The Birds, the Bees, and HIV

The two main ways that HIV is transmitted sexually is by vaginal and anal sex. The mucous membranes of the anus and vagina are porous and allow entry of the virus into the bloodstream. Anal sex is riskier because tearing can easily occur, which provides another source of entry for the virus. Unprotected vaginal and anal sex are high risk activities.

I was often asked at the Hotline if you can get HIV from oral sex. This is a bit tricky because yes, HIV is present in semen and vaginal fluid, but the mouth happens to be a very inhospitable place for the virus to live. We have oral enzymes that break it down and the skin in our mouths is less penetrable than that of our genital regions. So, oral sex is considered a very low-risk activity for acquiring HIV.

That’s transmission. What about protection? The first method of prevention against HIV is a latex condom. Latex condoms, used properly, will prevent the transmission of HIV and other STDs (not to mention screaming babies). If a lubricant is used, it should be water based (not oil) and it should not contain nonoxynol-9, which was first thought to protect against HIV but is now known to damage the skin, making HIV entry easier. Other fun things that can be used to have safer sex are latex dental dams, plastic wrap, latex gloves and finger cots, all of which can act as barriers between the infectious fluids and mucous membranes or open cuts. Female controlled forms of HIV protection, like microbicides, are being developed but are not yet out on the market.

Because we are living, breathing humans, sometimes we make mistakes—like going on vacation, drinking twelve Mai Tais in one sitting, and hooking up with the hot cabana boy. That leads me to the next topic, which is testing. Almost all HIV tests look for antibodies to HIV, not for the virus itself. The time it takes for your body to react to the virus and make antibodies (called seroconversion) is known as the “window period.” The window period is typically three months, although some people don’t produce antibodies until six months. The window period can be extremely frustrating: you had unprotected sex with cabana boy and now you have to wait three months to get tested?! But getting a test any sooner may not give completely accurate results—it’s better to wait and be sure.