Completely agree with FlyFisher. I appreciate what Mathesa is saying, but I'm only going unprotected full service in a monogamous relationship. Providers are wonderful folks, but covered FS is the way to go. French? we can talk.
I know some of you are going to think that this isn't too Swift. I only ask that you read the "More than you ever wanted to know about condoms" series that I posted last night (below) before you flame me.
First, it is clear that ladies and gentlemen alike we are in what Public Health officals consider a "high risk" group. We have sex frequently and have multiple partners.
Second, it is clear that for us condoms cannot prevent infections. At best, they can reduce the frequency of infections (or, saying the same thing in different words, increase the mean time between infections).
Third, true safety can only be achieved if the entire community is free of infection.
Fourth, STD screenings (and treatment where necessary) can help eliminate STDs from the community -- or in the case of HIV, which cannot be cured, eliminate the carrier from the active community. (A complete screening at AIM costs $185. You can reduce that to $85 by having them do the HIV test only and sending your blood to the county for the remainder of the testing.) The question is, "How can we get everyone screened?"
My proposal is that the ladies say something like, "We can do everything (except anal) uncovered if you can show me a STD screening done within the last x (where x is a number picked by the lady that she is comfortable with) days indicating that you are completely free of STDs. Otherwise, we do everything, and I mean everything, covered." Seems to me that this would give guys a powerful incentitive to get screened regularly.
Is the lady safer doing uncovered sex with a guy who has been recently screened for STDs and found to be clean than she is doing covered sex with a guy who has unknown STD status? That is the $64,000 question. To some extent it depends on the prevalence of STDs in the general population.
Obviously, I think both the lady and the community would be better off with uncovered sex and frequent screening of clients than it is with covered sex and no or infrequent screening.
Just my $0.02 worth. I'm not a health care professional.
Mathesar,
I enjoy your statistical compilations greatly. The idea of having regular STD checkups to have unprotected sex has one nil factor: each of us is only as safe as our last session. You can be STD free, the lady can be STD free, but what if one or the other of us had unprotected sex and our previous partner caught something? Is that a risk factor with a variable degree thrown in anyone wants to take? The lady and I may trust each other implicitly but the variable factor of other partners and good intentions gets skewered. I don't get by on blind luck these days and "if it weren't for bad luck..I wouldn't have no luck at all. Born under a bad sign!"
So...I'll use protection for my sex partners and myself until comes the time I enter an exclusive, monogamous sexual relationship.
Completely agree with FlyFisher. I appreciate what Mathesa is saying, but I'm only going unprotected full service in a monogamous relationship. Providers are wonderful folks, but covered FS is the way to go. French? we can talk.
How safe does an STD screening make you and how long do you want to trust the results?
There is, of course, the issue of false negatives. How good are the tests? In particular, how long does it take to identify someone who is HIV positive after they become infected? Because it is geared to the Adult Industry where there are many exposures in a short period of time AIM uses a test for HIV that detects the virus itself instead of the test for antibodies. Detection after infection is more rapid but I don't think the test is government approved and there are questions about its effectiveness.
Assuming we are willing to agree that a person is STD free when the tests say he is, how long before we require another test? Not an easy question to answer.
In a post on this board a lady (if I remember correctly) said, "It is important to remember that when you have sex with someone you are having sex with everyone they have ever had sex with." What the STD test does, in effect, is chop off that history. You are only having sex with all the people your partner had sex with since the test.
A person is not certain to become infected on his first date after the test.
It is also important to remember that wearing a condom gives only partial protection if you are exposed to a STD. You are, in fact, trusting to luck even if you are wearing a condom. And the more times you have sex with partners of unknown STD status the more luck you need to remain uninfected.
Note that an exclusive, monogamous sexual relationship is the most dangerous kind of sexual relationship if your partner is infected with anything. If your partner isn't infected the risk is zero, of course, but then your risk is zero if you only have sex with uninfected partners regardless of the number. Relationships with multiple partners of unknown STD status (although regarded as high risk by the Public Health community) are intermediate in risk. Risk is probably primarily a function of how many times you have sex with an infected partner and it is irrelevant if it is one partner or many.
After reading articles about the situation in Africa and Asia I think we would be having a disaster in our community if we had anything like their fraction of the population infected -- condoms or no condoms. If very few people are infected it probably doesn't matter how much condoms reduce the risk (my best guess is a factor of about 7 for HIV). The risk is low with or without condoms because the risk that a random partner is infected is low. Of course, if a large fraction of the population is infected and you are having sex with random partners then anything less than perfect protection isn't going to be good enough. And I don't think condoms are good enough in that situation.
None of this answers the question as to how many dates a person can have before his STD screening isn't worth the paper it is written on. I get tested every six months. Almost all of my sex is with condoms -- I never ask a lady to do something she isn't comfortable with -- so my personal experience isn't going to say much about the risks of uncovered sex. But for whatever it is worth, I've never acquired a STD. Because of condom usage? Because I haven't had an infected partner? Who knows?
I tend to run about 10 to 20 dates between my semi-annual screenings. How likely would I be to acquire a STD in that number of dates if the sex were unprotected? How likely am I to acquire a STD in that number of dates if the sex is protected? I really don't know if any of my partners have been infected (but I doubt it) and I don't know the answer to either question. I do know that I'm not going to get infected if none of my partners is infected and I do know that if none of my partners is infected a condom is not serving any useful purpose (other than its role in birth control, of course). Well, on second thought, I guess a condom does serve a purpose if it makes the lady comfortable about having sex.
While a condom may be better than a lucky rabbit's foot in preventing infection, it isn't much better than the rabbit's foot for those having frequent sex with multiple partners if the goal is never to become infected and not just to reduce the frequency of infections. (Note in the study I posted that there are indications that "always" condom users and their partners have about the same infection rates as "never" condom users and their partners. Real life protection in the field is not always as good as expected in theory.)
My proposal doesn't provide perfect safety either unless and until we come up with some kind of medical scanner (I wonder if the ones on Star Trek do this) that the lady can wave over the guy and it says that he is free of STDs right now.
I guess that we all have to make our own decisions of what we are comfortable with and I agree 100% that we guys should respect the lady's boundaries. They have sex much more often than we do and therefore are running much higher risks than we do. They are probably less than certain about their client's STD status. Condoms DO reduce the frequency with which the ladies can expect to become infected in this situation and I don't wish to imply that I think othewise.
-- Modified on 1/30/2003 7:26:53 PM
I'm very much a fan of Mathesar, but I can't agree with him on this one. Regardless of testing, using barrier protections in sexual activities is the only way to go.
Here's the abstract from an article by Roper WL, Peterson HB and Curran JW (CDC, Atlanta GA 30333) American Journal of Public Health (1993) April; 83(4):501-503.
Commentary: condoms and HIV/STD prevention-clarifying the message
"In the United States and throughout the world, the majority of HIV infections are sexually transmitted. An estimated 12 million other sexually transmitted diseases occur annually in the U.S. Avoiding sexual intercourse altogether or restricting sex to partners known to be uninfected will prevent infection; this needs to be promoted as the most effective strategy. Studies show that correct and consistent use of latex condoms is highly effective in preventing sexually transmitted HIV infection and other sexually transmitted disease. The effectiveness of condoms depends on individual behavior leading to correct and consistent use. Further studies are needed to maximize the use and effectiveness of condoms for those who choose to be sexually active as well as to develop and evaluate other methods, particularly those under the control women. In the interim, our prevention message should be clear: When used correctly and consistently, condoms are highly effective: when used otherwise, they are not.
-- Modified on 1/30/2003 7:12:56 PM
-- Modified on 1/30/2003 7:14:11 PM
-- Modified on 1/30/2003 8:34:40 PM
"Avoiding sexual intercourse altogether or restricting sex to partners known to be uninfected will prevent infection; this needs to be promoted as the most effective strategy."
Exactly!
I admit that I am thinking "outside the box" in throwing out my proposal about how to achieve this.
Incidentally, my reference to Swift in my first sentence is a reference to Jonathan Swift.
The respect is mutual, and thanks.
Mathesar
Yes, I should have realized that you weren't advocating "eating the Irish children" to solve the problem.
Mathesar -- resident TER statistician and provocateur.
Irish children are notoriously stringy.
The problem with your proposal is that there is a period of time where an infected person can spread the disease, but the test still comes up negative. I'm not sure how large this window is on the RNA-based tests (like the Adult industry does), but there still is a window. I know for the normal ELISA-based tests it's 6 months.
that the odds against someone with a recent negative HIV test being HIV positive are about 400 or 500 to 1. I wouldn't want to bet my life on that though.
eom
Let's divide the universe of STDs into HIV and "everything else". I think this is justified by HIV's extremely low infectivity (currently estimated at 0.001 in a single act of vaginal intercourse) and unique deadliness.
The Haiti HIV study (link below) of "discordant" (one infected, the other not) heterosexual couples observed a seroconversion rate of 1.0 per 100 person years for couples who always used a condom, and 6.8 per 100 person years for couples who used condoms irregularly or not at all.
Note: given the estimated infectivity of 0.001 this implies couples were having intercourse about 70 times per year.
The protection given by a condom is strikingly less than perfect.
On the other hand, the low infectivity of HIV means that one's HIV status is extremely unlikely to change the first time one has sex or even the first twenty times (0.02 probability if all twenty dates are with someone HIV positive). Being screened for HIV and found to be negative is not worthless after the first time one has sex.
The situtation is not so good if we are talking about other STDs. Let us take gonorrhea, males have a 0.20 infection risk per act of sexual intercourse with an infected partner, but females have at least a 0.50 risk of infection per act with an infected partner.
Just one time of unprotected sex with an infected partner gives one a very good chance of being infected. Here the STD screening is untrustworthy after a single act of sex with an infected partner.
I don't have the exact numbers, but gonorrhea spreads very easily through oral sex. Giving a BBBJ to an infected male may not be as dangerous as unprotected intercourse, but it is still very very dangerous. Condoms reduce the risk of a BBBJ by a factor of 17 acording to a study done in Singapore brothels that I quoted previously.
Condoms merely slow the spread of a disease. They don't prevent the spread. However, even slowing the spread of disease is very very important. By slowing the spread of the disease the chances of containing and eliminating an infection in a given population are greatly improved.
Since we are having sex with multiple partners (which also tends to spread an infection once it enters the population) we need to be very concerned with keeping ourselves disease free so that we don't spread an infection (STD screenings) and protecting ourselves the best we can against the possibility that our partners are infected (condoms).
The paradox of condoms is that if we and our partners are disease free we don't need condoms for protection against disease and if our partners are infected then condoms don't provide sufficient protection (assuming we are having frequent sex -- for a once-in-a-lifetime fling condoms are pretty good protection). Sex with an infected partner is like Russian Roulette. Keep playing and you are eventually going to lose -- condom or no condom.
We need both regular STD screenings and condoms. Which does more to protect ourselves and our partners can be debated. (I think the answer depends, in part, on what fraction of the population is infected.)
-- Modified on 2/3/2003 9:59:00 PM
As I stated in my earlier post, I have always kept my regular check up appointments. Even during my three YEAR period of ABSTINENCE, I still kept up on my check ups and STD screenings - three years, no sex!
I have only been a Provider a short while, and in that time I've encountered one bladder infection (my first, and only) and one bad reaction to a condom with spermicide. So far, that's it. And that's enough! The only time I will EVER be with a man without a condom is in my personal, exclusive relationship. Just making the decision between offering a CBJ and a BBBJ was risky enough, and that's the only risk I take! Granted, I don't ask to see the Gents' health 'clearance', and am 'assuming' everyone is being responsible, but they can ask ME anytime, and I can provide it! I have also posted (on the SD board) that while I have asked my HMO for the gamut in STD screening, don't assume it's everything! I learned that my HMO does NOT screen for Herpes, and there is no screening for GW. Also, HEP B should be a part of the STD prevention plan for everyone.
As the saying goes, 'an ounce of Prevention is worth a pound of cure', it's also nice to have a freer mind..
xo
Sedona
This scheme WOULD work if:
1. Hobbiests/providers who contract a STD know immediately after the fact. However, it is possible to be infected and asymptomatic. There is a window between initial infection and appearance of symptoms. Some individuals remain asymptomatic over a long period of time. And it is not unknown to medical science for infected individuals to never develop antibodies.
2. Test results are documented perfectly and honestly by all parties. Nevertheless, lab errors still occur. Also, selfish hobbiests have incentive to fudge the documentation, and likewise financially desperate providers.
Realistically, unprotected sex should be reserved only for long-term, committed, monogamous partners.
In light humor and in know way meant as a mock of the thread master for this topic, I like him and so many of us would love to act out on the fantasy of unprotected sex completely..
Many out there feel we are deluding ourselves by having unprotected oral sex, but heh, I can live with that self delusion, after all I am Don Quixote, Man of Lamancha..
Here is my proposal.. I say that we all go out and have unprotected sex with each other completely doing it in every orfice and to the hell with caution. Let's all get infected with every disease, and then we don't have to worry anymore... We can releaxe and not sweat over who is safe and who is not.. because none of us will be and then we can relax and just continue along our hedonistic ways??
WOW...Better be careful...You may be perceived as having a sense of humor..!!! with everyone taking themselves so seriously, that seems to be a negative in these parts...*wink