The Bay Area Reporter - September 3, 1999
Terry Beswick

The activists, mostly members of ACT UP/San Francisco, were drawing attention to various opinions perhaps best summed up by their signs and chants, which ranged from the inflammatory "DPH, full of lies, they don't care if queers die," to the ubiquitous "HIV is a lie," the subjective "homo sex is best," and the surreal "AIDS is over."

The meeting was hastily scheduled following widespread media coverage of a recent DPH study (see the August 19 Bay Area Reporter), widely interpreted to show that oral sex without condoms, while not the riskiest of sexual activities, is not without risk for transmission of HIV, the virus that causes AIDS. The purpose of the meeting was to provide community members an opportunity to ask questions directly of the researchers, including epidemiologists Dr. Susan Buchbinder, of DPH; and Dr. Eric Vittinghoff, of the University of California at San Francisco (UCSF).

However, the presentations seemed to pose more questions than provide answers for some members of the audience, many of whom seemed to be looking for simple answers that were not available. The researchers frequently were forced to draw on anecdotal evidence and small, old studies to speculate about the risks of various sexual practices.

"I didn't learn anything today," one participant complained. "Why can't you get more people to be in the research?"

"When the risk [being studied] is really low, it takes thousands and thousands of people and a lot of money to draw definitive conclusions," Buchbinder responded. (See page 18 for information on how to volunteer for three HIV prevention studies.)

Vittinghoff and Buchbinder, co-authors of the recent study of 2,189 HIV-negative gay and bisexual men that attempted to assign relative levels of risk for various sex acts, focused their comments on describing the "risk factors" shared by many of the 49 men who seroconverted during their 18-month study. These factors included: high numbers of sex partners, including those who said they were HIV-negative as well as those who were HIV-positive, getting fucked without a condom, and -- less widely reported -- use of methamphetamines, and uncircumcised penises.

Appearing to back off from previous assertions that their study, published in the August issue of the American Journal of Epidemiology, showed an approximate 1 in 2,500 risk of HIV transmission via unprotected oral sex with ejaculation (none of the study's seroconverters reported exclusive oral sex), Vittinghoff said, "The evidence is clear that it does sometimes happen, but we can't determine what the risk is." He reported that 24 of the men in the study practiced oral sex exclusively, but "none became infected."

Attempting to translate all the arcane statistics and terminology was Paul Cotton, director of health programs at Steamworks, a gay bathhouse in Berkeley. He said that the most frequent question he gets from bathhouse clientele is, "How risky is oral sex?"

Kim Shafer, an epidemiologist with UCSF, said that she had done a thorough review of large cohorts of gay and bisexual men and, based on this review, estimated that perhaps 2 percent of gay and bisexual men who seroconvert become infected through oral sex.

"This is just a number, and we as a culture get hung up on numbers," commented Cotton. "It concerns me that media take these numbers and puts out a headline that says 'Oral Sex is Unsafe!' What we can say is that oral sex is unsafe, but it's a lot less risky than anal sex." For comparison, the DPH study estimated a 1 in 120 chance of becoming infected when engaging in unprotected anal sex with a known HIV-positive partner.

Cotton also spoke about the need to respect each individual's choices in determining their own level of risk they are willing to take. "In the last few years, we've seen a lot more people willing to have unprotected anal sex," he said. "Some people like myself have found it very easy to draw lines in the sand. For other people, that line shifts, and it can move the risk. ... Some people find that for a period of time, it's great to throw the condoms out the window, and that's an okay thing ..."

One questioner was particularly concerned about Buchbinder's assertion that uncircumcised men may be at increased risk for HIV, particularly given the higher ratio of uncircumcised men among communities of color.

Buchbinder responded that although this observation has not been duplicated in other studies, "My guess is that if it is a link, it could be an association with increased risk of herpes and other sexually transmitted diseases" in uncircumcised men, which could make individuals more susceptible to HIV infection.

Presenters were also unable to say whether use of speed and other methamphetamines, as well as poppers, led to an increased risk of HIV infection because of behavioral change, or due to suppression of the immune system. Local activist Hank Wilson spoke about studies showing dramatic immune suppression after only a few inhalations of poppers, which are commonly used to enhance sexual arousal.

Another questioner asked panelists to describe the level of risk for an HIV-negative top having unprotected anal sex with an HIV-positive partner, to which Buchbinder responded, "The risk is low enough that it doesn't come up as an independent risk factor." Buchbinder also commented that, "It is reasonable to assume that insertive oral sex is not risky."

One young man stood up at the end of the meeting and commented, "In the real world it sounds like fucking with condoms and sucking without condoms should continue to be the party line." He said that this has been his practice, and that for him, it will continue to be so.

The two-hour forum was repeatedly disrupted by the protesters, who frequently heckled the presenters and held aloft small signs reading, "another lying researcher." Many of the audience members found the protesters' outbursts offensive enough to elicit counter-chants of "Shame, shame, shame!"

After repeated warnings, four of the activists were dragged from the room by officers from the San Francisco General Hospital police force and the San Francisco Police Department; two of the protesters were arrested and later released.
990903
BR990903

Always watch for outdated information. This article first appeared in 1999. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1999. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .