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Safe Sex

More properly, safer sex, as the only 100 % foolproof means of avoiding infection with HIV through sex are solitary masturbation or total abstinence.   Because the human sex drive is so strong, and most people cannot realistically be expected to abstain completely from sex, safer sex is a viable alternative.   Safer sex describes those sexual activities which carry the lowest risk of HIV transmission, as opposed to unsafe sex, which describes those activities which carry the highest risk of transmission.

The following activities are classified as unsafe sex, carry a high risk of HIV transmission, and should therefore be avoided:

The following activities are classified as safe sex and carry low risk of HIV transmission:

While incidences of HIV transmission through oral sex are fairly rare, one should avoid having oral sex with a woman who is menstruating or ingesting semen during oral sex with a man, especially if the person is HIV positive and has a high viral load.   Unprotected oral sex with a woman who is not menstruating or with a man that is not done to completion carries a very slight risk of transmission, since small amounts of the virus may be present in vaginal or preseminal secretions.   Unprotected oral-anal sex also carries a slight high risk for HIV, but can expose one to parasites and hepatitis; the same holds true for ingesting feces or urine.   Oral sex should be avoided  for at least two hours after brushing or flossing one's teeth and should be avoided completely if there are cuts or sores inside the mouth.   Fisting or mutual masturbation to orgasm without a latex glove, or getting semen on the skin can carry a slight risk if the skin is broken.   Sex with multiple partners at once carries as much risk as being promiscuous.  Sex under the influence of drugs or alcohol is dangerous because one's judgment may be impaired and thus one may engage in risky or unsafe activities without thinking of the possible consequences.  Sex for money is also risky, as someone desperate or greedy for money may be willing  to do unsafe things for the right price.  Studies have shown that people can and will behave very irrationally when money is involved,  with regards to sex as well as other activities.

The most common form of safe sex is that involving the use of condoms, a practice first endorsed by US Surgeon General C. Everett Koop in 1985.   In HIV, condoms can be effective in preventing the transmission of other diseases, including gonorrhea, syphilis, herpes, and clamydia.   However, the effectiveness of condoms in preventing HIV transmission and other diseases is greatly reduced if they are not used properly.  Individual condom packets should never be cut or bitten open.  Oil-based lubricants, including vegetable shortening and hand lotions, can weaken condoms and increase the likelihood of their breaking, and so should be avoided; only water-based lubricants should be used.   Polyurethane condoms, which can be used with oil-based lubricants, have recently become available on the market.  They also have the advantage of conducting body heat, which increases pleasure and sensation.   Some gay men have also begun using  female condoms made from polyurethane with apparent success both with effectiveness and pleasure, but it is important to remove the inner plastic ring before use to avoid irritation and discomfort.   Condoms which are too small can break easily, so a man with a large endowment should use large or "magnum" sized condoms to avoid this.  To further reduce the risk of breakage, one should use condoms with reservoir tips and be sure to squeeze any air out of the tip before putting the condom on, which itself should be done by unrolling the condom - never pulling or stretching -, making sure that the tip is pointing outward.   If the tip does not point outward, then the condom has been put on inside out, in which case the condom should not be turned right-side out but instead thrown away and replaced with one put on correctly.  Most brands of condoms come with instructions, which should be read and followed carefully.   Condoms, and dental dams, should never be used twice or with more than one partner.   If a condom breaks during sex, one should stop immediately, and replace the condom with a fresh one if one wishes to continue with intercourse.

In the 1990s, condoms for women, or "femidoms" were introduced.   These are inserted into the vagina before intercourse.   While they are quite effective by themselves,  using them in conjunction with a male condom reduces the risk of HIV, STDs, and pregnancy even further.   Straight and bisexual women are especially advised to keep femidoms handy if they are sexually active, in case their partner does not have any condoms handy.  As with latex condoms, latex femidoms should not be used with oil-based lubricants, and should be replaced immediately if they break.  Instructions which come with the femidoms should be read and followed carefully.   Although the incidence of HIV and AIDS is rare among lesbians, gay women are also cautioned to practice safer sex, which may involve the use of dental dams during oral sex, and to avoid sharing sex toys that are not sterilized between uses, especially if their partners have ever had intercourse with men.

Many condoms come lubricated with nonoxynol-9, a substance originally intended as a spermicide to further reduce the risk of pregnancy for women having straight sex.  While nonoxynol-9 can kill the HIV virus, recent studies show that it can irritate internal tissues to the point that the risk of HIV transmission can actually be increased.   For this reason some medical authorities are now recommending that condoms and lubricants with nonoxynol-9 should not be used.   Lubricants with nonoxynol-9 should also not be used by themselves in lieu of a condom.

Yet another recent amendment to the list of safer sex practices involves the use of enemas or "male douches."  Because enemas can irritate and weaken the lining of the colorectal area, especially if cleansing agents like castille soap are used, and so may increase the risk of HIV transmission, some medical authorities now advise that the use of enemas as a preparation for anal sex be avoided.   Those who plan on being receptive to anal intercourse are instead advised to simply follow basic cleanliness procedures, and to simply stop and clean up if things get "messy."

If one chooses to be sexually active, then one should be willing to take the necessary precautions to avoid infection with HIV.  This applies even if one is already infected with HIV, as exposure to additional strains of the virus can speed up the onset of AIDS and increase its severity.   Anyone who engages in unsafe sex is at risk for HIV and AIDS, regardless of one's sex, sexuality, age, nationality, income, race, religion, or other classification or distinction.  While drug therapies can delay the onset of AIDS in persons with HIV for decades, they do not work for everyone, and while the various diseases and infections associated with AIDS may not be fatal, they can be very painful, very debilitating, and very unpleasant, and they can come back, many times.  While HIV infections in North America, Western Europe, and Australia are on the decline, and total HIV infections in the world represent only one percent of all sexually active people between fifteen and forty-nine years of age, HIV is not going away anytime soon and remains a very real threat.   For these reasons, if one is going to have sex, one should do so safely.

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