There is a tendency to think of Acquired Immune Deficiency Syndrome (AIDS) at the exclusion of all else when we think of safe sex. Yet that is not the case. Safer sex can reduce the risk of contracting a number of sexually transmitted diseases (STDs) ranging from herpes to urethritis. We realize that for trans folk looking at our own bodies can be the source of stress if not downright pain. Unfortunately there is no easy way around this one when it comes to reporting information about safer sex. We have attempted to keep this in mind while providing as much information as possible. In good conscience we could not withhold information for the sake of avoiding offense. It is our intent and desire to provide you with some facts and the tools to allow you to consciously determine which sexual activities you will engage in and how you can reduce your risk. What precautions you do or don't take are up to you and your partner and it's really none of our business, but we would much rather have your decision be an informed one rather than a default reaction.
The excuses that people use to justify having unsafe sex are varied: I didn't have a condom. I and my partner are monogamous. I was at a sex club and as afraid to be identified as different (or trans) by requesting condom usage. I have different dicks for different partners. I hate the taste of latex. I don't know where to get gloves. Dental dams are inconvenient. I can't get AIDS from oral sex. He couldn't maintain an erection with one. With a little preplanning and a little practice you can avoid the excuse.
The reasons that people use to justify not having safer sex are equally varied. Some people believe that they are impervious. Others believe that because they are involved with a "low risk group," despite the exchange of bodily fluids, they will be free from disease. This type of thinking is particularly rampant in the "politically correct" lesbian community. To the extent that some, but not all of us, came from that community, it is possible that those beliefs have carried over.
AIDS and STDs can affect anyone, irrespective of race, creed, color, religion, or affectional preference. It is the activity which places you at risk, not the sexual orientation of your partner. Thus, having unprotected sex with partners based on sexual orientation is a dangerous proposition. The other thing to remember with respect to sexual orientation is that it depends largely on self identification. If the fact that the woman that you are involved with identifies as a lesbian does not necessarily mean that she has not had any sexual contact with men (gay or otherwise). Latin men are notorious, based on cultural standards, for identifying only passive sexual activity as homosexual. In other words, the man who is the "insertor" does not identify as gay nor does latin culture see him as such.
TO INTERVIEW OR NOT TO INTERVIEW
Having run the gauntlet, self imposed or otherwise, to finally obtain a partner, whether it be for an hour or an eternity, now what do you do? Obviously it is far easier to avoid the issue altogether and just have sex. Talking about sex can be awkward or embarrassing, particularly if you have never done it before. You may feel uncomfortable about the questions themselves
You can't tell whether someone is infected or is suffering from an STD by the way they look. The manner in which they live or have lived their lives also won't be any guarantee. The only way to find out is to ask. Remember, the focus is not so much on sexual orientation, but on high risk contacts. Some factors that are important are: frequency, number of partners, last test, high risk activities performed within the six month period after the last test. In a sense you are forced to rely on the honesty of your partner who may have forgotten a high risk contact or be afraid of the repercussions of revealing such contact(s) or their own HIV status. Your best bet is safer sex. We each have a responsibility to truthfully report our high risk contacts to our partners and to take action to actively prevent the spread of AIDS and other sexually transmitted diseases STDs. Deciding whether or not to engage in safer sex is not tantamount to deciding whether or not you want to kiss someone with a cold. Lives are literally at stake.
If it's that awkward getting a history, you can always talk about safer sex. You can break the ice by asking a question such as "what do you think about safer sex?" or perhaps by asking "do you have any protection" or even by telling your partner "I hope you don't mind condoms/dental dams/gloves, etc. For further information there is an audiotape "How To Talk With a Partner About Smart Sex" by Bernie Zilbergeld, Ph.D. and Lonnie Barbach, Ph.D.
Even if you opt out of talking altogether you can protect yourself by engaging in safer sex anyway. If you do decide to engage in unprotected sex it would be wise to go with your partner and get tested before doing so. An HIV test will only provide data valid except for a 6 month window. If there were any high risk behaviours engaged in within the 6 month period prior to the test, the results are inconclusive. In other words, no result will benefit you. You should also keep in mind that while false positive results are more likely than a negative result, false negatives are a slim possibility.
In terms of evaluating risk, you need to know a little about the types of STDs and their modes of transmission.
SEXUALLY TRANSMITTED DISEASES
For purposes of safer sex practices you will want to note the potential signs and symptoms which may be experienced by your partner as well as yourself. All materials which we reviewed are As such, in situations where symptoms differ based on gender, both sets of symptoms are provided. We have attempted to cover the bases without invalidation of anyone's self identification or self perception.
How you apply it is up to you. Text set forth in quotes was derived from Taber's Cyclopedic Medical Dictionary, 11th Edition (1970) unless otherwise stated.
Bacteria/Infections/Fungi:
Gonorrhea is a "specific, contagious,. . . inflammation of the genital mucous membrane." It is a bacterial infection. 80% of those men infected usually exhibit between two to thirty days after infection while 50% of women do. Symptoms in men include a yellowish discharge from the penis and painful, frequent urination. Acute cases may involve severe pain and fevers. Other symptoms include increased vaginal discharge, irritation of the external genitals, pain or burning on urination, abnormal menstrual bleeding, lower abdominal pain, and/or a whitish vaginal discharge. Painful bowel movements may be indicative of anal gonorrhea and a sore throat of oral. Symptoms if the do appear will do so within two to eight days after infection.
Syphilis is "an infectious, chronic venereal disease characterized by lesions which may involve any organ or tissue. It usually exhibits subcutaneous manifestations, relapses are frequent, and it may exist without symptoms for years." It is caused by the treponema pallidum bacteria. Like gonorrhea it attacks the mucous membranes. Symptoms appear in stages. Within two to eight weeks from the date of infection, a chancre sore will develop. It starts as a reddish spot which becomes a pimple which ulcerates then heals within two months. The healing of the chancer sore(s) does not mean that you are cured. The second stage usually manifests approximately one week to six months after the chancre heals in the form of a red or pinkish rash which is often accompanied by fever, sore throat, headaches, joint pains, poor appetite, weight loss, hair loss. Sores appear near the genitals and can heal then return often. Relapses are common. In it's third stage syphilis enters a latency period then in approximately 30 to 50% develop into the last stage which is fraught with heart problems, eye problems, brain and spinal cord damage, with a high probability of paralysis, insanity, blindness and/or death.
Pelvic Inflammatory Disease is caused when "infectious agents invade the uterus" and spread to the surrounding tissue. Symptoms include severe lower abdominal pain and tenderness, nausea, vomiting, pain during intercourse, and/or fever. In acute or chronic cases a constant lower back ache and mild abdominal pain may be noted.
Candida is basically a fungus which grows out of control if something kills or otherwise affects the benign acid producing bacteria. Symptoms include vaginal itching and irritation, swelling and redness of the vulva, and a is a whitish thick discharge (sometimes resembling curds).
Gardnerella is an infection with symptoms similar to Candida although the discharge is watery and is accompanied by odor.
Cystitis is what is commonly known as a bladder infection. It is caused by bacteria traveling up the urethra and into the bladder. Symptoms include the urge to urinate frequently with only a small amount of urine being passed when attempted, burning sensation during urination, sometimes accompanied by blood.
Names for particular infections: Salpingitis - fallopian tubes, endometritis uteral lining, vaginitis - exterior vagina,vaginosis - vagina, ectocervicitis - exterior cervix, endo cervicitis - cervical canal, and nongonococal urethritis (NGU) - urethra.
Parasites:
Trichomonal vaginitis is an infection caused by a parasitic protozoa and is also known as a yeast infection. Symptoms can range from nothing at all to persistent burning and itching. If there is discharge it is usually heavy, greenish yellow, and odorous. If significant cervical irritation occurs vaginal spotting may be an additional symptom.
Pubic lice commonly referred to as "crabs" are blood sucking parasites which appear primarily in hair located near the genital region. Symptoms include itching, particularly at night, an allergic rash, and/or. The louse can be seen upon close inspection.
Chlamydia is a microscopic organism that is not viral, fungal or bacterial. Symptoms include painful urination, a watery mucous discharge, urethritis, blisters or genital pimples which later are accompanied by swelling of the lymph nodes near the groin.
Viruses:
Hepatitis is defined as an "inflammation of the liver of virus or toxic origin. It is usually manifest by jaundice and, in some instances, liver enlargement. Fever and other systemic disorders are usually present." There are different types of hepatitis. Hepatitis A is contagious to individuals handling blood or feces of the infected individual. Unprotected anal sex is a prime example of the potential for exposure. Symptoms include jaundice, loss of appetite, fatigue and/or weakness, nausea, vomiting, discoloration of urine (brown) and/or feces (grey or white), and abdominal pain and discomfort. Other possible symptoms include skin rashes and arthritis. Hepatitis B is highly contagious during the four to six weeks before the appearance of symptoms and slightly beyond and is mainly transmitted through contact with the virus carried in the blood. Most suffers believe that they have the flu The symptoms are the same as for A, but are more severe and of longer duration. Hepatitis C is spreadable through intercourse. It is viral in nature as well. The symptoms are the same as A and B, but tend to be milder and may or may not include jaundice.
Herpes is an "inflammatory skin disease" which is viral in nature. Symptoms usually appear within six days of exposure and include blistering which then rupture and become ulcerate. The ulcerated blisters look like cold sores and appear on the penis, labia, urethra, anus and the cervix. These sores have a tendency to last for two to three weeks. Other symptoms are pain, tenderness, itching, pain when urinating, and swollen lymph nodes near the groin. 39% of men and 68% of women infected with herpes have reported fever, headaches, muscle soreness or other general malaise continuing for at least two consecutive days which slowly diminish. There is a high incidence of cervical infection and a low incidence of meningitis and eye infections accompanying a herpes outbreak. Recurrences are common on a monthly or even yearly basis, but with reduction of the intensity of the initial symptoms.
Human papilloma virus [genital warts] are believed to be caused by a mildly contagious virus. They are pin point infections which manifest as visible, but small warts. Not all individuals show symptoms. Location of warts in the genital area may vary, but are most commonly noted on the shaft or tip of the penis, the scrotum, the labia, the opening of the vagina or even the cervix. Cervical lesions may be indicated by an abnormal pap smear. Symptoms similar to those of vaginal infections may also appear.
AIDS is believed to be caused by a virus (HIV) which weakens the immune system and allows opportunistic infections and diseases to attack and weaken the system further. HIV is spread when the virus enters the blood stream of an uninfected person. The virus may enter through a break in the skin or mucous membranes. The highest concentrations of HIV have been noted in blood and semen. It is also present, albeit in smaller concentrations in vaginal and cervical fluid as well as in breast milk. HIV has also been noted in pre-ejaculate, saliva, sweat, and tears although in minor concentrations.
There is no consensus as to whether pre-ejaculate is capable of transmitting the virus. However, in 1990, the San Francisco Department of Public Health recorded three cases of men who became infected with HIV through oral sex. Oral sex was the only reported high risk behaviour. One individual reported having engaged in receptive oral sex, and one instance of protected receptive anal sex. There is a question as to whether gingivitis contributed to the seroconversion. As the disease passes through the bloodstream, cuts or sores in the mouth may serve to facilitate transmission.
There is consensus in the belief that saliva, sweat and tears are insufficient to pass the virus. Yet warnings are still provided about the risks of transmission through broken or irritated skin.
BEHAVIOURS
Sexual behaviors are classifiable in two fashions: (1) as known or theoretical based on the scientific literature and current studies, and (2) in relation to risk (i.e. no, low and high). The American Association of Physicians for Human Rights (AAPHR) has rated risk based on whether the individual is receptive or performing the insertion, whether a condom is used, and the presence of ejaculate.
Penile/anal and penile/vaginal penetration remain the highest incidence of infection. Vaginal and/or anal douching serve to increase the risk of transmission.
In terms of protection only abstinence and solo masturbation are totally and completely safe (I.e. No risk). However, total and complete abstinence as a means of protection from exposure the above diseases and disorders is not viable. Solo masturbation or yet no sex at all are not realistic expectations of humans. Even serial monogamy is no guarantee. Not only do you run the risk of a partner's infidelity, but your partner could have been infected long before you became involved.
There are things which you can do to minimize your risks, but in order to yield these benefits consistency is the key. You the more inconsistency the greater the risks. It is recommended that you:
¥ avoid contact with the blood, sperm, and vaginal fluids of others
¥ use condoms or other barriers (latex and/or nitryl) when engaging in intercourse
¥ if you notice sores or a discharge consider abstaining until your partner has had an opportunity to seek medical attention
Anal Sex: The friction from intercourse has a tendency to irritate the already permeable mucous membranes of the anus thus present the perfect opportunity for infection. It is very easy to cause small tears in the rectal lining which normally would not pose any serious problem to your partner. These microscopic breaks in the tissue make it easy to transmit the virus. It is believed that the mucosa itself serves as a means to transmit the virus. If you are allergic to non-oxynol 9, use of said product is believed to contribute to the transmission due to the irritation caused by the allergic reaction. The recommendation is that you avoid non-oxynol 9. If you are concerned about breakage, double bag (i.e. use two condoms or pull out prior to orgasm in addition to using a condom). You might want to experiment with condoms to determine what will yield the greatest pleasure for your partner.
You aren't immune from condom usage either. Whether or not you have a different dick for each partner, it is a good idea to use a condom. It makes clean up much easier and avoids the risk of bacterial or viral infections. It gets you both used to utilizing safer sex practices. Condom or not, it's always a good idea to clean your dick. A 10% solution of household bleach, adult toy cleanser, or hydrogen peroxide will do quite nicely. Be careful with bleach as leaving your equipment to soak may result in some discoloration.
Pulling out prior to ejaculation is not an effective means of protection as pre-ejaculate has between or unprotected digital penetration will also pose risks to both parties. You need to be particularly careful if you bite your nails, there is broken skin, and hangnails. Use a glove or finger cot for digital penetration. Use a condom for other forms of penetration.
Vaginal Sex: Unprotected vaginal sex is also high on the list. The presence of vaginal or cervical infections may contribute to increase the risks of contraction. Anything causing vaginal irritation will serve to increase the risks of contraction. Menstruation will increase the risk of transmission.
You need to take the same precautions as you would for anal sex with vaginal sex. Only water based lubricants should be used when engaging in vaginal penetration as the use of a petroleum product will promote and cause a horrendous yeast/bacterial infection. Always change condoms/gloves/dams when switching from anal to vaginal sex.
Oral Sex: Oral sex occurs when one person's mouth makes contact with the genitals of their partner. Whether or not unprotected oral sex can lead to transmission has been a hot topic for years. Despite the AIDS epidemic, people continue to perform oral sex without barriers. The greatest reduction of the risks that do exist is to use condoms. If you see a sore or a discharge on someone's penis, avoid unprotected oral sex. If you can't see (for those of you who prefer alleys) the rule of thumb is to use a condom.
To the extent that the virus is present in both pre-ejaculatory fluid as well as vaginal secretions. In both cases the risk appears to be greater to the person performing the oral sex (receptive partner) rather than the insertive partner. Don't kid yourself, there are risks to the recipient as well particularly with respect to the other STDs. Transmission of HIV is theoretically possible, thus poses a risk. In 1990, the American Association of Physicians for Human Rights (AAPHR) refined their guidelines regarding the risk of transmission. Oral sex was included in the revisions and are listed in the order in the order of highest to lowest risk.
¥ Unprotected (no condom) oral sex with men with ejaculation
¥ Unprotected (no barrier) oral sex with women
¥ Unprotected oral sex with men with preejaculate only
¥ Unprotected oral sex with men with no ejaculation or preejaculate
¥ Protected oral sex with men
Fellatio refers to oral sex performed on a male. Some people engage in unprotected sex believing that their stomach acid will neutralize the virus. Others prefer to give head, but not swallow. It is important to note that HIV exists in pre-cum as well as in semen. Not swallowing may not be as safe as you think. If you have recently brushed your teeth or flossed you may have microscopic cuts in your mouth which would increase the risk of passing HIV. Forcefulness on the part of the active party may irritate your mouth and throat which will make the tissues more permeable, thus increase the risks.
Geograhics also play a part in opinions. The majority view in Europe and Canada is that without open cuts or sores in your mouth the risk is minimal. The risk can be further reduced by refraining from ingesting pre-ejaculate and ejaculate. In the United States a more conservative view prevails. It is suggested that a condom be used from start to finish. As to brushing and flossing creating potential problems some authorities suggest that you refrain for two hours before and/or after sex while others suggest a 24 hour period.
Cunnilingus is oral sex performed on women. The debates which rage regarding transmission from sucking dick become even more heated in the area of cunnilingus. To the extent that the virus is present in vaginal fluid transmission is theoretical. While cunnilingus is believed to be on the low end of the risk scale, let's be real. If the odds are a thousand to one for winning the lotto and for contracting HIV chances are you will contract HIV before you win the lotto. Why gamble with your life?
Use of a dental dam is recommended. Latex dams tend to be cumbersom and unwieldy requiring two hands to use. You can use a glove slit up the middle if you need more surface are. A little lube on the side of the dam or the glove that is going to come into contact with your partner will increase sensitivity. If you insist on engaging in unprotected cunnilingus make certain that your partner is neither menstruating nor suffering from a yeast infection as these will increase the risk factor particularly if you have any cuts on your mouth, lips or hands.
CONDOM TIPS
When buying condoms pay attention to the expiration date. It's a good idea to have one or more on hand, just in case the opportunity presents itself. Pay attention to how long you have been carrying it around in your pocket. Change them after every couple of months. If you o your partner's objection to condoms is that they taste bad, try Gold Circle brand. They are unscented and unlubed.
Using condoms:
1. Carefully tear open the package so as to avoid damaging the condom. The last thing that you need is to tear it with your fingernail or with some other object.
2. The condom goes on better if the dick is hard. In fact, that's when you should put it on.
3. Do not open it up until you are ready to use it. Whatever you do don't inflate it.
4. Squeeze tip of the condom between your thumb and forefinger to expel air. Then place the still rolled up condom on the head of the penis or dildo. If your partner has a foreskin make sure that you draw back on the foreskin before applying the condom. Once you have it situated roll it down over the entire length of the dick. Get rid of any air bubbles.
5. Use only water-based lubricants. Beware of labelling "water soluble" is not the same thing as water based. A quick read of the ingredients will clue you into whether or not the lubricant is oil or water based. Oils tend to break down latex fairly quickly and will contribute to ruptures.
6. Withdraw the condom by holding the end against the base of the dick. This will prevent it from unravelling while still in your partner's body.
7. Use each condom only once. DO NOT under any circumstances reuse condoms.
***
Please send questions, suggestions, topics or requests for further information to Lbear@otherbear.com
Copyright © 1996
By Michael M. Hernandez and Sky Renfro
All Rights Reserved
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ACT UP/NY (ask for local contact): 1-212-564-AIDS Gay Men's Health Crisis (NY): 1-212-807-6655 National Minority AIDS Council: 1-202-544-1076 Women & AIDS Resource Network: 1-718-596-6007 San Francisco AIDS Foundation: 1-415-863-AIDS
http://www.stopaids.org/AIDSpre.html#Oralfacts
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