Washington Blade - August 24, 2001
Eric Erickson

The study is being conducted by researchers at the University of California at San Francisco and was presented at the second National HIV Prevention Conference last week in Atlanta.

While the findings from the study are preliminary, they have already sparked controversy among AIDS activists across the country.

"It's been acknowledged for a long time that people can acquire HIV through oral sex - I don't think anyone is disputing that. What people are at odds about is what is the risk," said Dr. Kimberly Page Shafer, who is conducting the study.

"If you talk to HIV counselors, they will tell you that the one question that all of their clients ask them, irrespective of their sex, their gender, their orientation, the one question that is universally asked is 'Can I get HIV from oral sex?'"

Shafer and her colleagues interviewed 198 people for the study. The subjects were all seeking anonymous HIV testing and had engaged in oral sex only during the six months prior to being involved in the study.

Researchers tested the study subjects for HIV using advanced blood tests that can distinguish between a new and an old infection. Only one person in the study tested positive for HIV and researchers determined it was an old infection.

Shafer said many of the people in the study performed oral sex on a partner they knew to be HIV positive.

With no one in the study testing positive for a recent HIV infection, preliminary numbers from Shafer's study put the statistical chance of getting HIV from oral sex as low as 0 percent and only as high as 2 percent.

CDC study shows higher risk

In February 2000, the CDC released findings from a study that on the surface appears to contrast the findings from Shafer's study. The CDC study said oral sex "contributes significantly" to the spread of HIV. Eight percent of the subjects in the CDC study appeared to have been infected with HIV through oral sex.

"We actually don't see them as contrasting one another," said Dr. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD & TB Prevention, of the two studies on oral sex and HIV transmission.

"Even in her press release, [Shafer] made the statement that while rare, it is possible to acquire HIV infection orally," he said.

Both Valdiserri and Shafer pointed out distinct differences in the methodologies used in the two studies. All subjects in the CDC study were HIV-positive going into the study and then were asked about their sexual behavior to determine how they were infected. In the UCSF study, subjects were only engaging in oral sex prior to being involved in the study.

"If you're looking at behavior that has a relatively low risk of transmission," said Valdiserri, "it's not surprising that if you pick 198 people at one particular site ... none of them are infected. That contrasts to the other study where you start out by looking at people who are recently infected within the last six months and then you go and interview them about their sexual practices."

Shafer agreed and said many people are misinterpreting both studies.

"That other study should not be interpreted to suggest that 8 percent of people get HIV from oral sex," said Shafer. "My study, similarly, shouldn't be interpreted as no one gets HIV from oral sex."

Ongoing oral sex debate

The connection between HIV infection and oral sex has been debated since HIV was discovered. Andrew Sullivan, an openly gay author and former editor of the New Republic, said he was the subject of public ridicule when he said he believes his HIV infection was the result of oral sex.

"I have no reason to make this up," said Sullivan. "It seems to me the most plausible way I got it. Of course, I don't know for sure, who does? Just because it happened to me doesn't mean it's a major risk for most people."

Another AIDS activist, San Francisco's Michael Petrelis, questioned the timing of the UCSF study.

"Does UCSF really want me to take them seriously when they wait 20 years to try and answer the question 'Does oral sex transmit HIV?" Petrelis said. "I'm sorry, but gay men in San Francisco that I asked about this study said they were not waiting for the results of this study to come out.

"Gay men in San Francisco have not been waiting to practice oral sex for the UCSF researchers to tell us whether they believe it's safe or not," he said.

But that's exactly why Shafer said she believes her study is important. Shafer wants to find out why some people, like Sullivan, may have been infected with HIV through oral sex and why other people escape infection despite the same sexual practices.

Shafer said her study would continue for about two years while she looks at co-factors that could play a role in HIV transmission through oral sex. She said she wants to determine whether it makes a difference if the person performing oral sex swallows the ejaculate of an HIV infected person.

The study will also examine if HIV has a higher risk of transmission if the person giving oral sex has trauma or open sores in their mouth.

According to one of the country's most respected AIDS experts, these factors do make a difference. Dr. Robert Scott has been treating people living with AIDS since the epidemic broke in the early '80s. He said if a person does not have open sores in their mouth, transmitting HIV through oral sex is "virtually impossible."

"I have over 400 patients who have HIV disease," said Scott. "We carefully looked with those patients at their risk and their transmission has almost always been through either vaginal or rectal intercourse.

"If we could, in fact, get people to use rubbers when there's either vaginal or rectal intercourse, I think that we could stem the transmission of this disease by 99.9 percent," he said.

Scott said swallowing ejaculate would not increase risk, as long as the mucus membrane is intact, because "the acids in the stomach will kill the virus, period."

While the numbers released from Shafer's study are preliminary findings, she said it's important people know the risk of HIV transmission from oral sex is "very low."

"If they're faced with choices in their sexual life, at which point it makes no difference, I think it does make a difference," said Shafer. "We've seen risk behaviors going up and incidence rates going up. Let's remind ourselves that there are safer alternatives."

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