Posts Tagged 'HIV'

Luck’s a chance, but trouble’s sure: HIV prevention efforts during the World Cup are being undermined


I’m very lucky. The only time I was ever up shit creek I just happened to have a paddle with me. ~
George Carlin

If you google “fifa world cup hiv” and click on the “I’m feeling lucky” button, you will find a good article from allAfrica.com about how FIFA is hindering HIV prevention in South Africa during this year’s World Cup. But luck’s a chance, and you could just as well have run across predictable propaganda in a corporate-friendly Reuters article. Reading the latter, you would think FIFA is leading the campaign with banners flying and money sacks open. The truth is just the opposite. In a sport devoted to the glorification of hard young bodies, unheard-of personal wealth, and vaunted celebrity, HIV is an image-tarnisher, an unlucky coin toss in life’s game of chance. FIFA’s neglectful attitude to HIV prevention and its lack of engagement with and support for local AIDS organizations is making headlines. Sexually active football fans will be in need of much good luck in the coming month. Their health seems to be of little concern to football organizers, who have spared no effort to make sure that supplies of beer will not run out.

When you think of the extraordinary sums of money to be made in the coming weeks and the fabulous riches of the football clubs, it is an outrage that FIFA has not donated at least the modest half million dollars (4 million Rand) required by the South African National AIDS Council to fund an HIV prevention campaign during the tournament. It is equally appalling to learn that FIFA is actively banning the distribution of condoms at World Cup stadiums and other venues.

Although the lords of football made the right noises in a public announcement earlier this year, FIFA is now being criticized by AIDS organizations, both for its action and inaction in South Africa, and for its general insouciance and ignorance about HIV prevention. In the midst of contradictory statements and corporate spin, it emerges that about all FIFA has actually agreed to is the installation of condom dispensers in toilets at the stadiums. It also claims to have encouraged health authorities to set up “fan service areas” in South African cities during the tournament. These feeble gestures come as the planet’s wildest party is about to begin in a country with the largest number of HIV carriers, with an estimated 5.7 million people infected. There are 1,400 new HIV infections every day and nearly 1,000 AIDS deaths.

“To date Fifa has not permitted any civil society organisation to distribute HIV- or health-related information and Fifa has not provided any written confirmation that condoms may be distributed at stadia and within the fan-fests,” South African AIDS groups said in a statement. “This is despite the fact that commercial sponsors selling alcohol will have dedicated spaces available.”

For the sex trade a World Cup event is like having all the navies in the world dropping anchor in your home port. Vats of alcohol are sure to be consumed as foreign fans drink to lady luck and rub shoulders with locals. But in a country where one in five adults is living with HIV, the price of throwing caution to the wind and having unprotected sex with a local, let alone a sex worker, could be extremely high.

It is estimated that 100 million condoms will be needed to meet increased demand during the World Cup. Despite some generous donations from Britain and the UN, there probably won’t be enough condoms for football revellers. That’s bad enough, but as a South African expert has said, the problem is not just the quantity of condoms available – it’s also the lack of a high-profile safer sex campaign.

FIFA is not the only one at fault. South African laws that criminalize sex work compound sex workers’ individual risk for HIV and compromise broader public health goals. A massive international sporting event like the World Cup will undoubtedly increase demand for paid sex and, particularly in a country with hyper-endemic HIV, will guarantee a sharp rise in HIV-infection rates through unprotected sex.

In a paper published last December in Globalization and Health, a group of activists called on South Africa to respond to the challenges the sex industry poses in a strategic and rights-based manner, using the World Cup events as an opportunity to attribute more weight to public health goods than to an ideology based on sexual moralism – an ideology that time and again has been proven ineffective in preventing HIV in South Africa and beyond. The authors argue for a moratorium on the enforcement of laws that persecute and victimize sex workers during the World Cup period.

The prospects are not encouraging. While the world rightly celebrates South Africa’s pride in hosting the games, amidst all the hoopla the HIV epidemic is only going to grow worse. When the party is over and the teams and their fans have gone home, as FIFA calculates its profits epidemiological statistics will begin to tick ever upward. You’ll be able to google them in a year or so.

Luck’s a chance, but trouble’s sure. It’s one thing to click the “I’m feeling lucky” button – but having sex without a condom during the World Cup is like being up the creek without a paddle.

flickr photo by dmountain

The troubling reality of sexual lubricants: while promising enhanced pleasure, they facilitate infection


New research presented at the Microbicides 2010 conference, as reported in Medscape, indicates that several common over-the-counter sexual lubricants can damage rectal and vaginal tissue, thereby increasing vulnerability to a number of sexually transmitted infections (STIs), including chlamydia, gonorrhea and HIV. These results build on previous studies with similar findings [1-2].

Rectal lubricant gels are widely used [3], but the evidence is now pretty convincing that the hyperosmolar kind (those with a higher concentration of salts and sugars relative to epithelial cells with which they come into contact) can cause significant damage to sensitive tissue and greatly increase the danger of infection. There has also been some research on the common use of saliva as a sexual lubricant, especially among men who have sex with men [4], but more studies are required to determine whether saliva use in this way contributes to transmission of saliva-borne pathogens.

According to a press release from the Microbicides 2010 conference, in the United States alone receptive anal intercourse is practised by 90 percent of gay and other men who have sex with men. Moreover, the practice is not limited to men. U.S. estimates and surveys in the United Kingdom indicate between 10 to 35 percent of heterosexual women have engaged in anal sex at least once. Globally, estimates suggest 5 to 10 percent of sexually active women are having anal sex. Despite enormous efforts to promote condom use, especially in the past quarter century, most acts of anal sex go unprotected.

All this begs the big condom question. Although the recent research on lubricants is troubling enough, it should not distract public health authorities and community-based organizations from emphasizing yet again the plain fact that consistent condom use is the best way to prevent STIs [5-6].

REFERENCES

1. Fuchs EJ, Lee LA, Torbenson MS, Parsons TL, Bakshi RP, Guidos AM, Wahl RL, Hendrix CW. Hyperosmolar sexual lubricant causes epithelial damage in the distal colon: potential implication for HIV transmission. J Infect Dis. 2007 Mar 1;195(5):703-10. Epub 2007 Jan 23. PubMed PMID: 17262713.

2. Sudol KM, Phillips DM. Relative safety of sexual lubricants for rectal intercourse. Sex Transm Dis. 2004 Jun;31(6):346-9. PubMed PMID: 15167643.

3. Javanbakht M, Murphy R, Gorbach P, Leblanc MA, Pickett J. Preference and practices relating to lubricant use during anal intercourse: implications for rectal microbicides. Sex Health. 2010 Jun;7(2):193-8. PubMed PMID: 20465986.

4. Butler LM, Osmond DH, Jones AG, Martin JN. Use of saliva as a lubricant in anal sexual practices among homosexual men. J Acquir Immune Defic Syndr. 2009 Feb 1;50(2):162-7. PubMed PMID: 19131893.

5. Weller S, Davis K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002;(1):CD003255. PubMed PMID: 11869658.

6. Mindel A, Sawleshwarkar S. Condoms for sexually transmissible infection prevention: politics versus science. Sex Health. 2008 Mar;5(1):1-8. PubMed PMID: 18361848.

cc flicker photo by Erik Pronske

Frankly, we do give a dam: differentiating between dental dams and sex dams

An alert public health official in Winnipeg pointed out that my post on oral sex barriers failed to distinguish between dental dams and sex dams. I freely admit to having been vague on the distinction between the two, this not being an area of expertise for me. So I delved a little more deeply into what the web could offer. Because the primary literature is so focused on condoms (male or female), the web is often the only resort for the safer sex researcher. When you consider the popularity of oral sex in the general population and the clear documentation on disease transmission by means of oral-genital or oral-anal contact, it is surprising and distressing to see so little research.

Try a search in Scopus, for example, on “sex dams.” 15,000 journals and not a single mention. One fares a little better with the search term “dental dams,” until it becomes clear that all the serious research strictly involves their use in dental practice.

Differentiating the dams

In my defence I should say that the term “dental dam” is frequently used to refer to any patch of latex, polyurethane or polyethylene used for oral stimulation during sex. Many safer sex web pages use the phrase exclusively, without mentioning sex dams. It is not surprising that this leads to some terminological confusion. Yet there is a notable difference between the two types of dams, and I hope that the following will be a useful clarification.

A dental dam is a small latex patch, normally 5 or 6 inches square, used in dental procedures. A sex dam is a delicate latex sheet, usually 10 by 6 inches, specially designed for oral sex. It is larger and much thinner than a standard dental dam and frequently comes in various colours and flavours. Polyurethane sex dams are also available commercially, but again, don’t expect to find terminological exactitude or you may miss the Hot Dam Banana Flavored Polyurethane Dental Dam when you do a Google search.

Sex dam benefits

The major factors that differentiate the dams are size, look and feel, taste and smell, thickness, and transparency. Sex products need to be “fun,” a basic requirement often forgotten by those whose main concern is to get the science right.

  1. A good sex dam should be large enough to fit over the entire genital or anal area. Normal dental dams or cut-up condoms are really too small for cunnilingus and anilingus, however “approved” they may be as a barrier.
  2. Some condoms have a powdery surface that is not suitable for oral contact, and dental dams are too rubbery and clinical. The tactile sensation involved in using a dam for pleasurable stimulation is important, for the giver as well as the receiver.
  3. Sex dams are usually scented to hide the turn-off latex stench, and flavoured to please the tongue.
  4. Sex dams are also very thin and delicate. They are designed to give pleasure. A good thing, since there is very little pleasure in trying to find and purchase them on the web or in shops. It goes without saying that a thick, podgy slab of latex has all the sex appeal of a placemat.
  5. Finally, the transparency of a dam is an important motivator. We’re talking sex here, after all, not wrapping cutlets for the freezer. One of the reasons that plastic wrap is used at all is that it allows both sexual partners to see the erogenous terrain, as it were. This is a definite plus when it comes to sexual pleasure. A well-designed sex dam should have this characteristic of transparency or at least translucency.

Alternatives to dams

As I explained in my previous post, most of us who might benefit from them do not have easy access to good sex dams. That is why efforts have been made to suggest safe alternatives, even in the face of the overwhelming lack of good evidence as to their efficacy.

SexualityandU.ca, a Canadian safer sex website, has a good definition of the use of what it terms “dental dams” for oral sex, and it has the most reasonable advice I have been able to find for anyone thinking about using plastic wrap as an alternative barrier:

Some people also use non-microwaveable plastic wrap (Saran Wrap®) as dental dams. This has not been studied in depth yet, but there is evidence that non-microwaveable plastic wrap can stop virus-sized particles, which could mean it can prevent STIs. Until this has been studied in more detail, sticking with latex dams or condoms (or even a cut-open latex glove) is probably your safest bet.  However, plastic wrap is certainly better than nothing, as it does provide at least some level of protection against STIs.

CDC would have done well simply to borrow this balanced and objective plain-language explanation for its revised pronouncement of last June on oral sex and HIV risk.

The SexInfoOnline website, maintained by students from the University of California, Santa Barbara, offers well-illustrated instructions on how to make an oral sex barrier using a standard condom. The final photograph shows revealingly just how small a cut-up condom actually is. Although somewhat chaotically organized, SexInfoOnline is an excellent resource. For example, I learned the meaning of “queefing,” a spicy new addition to my vocabulary.

Compare the cut-up condom photo to this illustration of a sex dam found at Sheer Glyde Dams, a U.S. commercial website that is known to ship product to Canada and Australia. The difference is considerable. A dental dam, the kind used by your dentist, is somewhat larger than a sliced condom, but not as large as the typical sex dam produced for sale at sex shops, on commercial websites, and very occasionally at pharmacies.

The best instructions I have seen for constructing an alternative dam from a condom or latex glove can be found at the website of Agence de la santé et des services sociaux de Montréal. The information is available in English and French accompanied by detailed colour photographs. With predictable Canadian reserve, the instructions, thorough as they are, do not show the practical application of these improvised barriers in situ.

Another good general resource on oral sex and HIV prevention is thebody.com.

Dams around the world: Lecktücher, digues dentaires, fazzoletti di lattice

In German the thick latex sheet used by dentists is called der Kofferdamm. For sex dams the Germans employ the more sexually suggestive word das Lecktuch (lick sheet), which for no apparent reason is in the neuter gender. The plural form is Lecktücher. One occasionally finds the more sedate term Latextuch, but it’s not as popular.

The French language is content to settle for a single term for the dental/sex dam. It is the (appropriately) feminine la digue dentaire. Digue is also the French word for dike.

The Italians use the term il fazzoletto di lattice (literally, latex hanky), whereas the Russians simply transliterate the technical German term: коффердам.

Be wary of Wikipedia entries

Wikipedia’s article on dental dams is adequate for a simple explanation of their use by dentists. But it is very disappointing for the sex researcher, devoting all of two sentences to the subject of their sexual use. You will have to go to the entry on cunnilingus to get more on the safer sex angle. As we have seen, there are far better sources on the web for this kind of information.

The German Wikipedia has a lengthier article, whose only reference, curiously, is to the Canadian site sexualityandU’s page on dams.

The French Wikipedia entry falls somewhere between the English and the German coverage. Its single reference is to a poorly illustrated, bare-bones instruction page on a French AIDS prevention website. Come on, francophone colleagues. Get snapping.

The Italian Wikipedia entry provides only very general information, like the French. But the Italian entry at least has a reference to a relatively decent PDF on lesbian health issues.

The Russian Wikipedia entry is all business, i.e., dentistry only. The sexual use of коффердам (a transliteration of the German term) is as far from view as Lenin in his tomb.

Plastic wrap around the world

It’s a relief to see that, despite the lack of adequate research support, there is general agreement in many countries that the clear, scritching, clingy stuff we use to keep old pizza slices in the fridge is not the best means of warding off a serious sexually transmitted infection.

In French the term for plastic wrap is film alimentaire. Browsing through various French websites I saw general consensus that le film alimentaire n’est pas du tout recommandé (because it’s porous).

The Italians concur: la plastica alimentare è un mezzo poco sicuro (plastic wrap is a less secure method).

German safer sex sites also consider die Haushaltsfolie (lit. “household foil”) as less than ideal, to be used nur im Notfall (only in a pinch).

Saran wrap is a wonderful invention. It’s irresistible for pranksters and goofballs too. The Urban Dictionary defines it thus:

saran wrap: the original (1950s, early 1960’s ?) clear foodwrap that teens used when they were too scared to go buy condoms. “I’m a saran wrap baby.”

Beneath the humour, however, is the sticky reality that plastic wrap is commonly being used for purposes for which it was never designed. In light of the significant concern about the risks of using plastic wrap for any kind of sexual encounter, it is inexcusable that science has not given it the kind of attention that has been lavished on condoms, gloves, masks and other barriers to infection. It is not stretching a point to assert once again that more research is urgently needed.

A note on kissing and STIs
My contact in public health also expressed concern that I had linked kissing with transmission of the human papillomavirus. I believe there is adequate support in the literature for this position [1,2]. In short, along with things like the common cold, mononucleosis, influenza and meningitis, kissing can also pass on some sexually transmitted infections: HPV, herpes simplex, and syphilis.

References

1. Slots J. Oral viral infections of adults. Periodontology 2000. 2009 Feb;49(1):60-86.

2. Kreimer AR. Oral sexual behaviors and the prevalence of oral human papillomavirus infection. J Infect Dis. 2009 May 1;199(9):1253-4.

dental-dam-kit

Oral sex and plastic wrap: the CDC sandwiched between a riddle and an enigma

Every year we make enough plastic film to shrink-wrap the state of Texas. ~ EcoSection.com. Tweeted 31 Mar 2009. http://twitter.com/ecosection

Two years ago, with tongue occasionally in cheek, I wrote a lengthy discussion about my efforts to find information on the effectiveness of plastic wrap (a.k.a. cling film, sandwich wrap, shrink wrap, Saran Wrap) as a safe barrier for oral sex. At that time I found this cautious admonition offered by the Centers for Disease Control and Prevention (HIV/AIDS among women who have sex with women, June 2006): “Plastic wrap may offer some protection from contact with body fluids during oral sex and thus may reduce the possibility of HIV transmission” [1].

Well, we can put our rolls of Saran wrap back in the kitchen drawer. It appears that the CDC is shrinking from even that heavily qualified recommendation. In a fact sheet released last June, Oral Sex and HIV Risk, the CDC emphasizes the risk of oral transmission of a number of diseases and continues to advocate the use of physical barriers such as condoms and dental dams. However, on the issue of plastic wrap the CDC has changed its tune:

At least one scientific article has suggested that plastic food wrap may be used as a barrier to protect against herpes simplex virus during oral-vaginal or oral-anal sex. However, there are no data regarding the effectiveness of plastic food wrap in decreasing transmission of HIV and other STDs in this manner and it is not manufactured or approved by the FDA for this purpose [2].

As I found in doing the research for my previous post, the CDC is right to be cautious about plastic wrap. Simply put, there is no research that tests the effectiveness of ordinary sandwich wrap as a barrier between lips and tongue and what they seek to titillate sexually. Whether it is sheer squeamishness on the part of the scientific community, or sex-phobic avoidance, or merely benign neglect, the fact remains that after many years of shilly-shallying about oral sex barriers, a major U.S. health agency has admitted that its own recommendations have not been based on the evidence. While the CDC’s statement makes no admission of its responsibility to the many thousands who have struggled with this humble oral sex accessory based on its past recommendations, at least in publishing it the CDC shows its willingness to face the evidence gap while implicitly challenging the research community to put their money where their mouth is. So to speak.

Characteristically, Canadian public health officials cling to their formulas and soft-pedal the issue. The Canadian Public Health Association mentions only dental dams or condoms cut lengthwise as appropriate barriers for cunnilingus, ignoring altogether what to use for anilingus, or rimming. Not in Canada, eh? It is more surprising that the Canadian AIDS Society also leaves this issue alone in its web page on safer sex. Yet in its official guidelines on HIV transmission risk, CAS has this to say about plastic wrap:

Plastic wrap has also been advocated by some AIDS educators as a risk-reduction tool for cunnilingus and anilingus. Only one brand, Glad®, has been tested in the laboratory. It was found to be effective for preventing transmission of the herpes simplex virus. It has not been tested as a barrier for HIV. Plastic wrap is not subject to the quality control testing for filtering viruses and micro-organisms that condoms require. It is not as elastic as latex, but it is cheap, accessible and easy to use. However, plastic wrap marketed as “microwavable” is more porous than the conventional plastic wrap; it is not recommended for use during sexual activity [3].

Perhaps the CPHA and CAS should compare notes. As far as I can determine, neither organization is aware of the CDC statement of June 3, 2009.

Who is listening to the CDC?

Despite the considerable uncertainty concerning the use of plastic wrap barriers of any kind in oral sex, many organizations continue to support their use.

The Australian Federation of AIDS Organisations is still recommending plastic wrap along with latex dental dams. “Glad Wrap” is suggested for use during cunnilingus and rimming, although there is an admission that the recommendation is not based on any significant evidence beyond that of other AIDS prevention organizations. Without citing scientific evidence, AFAC launches into an odd discussion about microwaveable versus non-microwaveable wrap:

The peculiar debate about the effectiveness of microwaveable as compared to non-microwaveable cling wrap is difficult to evaluate. Many commentators have suggested that microwaveable wrap should not be used. The concerns about microwaveable wrap are understood to relate to the presence of pores in the wrap, which are designed to open at high temperatures, thereby releasing trapped steam. While the concerns sound reasonable, it seems unlikely that even the most passionate of sexual individuals will reach the temperatures of a microwave oven.

Trapped steam indeed. This lame attempt at humour does not disguise the fact that on this matter the Australians are talking out of their assertive derrieres.

Some websites encourage “creative uses” of plastic wrap. One dash-challenged example will suffice. Consensual Text put out by Planned Parenthood of Northern New England’s Education Department:

Using plastic wrap will protect you against HIV when engaging in anal sex – and it should be used during oral sex as well. Although vaginal and anal sex can pass HIV more easily – engaging in oral sex is not a safe practice. Use a barrier like shrink wrap whenever you have anal or oral sex. Have fun with plastic – wrap it up!

Less chirrupy, but no less odd in its own way, is a peer-reviewed continuing education document for dentists, which offers a recommendation on preventing disease transmission from operatory surfaces. The author includes plastic wrap in a list of effective protective barriers including “bags, sheets, tubing, and plastic-backed paper or other materials impervious to moisture. Their utilization on surfaces and equipment can prevent contamination of clinical contact surfaces” [4].

The need for more research

When it comes to plastic wrap not enough attention is being paid to the evidence – or the lack thereof. But, as I mentioned in my previous post, the paucity of sufficient research on the quality of plastic wrap as a barrier to infectious agents is no laughing matter. For some groups, there is no other choice.

The difficulty of obtaining condoms and the virtual impossibility of finding something like a dental dam in many prisons for men, means that a (possibly reused) sheet of Saran wrap is often all that comes between those engaged in oral or even penetrative sex. That consensual sex between men is not unusual in prisons is common knowledge. A study published this year shows that in the U.S. the estimated prevalence of HIV is more than five times higher among state prison inmates than among the general population. Many men seroconvert while incarcerated, some from injection drug use or tattooing, but the majority from unprotected sex [5]. I should mention again a poster prepared by the Project START Study Group, Sexual behavior and substance use during incarceration (2004), where we learn that 12% of incarcerated men in the United States are using Saran wrap and other plastic substances as a means of protection during consensual sex.

In another recent study of the Georgia state prison system it was found that of 43 inmates reporting consensual sex, 30% said they used condoms or other improvised barrier methods (e.g., rubber gloves or plastic wrap). This study does not always specify actual numbers of those using plastic wrap, but in one group 21% reported using improvised barrier methods only [6].

The HIV infection rate is increasing among women in general and among female prison inmates specifically. Incarcerated women report participation in unprotected consensual sex [7]. In a study of safer sex methods among women (not in prison) who have sex with women, 36 out of 92 respondents had used dental dams or plastic wrap as a barrier during oral sex [8].

Latex dental dams, of course, provide the same protection as a condom. However, although occasionally available for free from public health agencies, dams are not as easy to find as condoms and cost considerably more per square inch of latex. They can be purchased from commercial websites such as Safe Sex Canada, but it is not clear that many are doing so, especially teenagers or people on low incomes. Cut-open condoms will do the same job, but the resulting surface area is not as large as that provided by a dam. This could lead to “errors” when these improvised barriers are used for cunnilingus or rimming.

Although the CDC is declaring that there is insufficient evidence that plastic wrap is suitable for safer sex, a number of studies done in the past six years indicate that plastic wrap does afford protection from a number of infectious agents, even prions [9,10,11]. But there is no research that analyzes the safety of plastic wrap for sexual purposes, and not a word about its effectiveness as a barrier to HIV infection.

Facts about oral sex

Fact number one. There is lots of it going on – in most age groups, and in growing numbers among the young. There is no question of the increase in popularity of oral and anal sex among the heterosexual population. It is estimated that one-third of American men and women have experienced anal sex, and three-quarters have had oral sex. Annoyingly, it is not always clear in a research study how these types of sexual activity are experienced. For example, the common assumption appears to be that heterosexual men are only giving, not getting anal sex. Condom use during oral or anal sex is still relatively uncommon [12].

Oral sex among the young
There are no large-scale published studies assessing the prevalence of oral sex among younger Canadian teens. The sexualityandU.ca website gives a good overview of the situation in Canada. According to the Canadian Youth, Sexual Health and HIV/AIDS Study (Boyce et al., 2003), Canadian teenagers are more likely than in the past to engage in oral sex. Results from studies done in the United States contain inconsistent data about who is giving oral sex to whom, but all the data agree that a sizeable proportion of both male and female teenagers, ranging from 39% to 51%, reports giving or receiving oral sex.

One in four Canadian teenagers are sexually active at a mean age of 15 years. The mean age at first oral sex was also 15 years. Condom use is common, but 17% do not know that STIs can be transmitted through oral sex. Many teens are engaging in sexual behaviours that may threaten their health. Casual sex is reported by 38%. The most prevalent STIs in Canadian teens are HPV, chlamydia, and less commonly, genital herpes and gonorrhea. However, when questioned adolescents identify much less common infections as the most frequent (e.g., HIV and hepatitis B). The gaps in STI knowledge and some of the sexual behaviours of teens may explain, in part, the increasing prevalence of STIs in Canada [13].

With respect to oral sex, it is important to remember that over the last 30 to 40 years fellatio and cunnilingus have become a normative aspect of the adult sexual script and this trend has been followed by youth. Studies conducted on adolescent populations in the United States and Canada during and since the 1970s consistently show that oral sex is about as common as sexual intercourse, is most typically initiated at about the same time as intercourse, but precedes first coital activity for 15-25% of adolescents [14].

A study of more than 11,000 youth aged 12-25 years old attending a Baltimore clinic over a 10-year period concluded that oral sex and, to a lesser degree, anal sex, appear to be increasing among teenagers and young adults. The odds of reporting oral sex were approximately three times higher in 2004 than in 1994; odds of anal sex were twice as high [15].

Oral sex considered less risky and frequently not even “sex”
Many young teenagers consider oral sex more acceptable and less risky than vaginal intercourse [16]. In a recent study of California ninth graders more participants reported having had oral sex (19.6%) than vaginal sex (13.5%), and more participants intended to have oral sex in the next 6 months (31.5%) than vaginal sex (26.3%). Adolescents evaluated oral sex as significantly less risky than vaginal sex on health, social, and emotional consequences. Adolescents also believed that oral sex is more acceptable than vaginal sex for adolescents their own age in both dating and nondating situations, oral sex is less of a threat to their values and beliefs, and more of their peers will have oral sex than vaginal sex in the near future [17].

The CDC fact sheet on the risk of oral sex states: “some data suggest that many adolescents who engage in oral sex do not consider it to be ‘sex;’ therefore they may use oral sex as an option to experience sex while still, in their minds, remaining abstinent.”

Risk of transmission during oral sex and the need for a good barrier
Finally, the inescapable fact about oral sex is that there is ample proof that it can transmit various infections, including HIV, syphilis, gonorrhea, chlamydia, herpes simplex, and hepatitis [18,19,20,21]. Even kissing is implicated in the transmission of oral HPV. While the evidence for oral HIV infection is still debated, organizations such as the Public Health Agency of Canada, strongly maintain that people engaging in oral sex should use a barrier. The Canadian AIDS Society emphasizes that the risk of transmission of HIV (or other STIs) from any kinds of oral intercourse can be effectively reduced by the proper use of a latex barrier (condom or dental dam), and thus advocates the avoidance of unprotected orogenital or oro-anal contact. Neither organization advocates the use of plastic wrap in any public statement on oral sex.

“How do you use Saran products?”

The evidence shows a growing number of people of all ages engaging in oral sex play, often with little or no protection and with even less good information from reliable sources. This begs the question: why is there so little research being done on oral sex barriers, including plastic wrap?

I concluded my previous review with my take on why I thought researchers have failed to confront this important issue. It is still disturbing that, given the near universal recommendation by community organizations of this alternative barrier, that the large dose of cold water thrown by the CDC on their assertions has not flushed away the erroneous information they produce for public consumption. What is being advocated about the virtues of stretch-and-seal wrap as a barrier for oral sex is not supported by any credible evidence. These assertions are full of holes. I also suggested that the continuing drought of decent research on polyethylene as a sex accessory may be fuelled by sex-phobic and/or homophobic avoidance of a distasteful issue. After all, the manufacturer of Saran Wrap, SC Johnson & Son, calls itself a “family company.”

Nor is there much evidence that this is a promising area of research for ambitious scientists competing for government or corporate grants. At a time when enough polyethylene is being produced to shrink-wrap Texas or Turkmenistan, surely someone must be out there who can do the necessary science on density, porosity, permeability, and microwaveability to make the next update I do on this topic a little less onerous. But all the potential funders, even Bill and Melinda Gates, are clinging to their wallets and keeping their intentions under wraps.

Finally, what are the Centers for Disease Control going to do about this? They waited three years for research to appear to back their cautious recommendation of plastic wrap, only to admit in the end that nothing had resulted from their doing nothing. My question is, rather than waiting another three years as infections continue to increase, why don’t they find someone to fund a research project? Would the cost be that prohibitive? When you see the absurd things that do get published (have a look at the wildly funny blog NCBI ROFL for ample evidence of this), surely a decent study on the effectiveness or otherwise of plastic wrap as an oral sex barrier is in order.

References

1. Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. HIV/AIDS among women who have sex with women. 2006 Jun. Available from: http://www.cdc.gov/hiv/topics/women/resources/factsheets/wsw.htm

2. Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Oral Sex Is Not Risk Free. 2009 3 Jun. Available from: http://www.cdc.gov/hiv/resources/factsheets/oralsex.htm. The article referred to in this quote is probably: Garland SM, Newman DM, De Crespigny Ch. L. Plastic wrap for ultrasound transducers. herpes simplex virus transmission. Journal of Ultrasound in Medicine. 1989;8(12):661-3.

3. Canadian AIDS Society. HIV transmission: guidelines for assessing risk. 5th ed. Ottawa: CAS; 2004. Available from:  http://www.cdnaids.ca/web/repguide.nsf/Pages/45A115EBBCBA2586852570210054FC3E/$file/HIV%20TRANSMISSION%20Guidelines%20for%20assessing%20risk.pdf. The unreferenced article mentioned here is likely Garland, et al. (1989) as above.

4. DePaola LG. Preventing disease transmission from operatory surfaces. Academy of Dental Therapeutics and Stomatology; 2008.  Available from: http://www.ineedce.com/coursereview.aspx?url=1557%2fPDF%2fPreventingDiseaseTrans.pdf&scid=13875

5. 5. Jafa K, McElroy P, Fitzpatrick L, Borkowf CB, Macgowan R, Margolis A, Robbins K, Youngpairoj AS, Stratford D, Greenberg A, Taussig J, Shouse RL, Lamarre M, McLellan-Lemal E, Heneine W, Sullivan PS. HIV transmission in a state prison system, 1988-2005. PLoS One. 2009;4(5):e5416. Epub 2009 May 1. PubMed PMID: 19412547; PubMed Central PMCID: PMC2672174.

6. Centers for Disease Control and Prevention (CDC). HIV transmission among male inmates in a state prison system–Georgia, 1992-2005. MMWR Morb Mortal Wkly Rep. 2006 Apr 21;55(15):421-6. PubMed PMID: 16628181.

7. Knudsen HK, Leukefeld C, Havens JR, Duvall JL, Oser CB, Staton-Tindall M, Mooney J, Clarke JG, Frisman L, Surratt HL, Inciardi JA. Partner relationships and HIV risk behaviors among women offenders. J Psychoactive Drugs. 2008 Dec;40(4):471-81. PubMed PMID: 19283951; PubMed Central PMCID: PMC2746431.

8. Allen AA. Barriers: an analysis of the user of safer sex methods in the queer community. Thesis. Bachelor of Arts, Women’s Studies. University of Washington. June 2004. Available from: https://dlib.lib.washington.edu/dspace/bitstream/handle/1773/2057/Allen04.pdf?sequence=2

9. Makinde ON, Aremo BT, Aremo B, Akinkunmi EO, Balogun FA, Osinkolu GO, Siyanbola WO. Re-usable low density polyethylene arm glove for puerperal intrauterine exploration. East Afr Med J. 2008 Jul;85(7):355-61. PubMed PMID: 19133425.

10. Davies LN, Bartlett HE, Dunne MC. Cling film as a barrier against CJD in Goldmann-type applanation tonometry. Ophthalmic Physiol Opt. 2004 Jan;24(1):27-34. PubMed PMID: 14687198.

11. Rani A, Dunne MC, Barnes DA. Cling film as a barrier against CJD in corneal contact A-scan ultrasonography. Ophthalmic Physiol Opt. 2003 Jan;23(1):9-12. PubMed PMID: 12535051.

12. Leichliter JS, Chandra A, Liddon N, Fenton KA, Aral SO. Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States. J Infect Dis. 2007 Dec 15;196(12):1852-9. PubMed PMID: 18190267.

13. Frappier JY, Kaufman M, Baltzer F, Elliott A, Lane M, Pinzon J, McDuff P. Sex and sexual health: A survey of Canadian youth and mothers. Paediatr Child Health. 2008 Jan;13(1):25-30. PubMed PMID: 19119349; PubMed Central PMCID: PMC2528827.

14. Maticka-Tyndale E.. Sexuality and sexual health of Canadian adolescents: yesterday, today and tomorrow. The Canadian Journal of Human Sexuality. 2008 Jul 1;17(3):  85-95. Document ID: 1623790231.

15. Gindi RM, Ghanem KG, Erbelding EJ. Increases in oral and anal sexual exposure among youth attending sexually transmitted diseases clinics in Baltimore,
Maryland. J Adolesc Health. 2008 Mar;42(3):307-8. Epub 2007 Dec 21. PubMed PMID: 18295140; PubMed Central PMCID: PMC2350224.

16. Hollander D. Many young teenagers consider oral sex more acceptable and less risky than vaginal intercourse. Perspectives on sexual and reproductive health. 2005 Sep;37(3):155.

17. Halpern-Felsher BL, Cornell JL, Kropp RY, Tschann JM. Oral versus vaginal sex among adolescents: perceptions, attitudes, and behavior. Pediatrics. 2005 Apr;115(4):845-51. PubMed PMID: 15805354.

18. Leber A, MacPherson P, Lee BC. Epidemiology of infectious syphilis in Ottawa. Recurring themes revisited. Can J Public Health. 2008 Sep-Oct;99(5):401-5. PubMed PMID: 19009926.

19. Groves MJ. Transmission of herpes simplex virus via oral sex. Am Fam Physician. 2006 Apr 1;73(7):1153; discussion 1153. PubMed PMID: 16623201.

20. Oral sex more risky. AIDS Patient Care STDS. 2000 Apr;14(4):227. PubMed PMID: 10806652.

21. D’Souza G, Agrawal Y, Halpern J, Bodison S, Gillison ML. Oral sexual behaviors associated with prevalent oral human papillomavirus infection. J Infect Dis. 2009 May 1;199(9):1263-9. PubMed PMID: 19320589.

Photo credit: Wrap – the photo, by mariogirl. 18 Oct 2006.


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