SAFER SEX - WHAT DOES IT MEAN ?

When thinking about "safe" sex, it is important to realize that risk from various sexual practices often falls along a continuum, rather than having a clear safe vs. not safe boundary. Throughout this discussion, we will refer to "safer" sex, with the thought that by placing more or fewer "boundaries" around a particular sexual act, it can be made more safe or less safe. Although in the early years of the epidemic we placed individual sexual practices in specific categories of risk, nowadays we stay away from the categories and emphasize the logic behind safer sex guidelines. In fact, the safety of an individual practice depends on how people are doing it. Any sexual practice can be made safe or unsafe. For instance, mutual masturbation can become unsafe if people touch their own genitals after getting a partner's infected semen, blood or vaginal fluids on their hands. We hope to help you develop criteria to use to decide whether previous experiences you've had were safe or not, and how to stay safe in the future. It is helpful to think about safer sex using a wide definition of sexuality. Many people think about sex fairly narrowly. For instance, thinking that sex only starts when penetration takes place may limit people's ability to protect themselves and to enhance their sexual lives through safer sex. We consider sexuality to include any practices that a person finds erotic and sexually exciting. Remember, telephone hotline staffers are available to talk with you about any of these issues. Please feel free to call 1097 to clear your doubts on any of these issues. Most people are inclined to think that people who practice safer sex are only those who are concerned about getting HIV from their partners because they don't know their sexual partner(s)' HIV status or they know if their sexual partner(s) is/are HIV-positive.

In fact, there are other reasons why some people decide to practice safer sex Some examples:

HIV-negative people who always practice safer sex so they don't lose the habit of   protection. Also, if a person agrees, with ease, to practice safer sex, this is an   indicator that the person has practiced safer sex with previous partners. HIV-negative people in a sexual relationship who want to avoid dealing with   issues of trust between them. By practicing safer sex, there is no need to discuss   whether they are being monogamous. HIV-negative people who agree to practice safer sex with each other for six   months before they are tested again for antibodies, prior to conceiving a child. HIV-positive people who want to avoid getting reinfected with HIV. Scientists   believe that reinfection may accelerate the progression of the disease. Also,   evidence presented at the 12th World AIDS Conference indicates that it is   possible for someone with a drug-resistant strain of HIV to give it to another   person, which could limit their treatment options as well.

Of course, sexual partners who are HIV-negative, waited six months after their last risky activities to take the HIV-antibody test, and trust that neither one of them has current risks, may practice sex without protection. Among these conditions, trust in their partners is sometimes the hardest one to achieve.

Safer Sex and Pregnancy

One situation in which practicing safer sex is not an option is wanting to have a baby. Partners who are not sure of their antibody status can seek antibody testing to determine their status.

Safer Sex Guidelines
The most general way in which we can define "safe" sex is the following:
Why Latex?
Condoms and Other Safer Sex Devices
Types of Condoms
Using "Male" Condoms
Preventing Condom Breakage
Using Condoms During Oral Sex
Condom Availability
Using Dental Dams and Plastic Wrap for Oral Sex

Any sexual practice that does not let someone else's semen, blood, or vaginal fluids get into someone else's body. The parts of the body where HIV could enter the bloodstream are the anus and rectum, the vagina, the penis, the mouth, and the eyes. These body parts must be protected from contact with HIV-infected fluids. HIV cannot go through the skin unless there are open sores or bleeding cuts. We hope to give you the tools with which you can make your own decisions about where you want to fit in on the continuum from safer sex to riskier sex. Each time you do a sexual activity, you choose (whether consciously or unconsciously) the level of risk you are comfortable with for that moment. Safer sex often involves use of latex condoms, latex dental dams, plastic wrap, latex gloves and finger cots as barriers between the infectious fluids and mucous membranes or open cuts.

Why Latex?

Latex has been proven effective in preventing the transmission of HIV. Latex is a very resilient and strong material that does not allow HIV to pass through it. When used properly, latex products offer the best possible barrier for HIV and other sexually transmitted diseases.

Condoms and Other Safer Sex Devices

"Male" Condoms A condom is a sleeve, closed at one end, which fits over the penis. There are three types of condoms: latex, polyurethane and lambskin. The lambskin condoms may allow passage of HIV, and therefore are not recommended. Latex or polyurethane condoms are recommended because they do consistently prevent passage of HIV. "Female" CondomsA recently approved alternative to the regular condom, the "female" condom is a disposable vaginal pouch made out of polyurethane. It is soft and thin and has a latex ring at each end. The ring at the closed end goes into the vagina and over the cervix (the opening of the uterus). The other end stays outside the vagina and covers the labia (vaginal lips). The polyurethane covers the cervix and the vaginal canal. The vaginal condom is currently marketed under the name "Reality." This condom is also sometimes used by either men or women for anal sex, although it has not been designed for or tested for this usage.Latex Dental DamsDental dams are squares made out of latex that dentists use to isolate the tooth on which they are working. AIDS educators have advocated their use for oral sex, either mouth-vagina or mouth-anus. Because they were not originally designed for sex, they tend to be thicker than condoms."Dammit"This device consists of a couple of leather straps with snaps that can be adjusted around the legs to hold a dental dam in place, like a garter belt. This harness has several purposes: (1) one's hands are left free to hold or stimulate the partner and, (2) there is no risk of flipping the dental dam over and using the wrong (exposed to fluids) side for as long as the "dammit" is being used.Plastic WrapPlastic wrap is a common product in people's kitchens. It has been shown to prevent passage of HIV and it is recommended as a barrier for oral sex, either mouth-vagina or mouth-anus. Although dental dams can also be used for these activities, plastic wrap has the advantage of being transparent, thinner, cheaper, and easier to get.Latex GlovesLatex gloves are easy to find in drugstores and medical supply stores. They may be used to cover the hand when inserting the fingers or fist in the vagina or rectum. They may also be used by people who have open cuts in the hands or chronic skin problems such as eczema. Some people simply enjoy the feel of latex on their skin.Finger CotsFinger cots are made out of latex and cover only one finger. They can be found in medical supply stores.

Types of Condoms

There are a wide variety of condoms on the market. They can be lubricated or non-lubricated. They come in different colors, shapes, sizes, textures and thickness. There are condoms that are flavored, that glow in the dark, that play a short song when opened, etc. There is practically no limit to the selection. Some men complain that condoms make them lose sensitivity in the penis during sex. We encourage these men to try out different brands and types of condoms and select the ones with which they are more comfortable (they can masturbate with them to get used to them and feel more comfortable during sex with their partners). Some people find that although they may lose their sensitivity at first, after using condoms for a while they can regain it. And, of course, they feel more relaxed about sex since they know they are protected. There are no rules about what condom to use. Some men feel better with a thicker condom while others prefer a thinner one. Some people get excited about colors and flavors while others find these features boring or irrelevant. Some men claim that their penis is too big for a condom. We encourage them to try different brands (which fit different people in different ways; there are no "better" brands). There are also brands of condoms designed explicitly for men who have a large penis. Interestingly, few if any men say that their penises are too small for a condom.

Using "Male" Condoms

Pick up the condom by grabbing the "nose" (the reservoir tip) between your   thumb and forefinger (to ensure that no air bubble gets trapped in the tip, which   may cause breakage during intercourse). With both hands place the condom on the head of a fully erect penis (remember,   you are holding the "nose" in one hand; you roll the condom down onto the penis   with the other hand). Unroll the condom completely, all the way down to the base of the penis. Having   used both hands and held onto the reservoir tip, you have just ensured that no air   is trapped inside the condom. Not only does this prevent air bubbles popping the   condom during the friction of intercourse, but it also creates a vacuum, which   helps to keep the condom in place. Use plenty of water-based lubricant (some people use a single drop inside the tip   to keep the air out). When pulling out, the man or his partner should hold the condom between the   fingers so that it does not slip off and spill any semen inside the body.

Preventing Condom Breakage

The main reason for condom breakage is user failure. Although condoms are very resilient, they may become weaker when affected by several factors: Heat Condoms should never be left in places where they will be exposed to heat, such as glove compartments , under direct sunlight or in pockets of tight jeans. Old Age Condoms should be fresh when used. We recommend not keeping ondoms longer than a year. If there is any uncertainty about how old a condom is, it should be thrown out. Most condoms will have expiration dates on the package. Insufficient lubrication It is important to use a lubricant (such as saliva or a commercial lubricant like KY jelly or another product) to reduce friction on the outside of the condom during sexual intercourse. When in doubt, more lubrication should be added. Use of oil-based lubricant Oil-based lubricants affect the latex and make it break. Lubricants that should never be used include: Vaseline, baby oil, Crisco, hand lotion, massage oil, face cream, etc. Just look on the label for ingredients: water should be the first ingredient. Air Bubbles The main reason condom breaks during sex os because air bubbles get trapped inside them, which make them break due to the motions of intercourse. The air must be pinched out of the condom's tip before putting it on.

Using Condoms During Oral Sex

If you wish to perform safer oral sex on a man, you have the option of using non-lubricated condoms. Lubricated condoms do not taste good to most people and if there is nonoxynol-9 on the condom, it may cause numbness of the lips lasting several hours. Some people don't like the white powder that covers non-lubricated condoms. That white powder is cornstarch and can be easily wiped off with a wet washcloth.

Condom Availability

Condoms are, in general, very easy to find. Most drugstores carry them. However, in some places people have to ask the clerk for them, which can be embarrassing. Condoms are usually inexpensive. Some stores in Tamil Nadu have an arrangement of selling them at cost (that is, they charge only what the manufacturer charges them) to make them even more accessible. Most health departments and STD clinics have condoms available for free. We encourage you to keep a good supply of condoms available at home or at any place where you are likely to have sex. Having condoms readily available increases the probability of their being used. The condoms are available at NGO's of TNSAC, APAC and CAPAC.

Using Dental Dams and Plastic Wrap for Oral Sex

The dam or plastic wrap can be placed between the mouth and the vagina or anus during oral sex to reduce risk of sexually transmitted diseases. It is very important that you use a different dam or piece of plastic wrap every time that you perform oral sex. It is not a good idea to set the barrier aside and use it again because it's too easy to flip it over and forget what side touched the vagina or anus. Dental dams are not as readily available as plastic wrap. They can be bought from medical supply stores and drugstores. .

Risk from Specific Sexual Practices
Anal Intercourse
Vaginal Intercourse
Oral Sex
Watersports/Urine in Sex or Sex Play
Rimming (Oral-Anal Contact)
Fisting
Kissing
Mutual Masturbation
Solo Masturbation
Body Massage, Hugging, Rubbing
S&M Activities
Fantasy, Voyeurism, Exhibitionism, Phone Sex

Anal Intercourse

Anal intercourse without a condom is the riskiest activity for HIV transmission. The receptive partner (or "bottom") is at risk because the anal area provides easy access to the bloodstream for HIV carried in semen. The insertive partner (or "top") is also at risk because the membranes inside the urethra can provide an entry for HIV, possibly present in blood inside the anus, into the bloodstream. Using a condom from start to finish greatly reduces the risk. However, the risk is not zero because the condom could break. It is important that you understand that condoms are only effective against HIV if they are used properly and do not break.

Vaginal Intercourse

In a heterosexual encounter, HIV passes more easily from male to female than vice versa. Therefore, the woman is at more risk. No matter what the gender of the partners, latex can reduce the risk of HIV transmission and other sexually transmitted diseases.

Oral Sex

This is the "grayest" area when discussing risk, and is very controversial. In general, oral sex is much less risky for HIV transmission than anal or vaginal intercourse. But to properly assess risk, you must consider whether there is ejaculate, vaginal fluid, or blood present, because there are no absolute answers regarding oral sex and risk. Risk assessments involve "what substance/fluid" and "where it goes." The mouth is a less likely path for transmission because the mucous membranes are more protective than those in the anus/rectum or vagina and because fluids can't remain in the mouth (they are swallowed or spit out). So the "where it goes" part of the risk equation means oral sex is inherently less risky than anal or vaginal sex. However, you must consider the "what substance/fluid" as well. If there is infected ejaculate, vaginal fluid, or blood present, it increases the risk for infection. Blood contains the highest concentration of virus, followed by semen, vaginal fluid, and a distant last place, pre-seminal fluid. How much does it increase the risk? We can't say for sure. Certainly, not to the level of risk from ejaculation inside an anus or vagina. And we can definitely say that there are only a few documented cases of HIV in which the only possible source of infection was through oral sex, so the risk is still very low. But it is incorrect to equate the risk of oral sex with ejaculation to the risk of oral sex without. A person receiving oral sex is generally not at risk, because that person is coming into contact only with saliva. (There is a theoretical risk of transmission if the person performing oral sex had blood in her/his mouth.) Many people find using a condom unacceptable and are practicing oral sex on men without ejaculation. They are coming into contact with pre-cum (pre-ejaculate fluid). There is no conclusive evidence that pre-cum transmits HIV, but some studies suggest that HIV is present in this fluid. Again, go back to the two questions: "Is HIV present?" and "How much HIV is present?" Although HIV may be present in pre-cum, it is in very small amounts, and the mouth is not an easy path for transmission. This means unprotected oral sex without ejaculation is a very low risk activity for HIV transmission. Performing oral sex on a woman who is menstruating increases the risk because blood has more HIV than vaginal fluid. There is little data on how often HIV is transmitted via oral sex from an infected woman to an uninfected man.

Watersports/Urine in Sex or Sex Play

Urine does not transmit HIV. Even if the urine contained small amounts of blood, the fragile virus would be battered by acid, heat, friction, enzymes, and dilution. And again, it's important to think about how this fluid is coming into contact with another person. To transmit HIV, there would have to be a source of bleeding, and then we're not talking about urine transmitting HIV, we're talking about blood.

Rimming (Oral-Anal Contact)

Feces may contain some blood, but it poses very minimal risk for HIV transmission. However, rimming is a risk for transmission of hepatitis, parasites, and many other sexually transmitted diseases. Safe rimming means using a dental dam or plastic wrap.

Fisting

Fisting refers to inserting the fingers or hand into the rectum or vagina. When people talk about fisting, they almost always mean anal fisting, but the precautions are the same for both. Fisting could be risky for the insertive partner (or "top") if there is broken skin that would allow blood from the rectum or vagina into the bloodstream. Using a latex glove reduces the risk.

Kissing

This activity is not known to pose any risk for HIV infection. Saliva does not transmit HIV. One should be aware of cuts or sores in the mouth and, if concerned, not floss or brush right before French kissing. "Dry" or "social" kissing (with the lips closed) poses no risk for transmitting HIV.

Mutual Masturbation

The skin is an effective barrier against all sorts of organisms, and will stop HIV. Any possibly infected fluid on the skin should be washed off. An intact scab is as effective as unbroken skin. Open cuts in the skin might allow passage of the virus, but the breaks need to be open and/or bleeding to pose a risk. If there is any question, latex gloves or finger cots should be used. It is not (if one wants to be perfectly safe) advisable to ejaculate on someone else's penis or labia, nor to touch the genitals with someone else's fresh semen or vaginal secretions on the hand.

Solo Masturbation

With solo masturbation there is no fear of self-infection. Anything done solo is okay as long as someone else's infectious fluids are not present.

Body Massage, Hugging, Rubbing

With solo masturbation there is no fear of self-infection. Anything done solo is okay as long as someone else's infectious fluids are not present. With only skin-to-skin contact, these activities are risk free. This includes body-to-body rubbing ("frottage").

S&M Activities

This is safe, unless someone's blood, semen or vaginal fluid enters the bloodstream of another person. It can include bondage, tit or nipple play, spanking, discipline or any of a number of other activities, limited only by the imagination.

Fantasy, Voyeurism, Exhibitionism, Phone Sex

These can be elements of many safe activities. They can include costumes or uniforms, and can appeal to senses other than touch.