Ich weiss, dass es eigentlich nichts mehr hinzuzufügen gibt, aber weil die Diskussion trotzdem nicht endet, hier noch ein brandneues Forschungsergebnis. Es ist insofern politically correct, als auf beiden Seiten Männer sind.
Nachmals, jeder muss selber wissen, was er tut, und da wir hier von Erwachsenen sprechen, die etwas im gegenseitigen Einvernehmen tun, brauchen wir auch niemandem Vorschriften zu machen.
Das Einzige, wozu ich beitragen kann, dass die Entscheidungen auf guten Informationen basieren.
Auch dieser Bericht beantwortet nicht alle Fragen, aber er versucht, zwischen Facts und Fiction zu trennen.
Gruss
Cli
Oral Sex Among MSM and Risk of HIV
Since HIV was identified as being sexually transmitted, there has been considerable interest in the risk associated with performing fellatio. Although early studies found no independent risk for fellatio, the high correlation among multiple sexual practices raised the possibility that risk existed but could not be detected. Subsequently, case reports accumulated, largely among men who denied other risk behaviors. Researchers acknowledged that fellatio, although not an efficient route of infection, nonetheless appeared to carry a small risk.
Current „safe sex“ guidelines specify that unprotected orogenital sex is unsafe but constitutes low risk. A recent study of primary HIV infection in San Francisco (Page-Shafer K, Shiboski CH, Osmond DH, et al. AIDS. 2002;16:2350-2352) reported that 8% of HIV-positive participants acquired HIV from fellatio. This finding has been widely interpreted to mean that as many as 8% of HIV infections among men who have sex with men (MSM) are attributable to fellatio. The population-attributable risk percentage (PAR%) is of special interest, because even a low-risk exposure could result in a substantial proportion of infections.
The authors of this study present preliminary results from an ongoing investigation of orally acquired HIV infection, demonstrating that such infection is rare. They conduct analyses using previously published data to show that the PAR% of HIV attributable to fellatio is also extremely low.
From December 1999 to 2001, persons seeking HIV testing at an anonymous site in San Francisco were screened to identify those who in the past 6 months reported no anal or vaginal sex, had not injected drugs, and had performed fellatio on at least 1 male partner. Eligible participants completed a pre-HIV test survey, measuring a 6-month history of sexual practices. Postinterview, HIV serology tests were conducted using enzyme immunoassays, Western blot confirmation, and a sensitive/less sensitive enzyme immunoassay strategy to identify recently acquired infection among the participants.
Of 10,283 anonymous clients, 413 (4%) were eligible, and 243 (2.3%) participated. Of those, 239 (98.4%) were men whose median age was 39 years, and all were MSM. Four women were dropped from the analysis.
No recently acquired HIV infections were detected, and the estimated probability of orally acquired HIV was 0. The median number of fellatio partners in the past 6 months was 3, almost all (98%) unprotected. Approximately one third (35%) reported getting semen in their mouth, and of those, 70% swallowed it. Fellatio on a known HIV-positive partner was reported by 28% of respondents; 81% of these did not use a condom, and 39% swallowed ejaculate.
The PAR% rises as the number of partners increases: PAR% for 1 fellatio partner was estimated at 0.18%; for 2 fellatio partners, 0.25%; and for 3, 0.31%. The cumulative PAR% for 1 to 3 fellatio partners could thus be 0.74%.
The authors’ results are based on a modest sample size; therefore, they cannot rule out the possibility that the probability of infection is indeed greater than zero. The calculations showing very low PAR% are consistent with the findings of extremely low individual risk. In addition, if one considers that only a fraction of those who report fellatio are actually exposed to semen (35%), the PAR% will be considerably lower.
„These data confirm that the risk of HIV infection attributable to fellatio among MSM and in the MSM population is especially low,“ the authors concluded. „It is important that health professionals, including HIV counselors, have valid information to impart to their sexually active clients. If individuals believe that the risk of HIV from fellatio is high or on a par with well-documented high-risk exposures, such as anogenital sex, they may not feel that sexual behavior choices make a difference. Acquiring HIV through fellatio is significantly less risky than from anal sex, and therefore one’s choice of sexual practices do matter.“ [CDC HIV/STD/TB Prevention News Update, Monday, December 2, 2002]