There has been a great deal of discussion here of late concerning the STD risk - and in particular the risk of HIV infection - associated with oral sex. I would like to share with the providers and hobbyists on this discussion board some of the information I researched last night concerning this issue.
First, I would like to provide some historical background on this subject. The current CDC recommendations concerning the risk of oral sex - specifically receptive fellatio with ejaculation into the oral cavity - is based upon data coming out of the CDC Options project in 1999[1] and presented at the 7th Conference on Retroviruses and Opportunistic Infections in San Francisco in early 2000[2] This study found an 8% infection rate among HIV negative men having receptive fellatio with ejaculation with an HIV-infected male partner. The numbers presented in this data were very small (8 newly
infected men out of 102 previously HIV-negative men in the study group).[1][2] Nevertheless, this data, together with the Rotherberg study[7] has provided the basis for virtually all recommendations concerning risk of transmission of HIV through oral sex, and also appears to be the basis for many of the current recommendations for anti-viral PEP therapy (Post-exposure prophylaxis) for mucosal contact or contamination.[3-6]
There are a number of serious deficiencies in the CDC options project data and the current CDC recommendations that may not be common knowledge to the participants on this forum:
1) First, the Project sample size was too small for statistical significance.
2) Second, a later study analysing the CDC data determined that "...at least half of these subjects (sero-positive converters) had also engaged in unprotected anal sex..."[8]
3) Third, The CDC Options Project data has NEVER been published in peer-reviewed journal. Depending upon whom you want to believe this is either because the CDC has chosen not to submit the project for publication, or that it has been submitted AND REJECTED for publication because of the serious flaws in the study design.
4) Fourth, the current CDC recomendations on this issue improperly cite medical literature as supporting their recommendations, when in fact, most of this literature draws NO conclusions concerning the risk of HIV transmission through
oral sex or has NO ACTUAL DATA addressing the risk.[10-16]
5) The current CDC recommendations OMIT current peer-reviewed literature that contradicts the CDC Options Project data or current CDC recommendations.[17-20]
At the International AIDS Conference in Barcelona last year, two peer-reviewed and well designed studies were presented that specifically addressed the risk of HIV transmission through orogenital sex. The first study[19] was a 10-year study of oral sex between an infected partner and a non-infected partner. This study documented 210 person-years of patient followup, nearly 19,000 episodes of unprotected fellatio with over 1/3 of those episodes resulting in ejaculation into the mouth. This study found a ZERO incidence of HIV concersion in the uninfected partner. The authors of this first study concluded HIV that "...this seems to point to a very low probability of HIV transmission related to this practice, when other risk exposures are excluded...."
The second study was a smaller but statistically significant study out of San Franciso[20] which also found no sero-conversion to HIV from receptive fellatio with a 39% ejaculation rate into the mouth of the non-infected partner over a 2-year study period. The conclusion of this study is as follows: "It is important that health professionals, including HIV counselors have valid information to impart to their sexually active clients. If individuals believe that the risk of HIV from fellatio is high or on a par with well-documented
high-risk exposures such as anogenital sex, they may not feel that sexual behavior choices make a difference. Acquiring HIV through fellatio is significantly less risky than from anal sex, and therefore one's choice of sexual practices do matter."
Finally, this forum's participants should be aware that the current Bush administration has altered two online health fact sheets: The first is the CDC online fact sheet concerning condom use and STI (STD) prevention. The second sheet is on the National Cancer Institute (NCI) website and addresses studies discussing link between abortion and breast cancer. Fourteen House Democrats, led by Henry Waxman (D-CA), have sent a letter to Health and Human Services Secretary Tommy Thompson expressing their outrage that the White House is pushing its political agenda (Bush's agenda on abstinence-only education) into the realm of scientific fact. Whatever the reasons, the changes to these two fact sheets have been made arbitrarily and in contradiction to the existing scientific literature on both subjects.[21]
Massage, spin, manipulation, and even outright prevarication are unfortunately all-to-common practices in the scientific literature of late - whether one is attempting to fly their personal, political, or corporate agenda on their right wing, their left wing, or their economic wing. It appears that the CDC is not immune from this "spin-doctoring" and can no longer be relied upon to provide impartial and dispassionate advice on those issues of personal health and sexuality that conflict with the current administration's political agenda.
I do not suggest that providers (who are most at risk of HIV transmission from oral sex) change the practices they are comfortable with concerning CBJ versus BBBJ. There is plenty of evidence that HIV transmission is possible through oral-genital contact. But that evidence points to an extremely small incidence.
I do suggest that both providers and hobbyists exercise caution and a healthy dose of skepticism when relying upon the recommendations of CDC on any issues of sexuality. It has become obvious to me that the CDC is no longer immune from
the politics involved in sexual activity.
-- Modified on 6/8/2003 12:13:41 PM
thanks for your post. if i may summarize the key messages (that i took away) for anyone who was not inclined to digest it all
1. a *flawed* CDC study reports an 8% chance of an HIV+ gay man infecting an HIV- man who *received* the BBBJ(TC) ... the ~TC part and possible Greek influences have perhaps "tainted" the results (plus some other problems with clinical protocol)
HotOffLoad cites more recent/better (international) studies that indicate the risk is in fact minimal -- possibly ZERO! but if we are not told otherwise (by CDC or whoever) then we ... "may not feel that sexual behavior choices make a difference. Acquiring HIV through fellatio is significantly less risky than from anal sex, and therefore one's choice of sexual practices do matter." ... a VERY GOOD POINT! imagine the scenario of a poor lost soul who's thinking to switch from one unsafe sex practice to another and thinks to himself "well, if they're BOTH almost as dangerous, then ..."
now, my own take on all this is: say the 8% is bogus. fine! so let's drop it by a factor of 10 ... so say there is 0.8% chance of being infected. no, in fact, let's drop it by 2 orders of magnitude! ... so that means a 0.08% chance of being infected. but now think of the "empty chamber" russian roulette analogy and ask yourself how comfortable are you ... (emphasis on YOU) ... in playing this game? that a bullet will tear right through your brain (temple-to-temple) with 0.08% probability! (ok, perhaps getting a bit too dramatic, but you get my drift 
2. the Bush administration is dangerously (and treacherously!) tampering with the dissemination of the TRUTH about safe-sex (by strong-arming the CDC) and this, i think, is just CRIMINAL! this is what you get when you mix "church" and "state". if you ask me, the European sex studies (and policies) are far more likely to be trustworthy than those of a puritanical government like ours.
[exit stage left, carrying own soapbox]
-- Modified on 6/8/2003 3:26:01 PM
specifically AIDS, my first thought is that is is politically motivated, and geared to involve the hetero community in a gay problem. it is very easy to twist ambiguous factoids to one's liking.
for instance, how is it that everyone is SO positive that magic johnson contracted hiv through HETEROSEXUAL, unsafe, numerous entcounters, and mass orgies of rampant sex? because he/they said so?
Pardon me....but you're an idiot. Somebody please give Mr. Bertie a clue.
at first glance your post seemed only mildly homophobic to me. but after seeing danigirl's post i went back and read it again. but even then i was willing to let it slide ... UNTIL ...
out of curiosity (trying to size you up) i looked at some of your back posts (from January) and noticed what seemed to be a very disturbing pattern of thinking.
on a topic regarding "how fingering an unclean pussy is much more dangerous that uncovered intercourse" (not your words, someone else's) you had this to say:
"any cuts?,,then no sex for me, or at least extra precaution + a bandaid. too much masturbation make the skin break?,,again, no sex. i can wait till the bruise goes away." -- Bertie
well ... apparently you do have some concerns regarding saftey (with bandaids!?) and for broken skin ... that's progress ... but in the same thread, in reply to a painful case of urethritis (by someone else) you had this to say:
"well,,,you went through pain, and THAT is what i protect myself against. but you're alive, and it's the hiv that i worry least about." -- Bertie
so let's see: it's the HIV that you worry the LEAST about! yes? that's what concerns you THE LEAST!!? 
and it just goes on and on. my own personal favorite (so far) is your rant entitled: "there are other diseases, ya know!" ... a classic
now i'm a reasonable guy and i do try to give the benefit of the doubt to folks on msg boards (especially those who seem to enjoy playing a jackass more than in their real life). it's entirely possible (though unlikely) that i've misunderstood you [cough]
but even if i have misrepresented you and your words or even if i quoted you out of context, you still deserve a public tongue-lashing for that comment about HIV being a GAY PROBLEM!
every provider that you've been with and reviewed is now on my RED ALERT list!
PS. btw is it tongue-lashing or tounge-lashing? i forget! LOL
and what i post are two different things. WHAT I POST are things i perceive as questionable. if the medical community is vague about the transmission about hiv, and reports i read about(as on this page) continue to be suspect, or conflict with other reports, all i have left are questions. now, if you can point me to a link that shows with absolute certainty, cases of sexual hiv in the hetero community and its risks......
i don't attempt to be pc about hiv and the gay community. i am stating the obvious. and it is not homophoebic(where'd THAT come from?). arthur ashe and ryan white, blood transfusions, sharing a needle, hiv born,,,,these are not sexual transmissions and i don't even know why these were brought up.
the magic johnson thing is ,imo, reflective of the broader hiv knee-jerk reaction. just how much does anyone know FOR SURE. nothing, i suspect. in this litigous era we live in, is it not odd that no female sex partner(of the hundreds he's been with) has stepped forward with concern, to sue because her life has been placed in jeopardy. any female say she got hiv from magic? she could sue and at least get medical attention. or does everyone take his story as absolute truth.
i practise very safe sex, but i don't have to defend it to anyone, so long as i know it's safe. dude, if i have a skin break ANYWHERE on my body i don't imbibe. the bandaid thingy was a joke.
as for the issue of other std's to worry about. i think good old fashion gonorhea, herpes, and syphllis are more a concern to me as "easily transmittable diseases", than hiv...and that is all i meant.
The question as to whether HIV can be transmitted via heterosexual activities has indeed been answered in the peer-reviewed, scientific literature. There is no doubt that heterosexual transmission does occur. However, there remain some questions as to the degree of this transmission in various settings throughout the world, and is the subject of active investigations.
Although the CDC's website is typically viewed as the gold standard for answering these questions, an alternative approach would be to go to PUBMED, the U.S. index of all peer-reviewed biomedical research:
http://www4.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
Simply type in: HIV heterosexual transmission
You will be taken to 1800 titles/abstracts of peer-reviewed articles to begin your studies. Lay articles, which are typically subjective, are not included.
Your government tax dollars at work.
-- Modified on 6/11/2003 3:14:41 PM
I don't think Ryan contracted Aids thru gay sex nor did his little brother. And that isn't just twisting factoids to fit an argument according to your way of thinking?.
Although this responce will be like going into an intellectual battle with an unarmed man I will continue......
Lets look at the millions around the world that have contracted HIV thru blood transfusions ect. I am sure given your attitude and political outlook you would say they were all hiding in the closet.
The most frightening thing I find about you and people of your ilk, is that you listen to the hysteria and stereo-typing. Why mention Magic? Why not Arthur Ash...I mean he died of Aids. Is it jealousy because of what he does for a living, that he may have had the celebrity to run around like a whore and do as he pleased? I am not sure what your post set to do but start a troll to bring out a flurry of posts telling you how idiotic you look. I have seen it more often than not.
If telling yourself HIV is a gay problem and that helps you sleep at night, then more power to you darlin, but it will be painful and hard to deal with if and when the day comes that it is a HUMAN problem.
At least save your trolls for discussions that you might even have the slightest chance of debating. i am sure as this thread grows, if it does, you will be crucified. But then again maybe thats what gets you off......
my "hiv and the gay community" statement was of a sexual reference. i should have said that, as it would have saved you the trouble of typing 98% of your post.
or is the US and all the other "developed" countries in the world (where a technological infrastructure, modern medicine and SAFE-SEX practices are making a difference) our only concern?
let us not forget ... AIDS is a global planetary plague!
just because some inroads into treatment and prevention have been made in recent years, it doesn't mean we should all rethink our behaviour or adopt any kind of ideological revisionist attitude
it's simply NOT ENOUGH to practice safe-sex by one's own personal standards, because by its very nature this activity affects others (with potentially devastating consequences)
you wouldn't want an AIDS "typhoid mary" (non-infected carrier) sleeping around and saying to herself: "i'm cool with it ... so fuck the rest of you", would you?
BE SAFE people ... you go around only once
