Washington Blade - October 24, 2003
Stephen Fallon

" Uncircumcised men absorb HIV easier"

" Oral sex is risky, even for the receiving partner"

THREE BIG HEADLINES screamed warnings this month about "new" variables that can put people at risk of catching HIV. But these scary stories are each either not new or not accurate.

Dangerous condoms: Colombian Cardinal Alfonso Lopez Trujillo shocked many when he declared that condoms are only 90 percent effective in blocking HIV. The cardinal is not wrong; data show that people using condoms reduce their risks of HIV infection by just 87 percent.

That's because the term "condom use" is vague, covering everything from proper start-to-finish condom use on down to improper use: applying the condom late, using oil-based lubes, or failing to pinch the reservoir tip when rolling the condom on.

But the cardinal went too far when he compared using condoms to "playing Russian Roulette." It was also irresponsible for him to suggest that condom packages should carry a Surgeon General's warning, just like cigarettes - as if condoms were deadly.

The cardinal claims, "The AIDS virus is roughly 450 times smaller than the spermatozoon. The spermatozoon can easily pass through the 'net' that is formed by the condom."

It's true that HIV particles are smaller than sperm. If condoms were designed to just barely block sperm, the way a soccer net's wide weave can catch a soccer ball but not a ping-pong ball, then the cardinal would be correct in his implication that HIV just sails through condoms.

But condoms are actually made to block water molecules, which are 20 times smaller than HIV particles. HIV can't pass through an intact condom.

Uncut males face higher risks:

A new study of nearly 2,300 men in India found that uncircumcised men are eight times as likely to become HIV-infected as are circumcised men. Researchers explained that the inner surface of the foreskin does not have the same protective layer as the outside.

While this study identifies a true risk facilitator, it really just confirms what had been reported repeatedly for the past decade. Three years ago, Australian researchers summarized 40 past studies, and reached the exact same conclusion.

Why does foreskin soak up HIV? Part of the immune system can accidentally pull the virus in, thinking it's a good way to trap it and dispose of it. These immune cells (known as Langerhans' cells) are present even in unbroken foreskin, so HIV can be absorbed even if there are no visible cuts.

Of course, all of these studies become irrelevant if you always practice safer sex. Circumcision just gives tops a little more margin of error if they ever slip up, and penetrate another guy without a condom.

Oral sex risks: Another Australian study this week reported that five out of 75 recently infected men probably acquired HIV through oral sex.

Especially unusual was the authors' claim that even the partner getting a blowjob can catch HIV, if he has a genital piercing (a "Prince Albert" ring).

This was a retrospective study. That means researchers interviewed gay men after they had become infected, and asked them to recall what behaviors probably caused their infection. The researchers admit, "Even the most skilled interviewer cannot elicit a clear account of an event that is remembered through an emotional or drug-induced haze."

Prospective studies, by contrast, have currently HIV-negative persons report their sexual behaviors periodically. This way, if an infection occurs, its likely cause has already been recorded, and is less likely to be masked by embarrassment or denial.

The researchers acknowledge that these prospective studies "have not identified any cases of [oral sex] transmission."

For example, a recent 10-year study tracked 135 men and women who performed 19,000 instances of oral sex for their HIV-positive heterosexual partners. In 3,060 instances, the HIV-positive male partner climaxed into the female's mouth. Yet no infections resulted.

So there you have it: Three new Halloween headlines, but no real surprises. Use condoms when you have anal sex, unless you're with a monogamous partner and you have both tested HIV- and been hepatitis A and B vaccinated.

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Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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