variety of infections every day," he says. "I'm
not sure this is a valid issue."
GMHC educators express concern about possible unnoticed breaks in the mouth, such as
bleeding gums, that would increase the risk during unprotected oral sex. But others point
to the small number of AIDS cases that can be traced to oral contact and the emerging
evidence of saliva's protective role.
It comes down to a gamble. If you decide to play the odds with becoming infected, you
should remember that however long the odds may be, unprotected oral sex does sometimes
Courtesy of Risqilly BBS * Reprinted from The Advocate 11/6/90