The related link may make your eyes glaze over but it has a lot of good information. (I know I haven't digested it all yet.)
The interesting quote from the Penile-Vaginal Sex section is, "Per-act infectivity in two studies (62,63) was found to be low: 0.0005 and 0.0009 for male-to-female transmission, and 0.0003 and 0.0001 for female-to-male transmission. However, studies conducted in developing countries have estimated that per-act transmission probabilities are greater by a factor of 10 (44,64) for both male-to-female and female-to-male transmission.(65)".
In my analysis I was using the CDC estimate of 0.002 (i.e., 20 / 10000) for male-to-female transmission.
The lower numbers quoted here may help to explain the absence of cases in the Nevada bordellos.
Note that the higher numbers for Africa may be partially explained by the rarity of male circumcision in Africa. (Unfortunately, the barbarity of female circumcism is all too common, and may also contribute to the higher infectivities). As 2sense pointed out, recent data has shown a 60% reduction in per-act risk of HIV infection associated with male cicumcision.
-- Modified on 11/1/2005 1:32:14 AM
For a somewhat more complete version see the Related Link.
The equation is:
risk = protection_risk * relative_sex_act_risk * partner_risk * circumcism_risk / 10000
risk is the risk associated with a single sex act.
protection_risk is 1.0 for no condom and 0.15 if using a condom.
See the Related Link for the relative_sex_act_risk associated with various acts. For receptive vaginal intercourse this number is 20.
See the Related Link for various partner risks. For a hetrosexual partner with unknown HIV status selected at random from the US population it is 0.01.
The circumcism risk I did not know about until the post by 2sense ( http://www.theeroticreview.com/discussion_boards/viewmsg.asp?MessageID=159863&boardID=12&page=1 ). Since the US male population is mostly circumcised, I assume that the risk estimates for insertive sex in the Related Link are for circumcised males. This factor would therefore be 1.0 for circumcised males and 2.5 for uncircumcised males (if the act is insertive). It would be 1.0 for females since as far as I can tell male circumcism is not a factor in male to female transmission.
Thus for a female the risk of a single act of BBFS with a hetrosexual partner of unknown HIV status is
risk = 1.0 * 20 * 0.01 * 1 / 10000 = 0.00002
She can reduce this by requiring the use of a condom, i.e.,
risk = 0.15 * 20 * 0.01 * 1 / 10000 = 0.000003
Note that although these risks are small neither is zero.
Note also that reduced use of condoms would increase the fraction of the population that is infected and would (over time) increase the partner_risk factor.
It is certainly reasonable to use condoms to reduce the already small (with a single act) risk of HIV infection.
I certainly do not object to the fact that most women and many men feel more comfortable with condoms. Nor do I deny that they help reduce the spread of disease. (This effect is perhaps even more important for other STDs, many of which have much higher infectivities than HIV.)
However, it should be emphasized that the only safe sex is sex with an uninfected partner. Condoms reduce risk. They do not eliminate it.
-- Modified on 10/27/2005 10:46:44 PM
uses the word "infectivities" ?
Infectivities is not a word.
Yes, your stats regarding brothels are correct. And, yes there has not been one HIV case to date.
Regardless, there are many STD's other than HIV that I DO NOT WANT ANY PART OF nor will I take that risk.
Consider this, only people that don't have much too lose will offer BB.
Lurking beneath the surface could be other pathogens other than HIV that can harm your current or future partner/wife.
xo xo Lisa Butler
-- Modified on 10/28/2005 6:50:06 PM
A story Mrs Field's tells of how she got started making cookies involves a dinner guest who threw a dictionary at her after she said she got "orientated." He said there is no such word. Look it up for yourself. Well, the usual preferred word is oriented, not orientated (which is a word, come to find out) Quite different meanings, esp for Muslims with their prayer rugs. Orientate deals with finding compass orientation.
The question was, "Do you have numbers regarding the concentration or dilution of the hobbiest community relative to the general population?"
The answer is, no I don't. However I found an interesting link. (Google is amazing.) See Related Link below.
A couple of quotes.
"A study of 1,396 female sex workers in six US cities found an HIV seroprevalence of 12%, ranging from 0-47.5% depending on the city and the level of injecting drug use."
"Some rural counties in Nevada have legal prostitution governed by the state Board of Health. The Board requires that condoms be used for all acts of sex and that sex workers must be licensed and undergo weekly STD tests and monthly HIV tests, at their own expense. (9) As of 1993, no women tested positive out of a total of 20,000 HIV tests of sex workers."
My feeling is that our community is much more like the second quote than the first. However, since the hobby isn't legal and HIV testing isn't mandatory, I think the truth is that nobody knows for sure.
A second link that is less definitive but which I found to be interesting is http://en.wikipedia.org/wiki/Prostitution_in_Nevada .
As far as I know the quote, "Since 1986, when mandatory testing began, not a single brothel prostitute has ever tested positive for HIV" is correct.
If condoms were not used there would have been about 7 times as many cases. However, 7 times 0 is still 0.
Nevada has roughly 300 legal prostitutes and HIV testing has been mandatory for 20 years. That equals about 2,664,500 prostitute-days and your guess is as good as mine as to the number of sex acts that implies. From the formula I gave in my main post one would expect about 3 infections per million sex acts even when condoms are used for every act. For there to be zero infections the inference is that the HIV infection rate in the client population is lower than the 1% figure usually given for the US population as a whole.
-- Modified on 10/28/2005 1:05:27 AM
HIV sucks; but so does herpes, which also is not curable. The herpes numbers are what puts using condoms in the freakin' obvious zone.
The NIH website (see link) says:
-------------------
How can I protect myself or my sexual partner?
If you have early signs of a herpes outbreak or visible sores, you should not have sexual intercourse or oral sex until the signs are gone and/or the sores have healed completely. Between outbreaks, using male latex condoms during sexual intercourse may offer some protection from the virus. When used with these precautions, Valtrex can also help prevent infecting your partner during heterosexual sex.
-----------------
I'm not an MD and some input from a doctor would be helpful, but it does not appear that condoms are very effective in preventing the transmission of herpes.
In the article "Condom Effectiveness: Factors that Influence Risk Reduction," Fitche et al, Sexually Transmitted Diseases (Journal of the American Sexually Transmitted Diseases Association), December 2002, page 813, it says, "For STDs spread by genital fluids (HIV, gonorrhea, chlamydia, and trichomoniasis), an intact latex condom should prevent one's risk of infection following a single sexual exposure--provided the condom is used according to the seven steps for correct use recommended by the CDC and does not slip or break. For STDs classified as genital ulcer diseases (genital herpes, syphilis, and chancroid) and for HPV (which appears to be transmitted both by direct contact and through genital fluids), an intact latex condom may not reduce one's risk for a single act of sex, even when the condom is used "correctly" and does not break or slip. Despite even correct condom use, significant risk of infection may remain because disease transmission can occur from infected skin or lesions not covered by the condom."
-- Modified on 10/28/2005 1:44:39 AM
common sense sound over rule........
he does not appear to be making that claim. What he does appear to be writing is that the oft repeated post that going BB is a death sentence is not correct. Circumstances that lead to infection vary. It is absolutely wise to wear a condom, but doing so in the absence of other common sense behaviors will not necessarily protect you.
Still, statistics can be a useful tool.
And, no, I am not trying to say BB is safe. I am trying to say that covered isn't safe either. Just safer.
Gonorrhea is one of the most common STDs (or STIs). It is highly infectious. I have seen estimates of the per act infectivity of gonorrhea ranging from approximately 0.2 to greater than 0.5. (Unfortunately, I was unable to find an on-line source.) Thus, gonorrhea is at least 100 times as infectious as HIV. Note that the Related Link says, "Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired."
Fortunately, condoms give good protection against gonorrhea. The article "Promoting Condoms for Oral Sex: Impact on Pharyngeal Gonorrhea Among Female Brothel-Based Sex Workers," Wong et al, Sexually Transmitted Diseases, June 2002, page 311, says, "Our earlier prospective study on female based brothal-based sex workers in Singapore found that unprotected oral sex increased their risk of acquiring pharyngeal gonorrhea from their clients by 17 times (95% CI:8.0-36.5).
Thus, condoms give about 88% to 97% protection against pharyngeal gonorrhea. However, most escorts in Los Angeles don't use condoms for oral sex and most men don't request them for oral sex.
Perhaps the risk of pharyngeal gonorrhea is not taken seriously. Or perhaps the gains of going BB with BJs are felt to outweigh the risks. The escort I saw two weeks ago said, "I hate the taste of plastic. I never give covered blow jobs." And I knew one guy who said, "I won't see a provider who only gives covered BJs. I don't care what the risk is. A covered BJ does nothing for me."
Note that even with gonorrhea, using condoms for oral sex doesn't make you safe. However, you can expect to go 17 times as long between infections if you use condoms. Using condoms for oral sex definitely make you safer.
Of course, you have to ask how many of your clients have gonorrhea. If the answer is none, then you don't need a condom. You can only get infected if your partner is infected.
The ONLY safe sex is sex with an uninfected partner.
Unfortunately, with a highly infectious STD like gonorrhea a negative STD test becomes meaningless in days where for a low infectivity STD like HIV it takes much longer for the test to become meaningless. (Since the per-act infectivity of HIV is so low it is extremely unlikely that you will become infected the first time you have sex or even the first few times. With gonorrhea you may easily become infected the very first itme you have sex.)
Please note, once again, I am not an MD. I read some of the literature but there may well be gaps in what I know. My quotes are accurate, but there may well be important information of which I am not aware.
-- Modified on 11/1/2005 1:19:55 AM
If people in the hobby get careless about HIV, the risk to everyone will quickly go up. It's a low risk now, but each new infection gives a slightly higher risk of another.
People in this life *must* hold the line on this, for more reasons than one. Believe me, if HIV gets out of control due to hobby activities, lawmakers and LE will swiftly crack down on this.
statistics of street prostitutes? Very scary!
As one of my friends once said, "I wouldn't touch one of them with a ten foot penis!"
To which I would add, "Covered or not."
-- Modified on 10/31/2005 10:51:05 PM
in a couple of years, BBFS will earn providers one more "point" above a seven in TER's scoring system.
Time to retire *sigh*
The TER population is far from being representative of the average American or person, and I believe the average number of others a man or woman has slept with is around 7-8, not 20-1,000!!!
High-volume women have sex with new men 1-20x/wk, or 1-80x/month, depending on their style of how much they 'work'. Frequent hobbiests have been with up to 1,000 women as one prospective client, whom I didn't see, told me he had done.
Personally, see extraordinarily few and would Never do a BBFS -- have a bit of a head!!!
So, Mathesar, it's obvious you must greatly reconsider the 'partner risk' component of your equation, and I still haven't checked, and probably won't, the other components to your likely, further false equation..... But this one spoils it all.
Be safe, use protection Always!, and be kind and loving!!!
They come from the paper cited in the link http://www.theeroticreview.com/discussion_boards/viewmsg.asp?MessageID=151391&boardID=1&page=48 .
To repeat them here:
HETROSEXUAL PARTNER
HIV positive = 1
Unknown HIV status = 0.01 (partner selected at random from US population)
Negative HIV test = 0.0002
Note that (whatever the fraction of the TER population that is infected with HIV) condoms give 85% protection (used correctly and consistently possibly as much as 95%) and Varghese et al say that a recent negative HIV test gives 99.98% protection. (One can quibble about the exact meaning of "recent" of course.) Which is better, 85% protection or 99.98% protection? (Since total risk is the product of independent risks, the fact that these two are different factors in the equation does not matter--the question is accurate.)
I agree with what zinaval said above. If condom use decreased we could (eventually) expect the fraction of the population infected with HIV to increase. This would greatly increase the individual risk (in the absence of recent negative HIV tests).
A critical factor in modeling the spread of diseases is the number of people each infected person infects before he or she is cured or dies. If the number is less than one (and there are no external vectors) the disease tends to die out (or at least decrease to a very low level in the population). If this number goes to between 2 and 3 (if memory serves me correctly) you can get an epidemic or even a pandemic. From the public health standpoint condoms are important because they keep this number low. There is no doubt that an infected person will infect many fewer others if condoms are used.
Also, let me be clear. I believe the woman has an absolute right to control her own body. In fact if either partner desires to use a condom a condom should be used. Reasons and justifications are not required. Period.
My objection is to the statements that anyone not using a condom is stupid, evil, or crazy.
Covered anal has almost as much risk as BBFS, yet anal is regarded as a matter of personal choice and no stigma is attached while BBFS is regarded as being beyond the acceptable. Is this based on reason or emotion?
BBFS with a client who has a recent negative HIV test is safer (according to the CDC) that covered FS with a client of unknown HIV status picked at random from the population. Yet the first causes horror and the second is standard practice. Again, is this based on reason or emotion?
As I said, no one should do anything they are not comfortable doing. But I do think that rational risk analysis is required before we accuse others of being stupid, evil, or crazy.
-- Modified on 10/31/2005 4:41:08 PM
The related link may make your eyes glaze over but it has a lot of good information. (I know I haven't digested it all yet.)
The interesting quote from the Penile-Vaginal Sex section is, "Per-act infectivity in two studies (62,63) was found to be low: 0.0005 and 0.0009 for male-to-female transmission, and 0.0003 and 0.0001 for female-to-male transmission. However, studies conducted in developing countries have estimated that per-act transmission probabilities are greater by a factor of 10 (44,64) for both male-to-female and female-to-male transmission.(65)".
In my analysis I was using the CDC estimate of 0.002 (i.e., 20 / 10000) for male-to-female transmission.
The lower numbers quoted here may help to explain the absence of cases in the Nevada bordellos.
Note that the higher numbers for Africa may be partially explained by the rarity of male circumcision in Africa. (Unfortunately, the barbarity of female circumcism is all too common, and may also contribute to the higher infectivities). As 2sense pointed out, recent data has shown a 60% reduction in per-act risk of HIV infection associated with male cicumcision.
-- Modified on 11/1/2005 1:32:14 AM