--------------------------
HIV infection is the only STD for which formal meta-analyses have been published (28, 166). The most recent analysis by Davis and Weller (28) was evaluated. This analysis, in which only longitudinal or cohort studies were included, used the following criteria to select studies related to condom use and HIV/AIDS prevention:
(1) Sample included serodiscordant, sexually active, heterosexual couples;
(2) HIV status was determined by serology (so that exposure to HIV was known);
(3) Data collection included self report about condom use; and
(4) Study design afforded longitudinal follow-up of HIV uninfected partner.
Studies with insufficient condom use information and/or duplicate or interim reports on the same cohort were excluded.
Davis and Weller found twelve studies, which met these criteria (139, 29, 30, 150, 155, 158, 160, 161, 165, 108, 171, 173). The meta-analysis noted the direction of transmission (male-to-female, female-to-male, and unstated) and date of study enrollment. Condom usage was classified into the following three categories: always (100% use), sometimes, and never.
Among participants who reported always using condoms, the summary estimate of HIV/AIDS incidence from the twelve studies was 0.9 seroconversion per 100 person years. Among those who reported never using condoms, the summary estimate of HIV/AIDS incidence from the seven studies was 6.7 seroconversions per 100 person years. Overall, Davis and Weller estimated that condoms provided an 85% reduction in HIV/AIDS transmission risk when infection rates were compared in always versus never users.
Conclusions
The methodological strength of the studies on condoms to reduce the risk of HIV/AIDS transmission far exceeds that for other STDs. There is demonstrated exposure to HIV/AIDS through sexual intercourse with a regular partner (with an absence of other HIV/AIDS risk factors). Longitudinal studies of HIV- sexual partners of HIV+ infected cases allow for the estimation of HIV/AIDS incidence among condom users and condom non-users. From the two incidence estimates, consistent condom use decreased the risk of HIV/AIDS transmission by approximately 85%. These data provide strong evidence for the effectiveness of condoms for reducing sexually transmitted HIV.
-------------------
Note that the 85% risk reduction quoted closely matches the 86% I gave in an earlier post in this thread.
An 85% risk reduction means that you are much safer using a condom than not using a condom if your partner is infected. It does not mean you are safe. It you are having repeated sex with an infected partner it means that on average you can expect to go 7 times as long before you become infected if you use a condom.
The only safe sex is sex with an uninfected partner.
-- Modified on 7/11/2005 6:23:50 PM
I thought these threads deserved a wider reading.
Boston Thread:
http://www.theeroticreview.com/discussion_boards/viewmsg.asp?MessageID=43770&boardID=9&page=1
New York Thread:
http://www.theeroticreview.com/discussion_boards/viewmsg.asp?MessageID=55458&boardID=2&page=1
Perhaps I should board up my windows here in LA just to be safe.
PIGH
Oh, sure! Right!
Or is it that only the Boston Mod had the guts to raise the issue and do something about it?
d_d
Personally, I would not engage in BBFS, but I have to say that I am really surprised at the puritanical reaction many people here seem to be having to the concept.
We all engage in an activity that non hobbyists would consider to be high risk. Some members of our community consider DATY to be dangerous, but you don't see them talking about banning those of us who engage in it.
Why don't we let the BBFS people be. Hell, why not make it an official category. That way those that want it can get it and those that want to avoid it can easily do so?
This community is full of people that participate in an activity that is shunned by outsiders, and I am surprised that we are so quick to be the ones doing the shunning.
Again, I have no desire for BBFS. Do not mistake this message as a declaration of such. I am simply curious about the intolerance of it.
It seems to me that forcing those that engage in BBFS to stay "in the closet" guarantees that it will go on, but without any controls in place. Any provider you see might be one of those that does it.
But if we let it be mentioned in reviews, then we will have a better idea of who to see, or who to avoid, based on preference.
TER often does let the mention of BBFS slip through in reviews.
In searching reviews for two cities I will be traveling to in the next month, I found TER reviews mentioning BBFS being available from at least one highly rated provider in each city.
That made it easy for me to cross them off the list.
The only problem with letting it be mentioned in a review is that a po'ed hobbyist could easily write a review saying such was offered when it wasn't. Then the provider would lose good clients and get all the BBFS crazies emailing her.
I have had reviews mentioning that I did things that I DID NOT or WOULD EVER do such as video taping a session (hell, I don't even show my face on my site).
It would just be used as a weapon ( many gents already threaten bad reviews...this would give them another tool ) Sad but true. Rumors are a horrible thing and could ruin a legitimate girls business.
Just my 0.02
If someone wants to trash a provider in a review, they can do it now.
If someone wants to say a provider does something that she doesn't, they can do it now too. Greek comes to mind for many.
Adding BB as a category isn't going to make it any worse. Liars will lie, and we'll all have to keep taking the reviews with a grain of salt.
While a guy can trash a girl in a review now it isn't as bad. No girl's business will be ruined because of a bad review(s) saying she does Greek when she doesn't. However, saying a girl does bareback will scare alot more guys off and start the rumor mill going ( especially is she is new and doesn't have established regulars that know better). Poof....there goes her business. A shame but true. Liars will lie, but this gives them a real good tool to use as leverage.
to Invisible's post. (and kudos to Mr. I for making this national TER news)
Dangerous liaisons vs. dangerous lesions.
I agree to a point that it’s none of our business what people do behind closed doors, I am from Massachusetts after all. But if those practices affect those of us who choose not to participate in such a potentially dangerous behavior, then I think it is our concern.
Check the facts, STD’s can be contracted from oral sex. The odds are lower but it can happen. Those odds go up if BBFS is occurring. If there are folks in the hobby who are participating in consensual unsafe practices and you then innocently (well sort of innocently anyway) make an appointment, your life may be turned upside down.
Now does that make it our concern? I think so, but that’s just MHO.
Researchers at the Centers for Disease Control attempted to estimate the risks associated with different sex acts ("Reducing the Risk of Sexual HIV Transmission," Varghese et al, Sexually Transmitted Diseases, January 2002.)
The important relative risk data is as follows:
SEX ACT
Insertive fellatio 1
Receptive fellatio 2
Insertive vaginal sex 10
Insertive anal sex 13
Receptive vaginal sex 20
Receptive anal sex 100
CONDOM USE
Yes 1
No 20
I haven't read the original paper, but the related link gives the data quoted above.
Note that the relative risk of receptive anal sex with a condom (which many providers do provide and nobody is upset about) is 100 * 1 == 100 and the relative risk of receptive vaginal sex without a condom (BBFS for the woman) is 20 * 20 == 400. Thus, BBFS for the woman is only four times as dangerous as receptive anal sex with a condom.
Plus there is experimental evidence that indicates that condoms may only be 86% effective for HIV rather than 95% as assumed (7 to 1 relative risk rather than 20 to 1). See http://www2.niaid.nih.gov/newsroom/releases/haitihiv.htm . Hence, receptive anal with a condom may actually be nearly as dangerous as BBFS for the woman.
Also, please note that to go from relative risk to absolute risk you have to factor in the probability that your partner has HIV (about 1% of the adult population of the US is thought to be infected although for some subpopulations such as men who have sex with men and intravenous drug users the infection rate is much higher) and the probability of transmission of HIV in a single act of receptive vaginal sex (estimated as 1 chance in 500 in the absence of vaginal sores in either partner and assuming the infected partner is not in the early more highly contageous stages of the infection).
-- Modified on 7/11/2005 5:01:21 PM
You compared the relative risk of a receptive act
to the relative risk of a insertive act.
In the vast majority of encounters (sex between
a single male client and a single female
provider) the particpants can not choose whether to be one or the other.
Which means the most relavant comparison is the
relative risk between insertive acts (for the
male client) or between receptive acts (for the
female provider).
Anyway you slice it, ANY sex act w/o a condom is
much more highly likely to get any person
infected.
Also, I'm not sure how you equate BBFS to
insertive vaginal sex - that's for the male
only. BBFS has two particpants.
-- Modified on 7/11/2005 5:09:38 PM
That in some way or another, the statistics with the condoms are fudged, because they are based on self-reporting and field studies.
The main question I have is, does practice make a difference? Do people become more effective at using condoms?
I don't know that conditions in Haiti would be consistent with conditions in the US. There are some sexual practices in Africa that increase the possibility of transmitting AIDS. This study may indicate that condoms are less effective, but I presume the study was, of course, based on interviews. What people say in the interview and what they actually do may be quite different. It's cynical to say, but human beings aren't built for honesty, especially about sex.
The second is the assumption you make is that the 1 percent infection level is, in fact, stable.
The crucial fact is, it won't stay as low as 1 percent if high risk people, like us for instance, don't stay disciplined about this. And the higher that goes, the more further spread of this becomes likely. We've got to hold the line. Pleasure seeking does not imply reckless or undisciplined. And if this community is the one that lets the cork off this epidemic, than as bad as the disease is, the consequences from the civvie community alone may be equally as harsh.
American male homosexual community has drastically reduce the spead of AIDS/HIV. Justify and try to skew the stats all you want, analyze the percentages and what do you have?
Condoms reduce the risk. WTF else do you need to know? Are you going to try the Vodka and Cranberry Martini that the BBFS gang thinks eliminates any risk or are you going to where your wet suit?
Me its wetsuit all the way!
Happy snorkling,
cd
When I said it was someway "fudged" I didn't mean that they didn't markedly reduce risk. No! I meant just the opposite, that they are probably more effective than the estimated.
I meant that it's hard to know the precise percentage of effectiveness due to sampling issues alone. If anything I think their effectiveness with HIV may be under-estimated.
Moreover, my other question was whether they become more effective with practice, which would be a factor in habitual high risk activities. I think a category like "condom use" could be very incomplete without considering this.
I'll add, also, that our current illustrious administration is hell-bent on discouraging condoms. Good studies about them may be hard to come by in the US.
Please see my other post on this thread.
-- Modified on 7/8/2005 12:19:23 PM
for which there is more data, but I don't consider it likely.
Male condoms are generally regarded as reducing risk for many (but not all) STDs by about 87%. Female condoms may do slightly better. I typed in (most of) an article in the Journal of Sexually Transmitted Diseases on this subject. It required two posts because of length restrictions on posts. The links are http://theeroticreview.com/discussion_boards/viewmsg.asp?MessageID=92901&boardID=12&page=130 and http://theeroticreview.com/discussion_boards/viewmsg.asp?MessageID=92902&boardID=12&page=130 .
I agree with your point about the 1% infection rate.
If a disease is to increase in a population each infected person has to spread the disease to at least one other person (on average) before the infected person dies or is cured. Epidemics are critically dependent on the number of new infections from each infected person being significantly greater than 1.
Perhaps the most important role of condoms is to reduce the number of new infections from each infected person. If this number is below 1 the number of infected persons tends to decrease (in the absence of new infections from outside the population). Safety lies in having only a very small fraction of the population infected. You can't get HIV from someone who isn't infected.
-- Modified on 7/11/2005 5:33:35 PM
I agree with you totally. This seems to be pretty rediculous to me, what do any of us know about each other? Everyone here could swear up and down they don't or haven't partaken in BBFS does that mean it's not going to happen and go away? Give me a break. The possibilty of disease is there, is alway's going to be there, and isn't going to go away no matter what. If you pratice safe sex, as everyone should be, that's about all you can do other than quit all together. Something that bother's me more, or at least just as much, is the number of guy's who frequent TS's just as much as they do women provider's. Let's face it a TS doesn't have to worry about getting pregnant so who know's what goes on there and then could get transfered to one of the women. That bug's me but I guess not enough yet because I'm still here.
You cannot be serious. "Puritanical ethics" would dictate that a particular act was inappropriate on general ethics principal, while THIS is rather serious and justfied matter of public health and safety.
This hobby is only fun as long as it's safe, and I can't think of anything more dangerous, stupid or just plain SELFISH than to risk the lives, health and reputation of other people for something so easy to prevent from happening.
That's a line that no one should be encouraged OR allowed to cross. People are certainly entitled to their own sexual preferences, but this is not a simple matter of preference. This is a HUGE issue of safety that can and WILL have a direct impact on the lives of people who don't even want to have anything to do with it, if it goes unchecked!
You said:
"It seems to me that forcing those that engage in BBFS to stay "in the closet" guarantees that it will go on, but without any controls in place."
...Controls such as what??? The very premise of BBFS is that there ARE no boundaries in place to protect anyone involved. How do you propose we go about promoting such an insanely, stupefyingly dangerous act under any mask of "control?"
I think the ONLY way to protect those of us with a sense of self-preservation and common sense is to very clearly ostracise the careless morons who are putting ALL of us inderectly at risk with their stupidity. And yes, it IS stupidity!
All it takes is ONE provider working up a tidy reputation as offering BBFS, and a handful of "thinking with the small head" men to give her the thumbs up... and before you know it, we'll have a a dangerous new standard that other ladies WILL be held to by clients. And the thought of that both saddens and disgusts me.
It is up to each and every one of us to maintain the safety of our community. It's not like we're in monogomous relationships here- everyone networks with everyone else, and there's absoluely NO excuse for a provider OR client to be condoning such a reckless "preference" that can put all of us at risk.
Just my two cents.
xoxo
Denise
The controls I was referring to are the clear knowledge of who offers it and who doesn't.
If we all know that providers A, B & C offer BBFS, then the folks who want it can see them, and the rest of us can see providers D, E & F safe in the knowledge that they probably don't engage in such dangerous activities.
However, if no one is allowed to talk about it, then providers ?, ? and ? will still do it. Now the hobbyists who want it are bugging (and possibly offending) the providers who don't offer it, and the hobbyists who would prefer to avoid girls who do that have no way of knowing who to avoid.
Banning the discussion about it, in the hopes that that will stop people from doing it is like trying to stop teens from having sex by getting rid of sex-ed in school, and preventing them from having access to condoms.
(Yes, I am aware of the irony of that particular example)
And that is what I consider puritanical.
-- Modified on 7/8/2005 9:06:35 AM
"If we all know that providers A, B & C offer BBFS, then the folks who want it can see them, and the rest of us can see providers D, E & F safe in the knowledge that they probably don't engage in such dangerous activities."
What I'm saying is it shouldn't even be an OPTION up for official review or advocation in the first place.
Why?
Because who's going to make sure that Client-A doesn't hook up with Provider-A, contract something (a significant risk, in that situation) then hook up with Provider-D and pass it along to her?
Who's going to make sure that every girl who offers BBFS has their reputation permanantly marked to let ALL of their clients know that's the type of business she's running?
And finally- who is going to come to the defense of SAFE providers who refuse to do this, if it becomes a popular preference? I've seen guys who be big enough jerks to publicly shred a lady who doesn't offer a BBBJ- and call me paranoid but I don't think there are men above denagrading a provider for not offering BBFS if it becomes popular in a mainstream way.
Moving right along...
"However, if no one is allowed to talk about it, then providers ?, ? and ? will still do it."
I don't think that discussion should be banned. I think THEY should be banned. If it's clear that their reckless behavior is not tolerated around here, they WILL go away. They WILL realize they are not welcome to spread their stupidity (and their STDs). And if they continue to work the way they do, they'll be forced to do so under the radar as they already have, thereby limiting the damage they can cause.
"Banning the discussion about it, in the hopes that that will stop people from doing it is like trying to stop teens from having sex by getting rid of sex-ed in school, and preventing them from having access to condoms."
I don't think that's a good analogy. I understand where you're coming from, but give me a break here- you KNOW those are apples and oranges.
First of all, we're NOT talking about sex as a broad subject, which could be interpreted a thousand ways as either good or bad. We're talking about unprotected sex with a woman who's in the business of seeing MANY men, and you'd be crazy to give me ONE good justification for that. If you can give me ONE good thing that can come of that, then I'll concede the point to you. The fact is, it's a lose/lose situation, with nothing but harm to come of it.
Second, I'm not advocating that we ban discussion of it. I'm advocating that we ban the participants of it.
I'm a pretty liberal person, but this is something I'll never EVER justify or even ignore. I've seen too many people hurt by f*cking the wrong person without protection, and the risk factor increases ten fold if one did so in OUR community.
That's all I can say.
xoxo
Denise
Hanging around gay men, I know more than many hetero men & women on activities I'll never bother with, fortunately. It's not hard to find STD risks vs. activities & condom use. This information is widely disseminated by CDC and other public sites. Here's the CDC fact sheet on condom use: http://www.cdc.gov/nchstp/od/latex.htm
If you want stats, click on the link to the NIH report. http://www.niaid.nih.gov/dmid/stds/condomreport.pdf
I do want to note the NIH report came out in late 2000, and there have been more findings from studies following the report which are more scientifically rigorous. The CDC fact sheet is inclusive of information from studies after the 2000 report.
I did pull out the two reasons why it might be useful to strap on that condom.
HIV/AIDS:
"From the two incidence estimates, consistent condom use decreased the risk of HIV/AIDS transmission by approximately 85%. These data provide strong evidence for the effectiveness of condoms for reducing sexually transmitted HIV."
Gonorrhea:
"The panel deemed, however, that the collective strengths of these studies demonstrated that correct and consistent condom use would reduce the risk of gonorrhea for men. The available epidemiologic literature does not allow an accurate assessment of the degree of protection against gonorrhea infection in women offered by correct and consistent condom use."
-- Modified on 7/8/2005 7:20:06 AM
I agree that this is hypocritical. The scoring guidelines for reviews gives extra credit for greek, bbbj, and daty. All of these activities carry very high risk. Don't get me wrong, I would run from bbfs. I don't do daty and I don't do bbbj.
I don't believe the board standards are applied consistently. The policy clearly states that the boards are not for provider availability announcements. Yet about 1/3 of the posts are on local boards are just that. I have been flamed openly and my attempts at defending myself not put on a board. People who post drivel aren't even on moderated status.
And, provider availability announcements are disallowed on this board, but are allowed on the regional boards.
An adage by the year 2550, and always fresh before then.
Again I state, WTF else do you need to know.
-- Modified on 7/11/2005 6:33:26 PM
--------------------------
HIV infection is the only STD for which formal meta-analyses have been published (28, 166). The most recent analysis by Davis and Weller (28) was evaluated. This analysis, in which only longitudinal or cohort studies were included, used the following criteria to select studies related to condom use and HIV/AIDS prevention:
(1) Sample included serodiscordant, sexually active, heterosexual couples;
(2) HIV status was determined by serology (so that exposure to HIV was known);
(3) Data collection included self report about condom use; and
(4) Study design afforded longitudinal follow-up of HIV uninfected partner.
Studies with insufficient condom use information and/or duplicate or interim reports on the same cohort were excluded.
Davis and Weller found twelve studies, which met these criteria (139, 29, 30, 150, 155, 158, 160, 161, 165, 108, 171, 173). The meta-analysis noted the direction of transmission (male-to-female, female-to-male, and unstated) and date of study enrollment. Condom usage was classified into the following three categories: always (100% use), sometimes, and never.
Among participants who reported always using condoms, the summary estimate of HIV/AIDS incidence from the twelve studies was 0.9 seroconversion per 100 person years. Among those who reported never using condoms, the summary estimate of HIV/AIDS incidence from the seven studies was 6.7 seroconversions per 100 person years. Overall, Davis and Weller estimated that condoms provided an 85% reduction in HIV/AIDS transmission risk when infection rates were compared in always versus never users.
Conclusions
The methodological strength of the studies on condoms to reduce the risk of HIV/AIDS transmission far exceeds that for other STDs. There is demonstrated exposure to HIV/AIDS through sexual intercourse with a regular partner (with an absence of other HIV/AIDS risk factors). Longitudinal studies of HIV- sexual partners of HIV+ infected cases allow for the estimation of HIV/AIDS incidence among condom users and condom non-users. From the two incidence estimates, consistent condom use decreased the risk of HIV/AIDS transmission by approximately 85%. These data provide strong evidence for the effectiveness of condoms for reducing sexually transmitted HIV.
-------------------
Note that the 85% risk reduction quoted closely matches the 86% I gave in an earlier post in this thread.
An 85% risk reduction means that you are much safer using a condom than not using a condom if your partner is infected. It does not mean you are safe. It you are having repeated sex with an infected partner it means that on average you can expect to go 7 times as long before you become infected if you use a condom.
The only safe sex is sex with an uninfected partner.
-- Modified on 7/11/2005 6:23:50 PM
who never use condoms (top of page 14). They do not distinguish between insertive and receptive vaginal intercourse. This means if you have unprotected vaginal intercourse and your partner (or all your partners) are HIV positive you can expect (on average) to become infected in about 15 years.
Using a condom increases that to 111 years.
However, it appears that they did not ascertain the frequency with which couples were having sex. I would expect that providers are having a lot more sex than civilian women and that the mean time to infection would shrink accordingly.
Of course, if not all the provider's partners are infected the mean time to infection would increase. The numbers given assume all sex acts are with an infected partner.
This is not like censoring pornography. It's not even in the same category. Promoting this activity in our high-risk group is a threat to my health and life, a threat to all of us, and a threat to a lot of other people's lives if this disease spreads among us.
It goes further than that. As I said in the other post, expect the civvie community to come down on us even harder if AIDS is spreading, and it becomes two or three percent of the population, or higher. If things seem to be getting hot now, we are going to be treated miserably if we don't hold the line on this epidemic. We may expect not just a witch hunt, but witch burnings if that happens.
Now, given the level of threat that I've just described, there are worst things that could happen to them than just being embargoed, isolated and banned. They could say what they want among their own numbers, but they need to be identified and isolated, and if they won't stop, perhaps even outed. Their behavior is deplorable, ignorant and stupid.
any other sexual acts.
I don't think anyone is advocating promoting BBFS. What I do object to is the notion that BBFS is evil and should not be discussed and that we will all be perfectly safe (from both HIV and the so-called civvie community) if we have our own witch hunt.
He simply will not let this individual post on
the boards he moderates.
I think he's out of line myself.