[Question #11020] HIV transmission

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17 months ago
I have some questions about HIV transmission. I am a single male who regularly meets with sex workers. To avoid HIV, I never engage in vaginal sex. I also abstain from oral sex, with the sole exception of allowing sex workers to lick and suck my scrotum. Additionally, I request that sex workers lick and suck various parts of my body and massage my body using their genitals. I also engage in French kissing.

I believed I would never contract HIV until recently, when I read online that HIV infection is possible from the activities I engage in. I hope to resolve my confusion through this forum. My questions are as follows:

Suppose I have recent cuts, abrasions, or skin conditions such as folliculitis and slightly bleeding pimples on my skin (back, legs, arms, chest, armpit, scrotum, etc.).

1. If someone's genitals slide (firmly) over my skin (back, legs, arms, chest, armpit, scrotum, etc.), resulting in direct contact between their genital fluids and my small cuts, abrasions, slightly bleeding pimples, folliculitis, etc., am I at risk of contracting HIV?
2. If someone licks and sucks on areas of my skin (back, legs, arms, chest, armpit, scrotum, etc.) where there are small cuts, abrasions, slightly bleeding pimples, folliculitis, etc., am I at risk of contracting HIV?
3. Can HIV be transmitted through French kissing, especially if I have mouth sores that may bleed, bleeding gums, or other oral health issues?

If anything above is unclear, please let me know. Thank you for your help.
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H. Hunter Handsfield, MD
17 months ago
Welcome to the forum. Thanks for your confidence in our services.

As I first read your question, I was ready to reply after the first paragraph -- that the events you describe are entirely risk free for HIV infection. Then paragraph 2 made it clear you have found some misinformation somewhere. I am quite confident you did not read that the described activities are risky on any professional or professionally moderated source. There's certainly a lot of online buzz on sites by and for people at risk -- like Reddit, for example, where many discussions are dominated by anxious persons or those who are frankly untruthful, either intentionally or out of poor information they received elsewhere.

Those comments pretty well cover your numbered questions, but to assure no misunderstanding": 

1,2) There has never been a known, scientifically confirmed transmission of HIV from these sorts of contacts. Saliva does not transmit HIV; in fact, saliva kills the virus. Exposure to oral fluids carries little or no risk. Even swallowing HIV infected fluids is almost entirely risk free.

3) There's a bit of controversy about French kissing. For the reasons above, it is clear that if this ever transmits HIV, it is extremely rare. On the other hand, it is biologically plausible that in the presence of gum bleeding etc there might be small risk. But here too, there simply has never been a scientifically documented cases.

In summary, for all practical purposes, the sexual events described are entirely risk free for HIV, as well as other STIs. I realllywouldn't worry about it. If you continue to be concerned, of course you're free to get tested for HIV from time to time. If you do so, you can count on negative results.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD 
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17 months ago
Thank you for your reply. You are right; after conducting some random searches on HIV transmission, I became confused. I have some follow-up questions. Thank you in advance for your patience.

1. If my skin is not intact, for instance, with broken pimples and abrasions, and someone with oral conditions such as bleeding gums licks and sucks these broken pimples and abrasions on my skin, are you suggesting that HIV transmission is biologically impossible? I assume there is blood contact and that someone’s mouth becomes a confined space during sucking. Or are you simply saying that the risk is too low to worry about?
2. So, even if HIV transmission through French kissing is biologically possible, is it safe to say that the risk is extremely low and can be ignored, correct?
3. If I continue with the lifestyle I mentioned earlier, namely regularly seeing sex workers who lick and suck various parts of my body and massage my body using their genitals, is it safe not to check my skin condition beforehand?
4. If I abstain from having sex (except for receiving scrotum licking), is it correct to assume that I don’t need to test for HIV regularly?
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H. Hunter Handsfield, MD
17 months ago
1. Such transmission is not "biologically impossible"; that is, I cannot say that such contact has zero risk. But with no known cases that it ever happened, you can consider the risks of such events to be zero for all practical purposes.

2. Exactly correct.

3. Yes, I agree; that is, I see no need to search for minor skin lesions in order to avoid them during your sexual activities.

4. There are two reasons for HIV testing. First is medical and risk-based. On that ground, these activities do not require HIV testing. The second reason is for reassurance. If despite this knowledge you're going to worry about it, then you might consider testing from time to time, like maybe every few months or once a year -- simply for reassurance. But not after each such sexual experience.
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