Know the risks, but err on the side of caution

Dear Dr G,

In the era of the Covid-19 pandemic, we are all working from home and not socialising much, in person anyway.

However, I am sure during the lockdowns and the movement control order, many lonely hearts begin to look for love online.

I am no exception, as I started using a dating app and got to know someone reasonably well over the past six months. We have chatted online but not met in person.

I think we are quite open and even discuss the potential of sexual encounters after the MCO.

Of course, the sad reality is that when we engage in sexual activity for the first time, we often do not know the past sexual encounters of the partner.

In the past, I have met several sexual partners on casual occasions and foolishly engaged in unprotected sex. I must admit the anxiety following such intercourse was tremendous, and I hated the experience of uncertainty and fear while waiting for the complete six months to ensure I did not contract HIV.

I promised myself the next time I embark on a sexual relationship, I would like to know my risks and exactly what I am in for.

I would like to put Dr G on the spot for the risk stratification of HIV.

What is the risk of HIV transmission through kissing?

Can you tell me what exactly is my risk of getting infected with HIV through oral sex and other intercourse?

I think this will help me (and your other readers) to work out a “calculated risk” when considering “going too far”

Regards
Risk-taking Richard

The exact risk of HIV transmission is difficult to measure with different modes of sexual behaviors. On one hand, the HIV status and viral load of the infected person is not always known. On the other hand, the state of immunity of the HIV negative partner is also difficult to quantify.

Clinical data is available to help individuals to broadly work out exactly how risky are different modes of sexual encounters, with HIV positive and negative individuals.

The likelihood of HIV transmission from a person with HIV to a HIV-negative individual depends on the mode of sexual activity. The highest risk behavior that can transmit the virus is by unprotected anal sex, and the other risky mode of transmission includes unprotected vaginal intercourse, needle sharing and vertical transmission from mother to baby.

Although the HIV virus can be detected in saliva, the evidence shows that HIV is not transmissible through kissing. This may be due to the combination of antibodies and enzymes found naturally in the oral cavity that can prevent HIV infecting the new cells.

Scientific studies all support that the HIV virus is spread through the exchange of bodily fluids such as blood, semen, and vaginal fluid but not saliva, therefore kissing as a first step to a sexual encounter is always safe.

Oral sex, on the other hand, are sexual acts that involve one person kissing and licking the other person’s genitals. The medical literature also agrees the risk of HIV infections is low here, but it is not risk-free.

The risk of HIV transmission during oral sex depends on bodily fluid containing the virus (semen and vaginal secretion) transmitting into the blood stream of the HIV-negative person with the presence of inflammation, cuts, or sores in the oral cavity.

Thus far, there are also no documented cases of someone being infected with HIV through receiving cunnilingus from a woman with HIV.

Globally, the most frequent route of transmission is unprotected vaginal intercourse. There are differences in biological risks of viral acquisition for men and women, also high and low-income nations.

The calculated risk of viral transmission to female having sex with HIV-positive men is 0.08% (translated to 1 in 1,250) and risk to males with infected females is 0.04% (translated to 1 in 2,500).

In low-income nations, however, the risk is 1 in 300 (or 0.33%) for both sexes. A woman is twice as likely to contract HIV from a viral-positive male partner, and in low-income countries, the transmission rates are higher and seem to be similar in both sexes.

Unprotected anal intercourse carries the highest risk of HIV transmission. The virus is more likely to pass from a HIV-positive partner to the receptive partner.

In a recent study in Australia, the accurate calculation of per-act-risk of receptive anal intercourse to both men and women is estimated to be 1.4%. This translates to a 1 in 70 risk of contracting HIV.

When it comes to sexually-transmitted infections, taking too many risks may end up with lifelong consequences. For some risk-takers in sexual promiscuity, contracting viral infections such as herpes or HPV (Human Papilloma Virus) may not have curative potential.

However, the “inconvenience” of utilising antiviral medications during the outbreaks often seems regrettable but acceptable for many “offenders” with calculated risks.

Sadly, this can also end up with the ultimate price to pay for serious infection such as HIV.

One of my favorite authors, TS Eliot, once said: “Only those who will risk going too far can possibly find out how far one can go.”

When Dr G is put on the spot on the risk stratification for HIV, compounded with Covid-19 transmission, his view is: “This is a risk you don’t want to find out you have gone too far!”