Dear Dr Hook and Dr Handsfield:

I am sorry for making this post a bit long (and a bit explicit), but I wanted to seek clarification on the risk of contracting HIV under various key scenarios. I know some of these encounters have been addressed but it is always good to stay updated with knowledge on the risk of contraction and practice safe sex. Appreciate if you could address the risk of HIV contraction, should a man have any of these encounters with a HIV positive woman (worst case scenario):

1. Sexual intercourse with condom protection, assuming no breakage of condom. Please note that I recently came across a post by a researcher on one of the social media platforms that traditional condoms are permeable for most of the viruses (100nm), especially HIV (120nm) and that traditional condoms might simply not always be effective, even if there are no breakages or slippages.

2. Please also address the risk should the condom slip away briefly or break, leading to brief bare exposure

3. Oral sex perfomed by the man on the woman

4. Oral sex performed by the woman on the man, until the end

5. Mouth to mouth deep kiss

6. Sucking of the woman's breasts by the man

7. Licks performed by the woman on any other part of a man's body (except the penis)

Sorry again for seeking answers to all possible scenarios, but your answers will help create awareness, leading to both safe practices and doing away with needless anxieties. Thanks again.

1. There are no data on the exact risk per condom protected exposure. In theory, 100% protection, except that undetected condom failures sometimes happen. The theoretical possibility that HIV or other infectious agents could pass through intact latex is just that, theoretical only. There are NO known or proved (or even suspected) cases in which it actually happened.

2. Also no data. The average risk for a single episode of unprotected vaginal sex, if the female partner is infected, is around 1 in 2,500. With a condom, it's probably a hundred fold lower, i.e. 1 chance in a quarter million. Presumably the risk rises with the duration of unprotected exposure. If withdrawal is immediate after breakage, the chance remains very low. But as just noted, the risk is low even with no condom at all.

3. Zero risk or close to it. There has never been a case of HIV known to have been transmitted by cunnilingus (oral vaginal contact), in either direction.

4. If the oral partner has HIV, the risk for the penile partner from oral sex has been estimated at 1 in 20,000. That's equivalent to receiving BJs by infected partners once daily for 55 years before infection might be likely. There are few or no proved cases in which this ever happened. In other words, zero risk for all practical purposes.

5. There is a single report of apparent HIV transmission by kissing. Zero risk for practical purpose.

6. There is no risk of oral contact with skin anywhere on the body. That includes breasts and nipples.

7. Zero risk for sure.

Let me know if anything isn't clear.

HHH,MD

This puts to rest a lot of confusions in my mind. As always, thanks a lot for your expert advise.