Giving and getting a mouthful
Christmas comes but once a year but questions
from HIV positive people about oral sex are far more frequent, writes Jack
Summerside
Illustration C(Aitch)
Advice
on oral sex is often unrealistic and almost always confusing. Health promotion
literature usually rattles on about fellatio (cock-sucking) and ignores cunnilingus
(oral sex involving vaginas) but it never actually points that out.
You’re usually left guessing about other kinds, and just about everything
is written from the perspective of an HIV negative person. So it gets kind
of hard for us to turn that advice around and get a clear idea of what we
as HIV positive people need or want to know.
This month I will try to unwrap the mysteries and myths of HIV and oral sex.
I’ll try to be clear about what kind of sex is involved, who is doing
what with whom, and spell out the HIV risk to negative partners.
And, before those complaints come flooding in, I am saving rimming (oral on
the anus) for special attention in the future.
Positive cock - negative mouth
You’re an HIV positive man having his cock sucked by an HIV negative
person. It makes absolutely no difference whether the mouth belongs to a man
or a woman, whether you or they are gay, bisexual or just full of holiday
spirit.
In most circumstances, the risk of that person getting HIV from you is very
low indeed. There are an extremely small number of documented cases of HIV
transmission happening by someone negative fellating a positive man, but these
almost all involve other circumstances that greatly increased the risk.
Factors that increase the risk of HIV transmission include:
• Presence of another sexually transmitted infection (STI) in either
or both partner, especially ones that create sores or lesions on the penis,
mouth or throat such as active herpes sores or gonorrhea.
• Sores on the penis create an additional route for HIV to get OUT of
the positive man.
• Sores on the lips or in the mouth or throat of the negative person
doing the sucking can create a route IN for HIV.
• A high viral load in the positive man. This can be because they are
sero-converting, because they are not on HIV treatments or it is failing to
suppress the virus, or because they have another infection, including an STI.
• If the negative person has a suppressed immune system because they’ve
been unwell or due to medical treatment such as chemotherapy.
Spit or Swallow?
• It’s probably wiser not to cum in the negative person’s
mouth. A positive man’s semen might well have some HIV in it and that’s
the most likely risk in a negative person’s mouth. It’s also only
polite to ask nicely if they want you to, rather than surprising them with
an unexpected Christmas snack.
• The decision to spit or swallow is theirs. The jury is still out but,
on balance, the current view tends towards spitting and avoiding sloshing
the semen about in the mouth.
• Opinions differ and there is some argument for swallowing to get it
out of the mouth quickly and smoothly. It’s a matter of taste and the
power of the gag-reflex. The main point seems to be for the negative person
not to have cum in the mouth for a long time, whether it goes in or out.
Positive vagina - negative mouth
You’re an HIV positive woman, with an HIV negative partner going down
on your vagina. Once again, it’s of no consequence whether your partner
is male or female - a mouth is a mouth, regardless of their sex. I’m
not aware of any reliable documented cases that have shown HIV transmitted
in this way.
A few years back, people were encouraged to use dental dams for this kind
of sex. I don’t know if you can still get them, but they were like little
handkerchiefs made of thin rubber. Safer sex advice used to mention them all
the time, and advised you how to cut up a condom to improvise one if you didn’t
have one handy. I can honestly say I’ve never found anyone who has ever
used one. My personal view is that I don’t see the point. As far as
HIV transmission is concerned, the risk to a negative partner going down on
you is tiny.
Things to take into account:
• There is HIV in vaginal fluids, but much less than in semen. HIV viral
load can vary, in the same way it does in blood, according to the health of
the woman.
• Even if a woman is menstruating it’s still pretty much dead
blood.
• STIs that produce sores on or around the vagina can create a route
OUT for HIV through blood.
• Fresh blood from damage to the vagina or labia (try using lube!) can
also create a route for HIV to get OUT.
• Having said that, the HIV would still have to get INTO the person
going down on you through sores or cuts in their mouth, throat or on their
lips.
All of these make the potential risk of HIV transmission in this way pretty
remote. And to be honest, neither party is going to feel much like willingly
giving or receiving a whole lot of cunnilingus if they are nursing a vagina
or a mouth as sore as that.
Negative
cock - positive mouth.
Let’s assume you’re an HIV positive person sucking an HIV negative
man’s cock. To get straight to the point, I can’t see any way
on God’s Earth that HIV can feasibly be transmitted from you to him.
For HIV to get OUT of you and INTO him, the negative man would have to have
cuts or open sores on their penis, and you would have to be bleeding quite
profusely from the mouth or throat.
Cuts, sores and bleeding on this scale make a blow-job in these circumstances
unlikely and pretty unappetising in my opinion, but maybe I’m just fussy.
Of course, this situation would be different if the blow job was taking place
in a non-consensual sex situation. Nevertheless, the risk is still so unfeasibily
small that it seems unlikely.
And of course, questions about whether to cum or not, or whether to spit or
swallow, are immaterial when it comes to the risk of HIV transmission because
it’s an HIV negative man’s cum.
Negative vagina - positive mouth
This time we are talking about an HIV negative woman on the receiving end
of cunnilingus (vagina sucking or licking) being performed by an HIV positive
person. Again, it’s hard to see how HIV would get OUT of positive person’s
bloodstream through their mouth and into the vagina of the negative woman.
Not unless there were some serious open wounds or sores on both parties.
Following all that, it’s worth mentioning some health concerns relevant
to you as the HIV positive person.
• If the negative person you are having oral sex with has STIs such
as herpes, syphilis, gonorrhea and so on, then these can be passed on to you,
especially if they have sores on their genitals or mouth depending on who
is doing what.
• If both of you are positive, there’s the possibility, albeit
pretty remote, of one re-infecting the other with their drug-resistant or
more aggressive strain of HIV.
• If one of you is living with a blood-borne virus like hepatitis C,
transmission would be extremely unlikely in any direction during fellatio
or cunnilingus.
A brief note on condoms in cock-sucking.
As far as HIV is concerned, condoms are utterly pointless if it’s a
negative man being sucked. There can only be a point of using a condom if
it’s the positive man being sucked by someone negative. My own personal
view is that the thought of having someone suck my cock with a condom on it
renders the whole activity so repellent, I’d rather find something else
to do. And I really wouldn’t want to date someone whose palate was so
jaded as to think that a strawberry flavoured condom tasted like real fruit.
You can email Jack at jsummerside@ukcoalition.org
