The Risky Business of Unprotected Sex

Cuban American erotic novelist, Anais Nin once said; “And the day came when the risk to remain tight in the bud was more painful than the risk it took to blossom”.

I celebrated my 46th birthday last week and this is often a day I reflect on my life and career. How many risks have I taken in my lifetime? By definition, isn’t being a doctor a ‘non-risky’ profession? If so, will I live to regret not taking risks, as Mark Zuckerberg once warned; “The biggest rick is not taking any risk, in a world that changing really quickly, the only strategy that is guaranteed to fail is not taking risks”.

T. S. Eliot, arguably one of the most important poets of the twentieth century once said; “Only those who will risk going too far will find out how far can one go”.

I come across men and women taking risks in sexual relations everyday in my job. How far is one willing to go when it comes to taking risk in sex? This is the topic of our discussion this week.

Dear Dr. G,

Thank you so much for reading my email.

My name is David, aged 26 and currently single.

I am sexually active and have been involved in several relationships.

I understand the importance of protection, but I often find condoms very cumbersome and they sometimes break or slip off.

Often, in the heat of the moment, I take the risk and have a sexual encounter with no protection. I understand it is a stupid thing to do, but I often wonder how much risk have I exposed myself to by doing do?

Can you tell me what are the risks of HIV transmission?

Can HIV be transmitted through kissing, hugging and sharing a toilet?

What is the risk of exposure when it comes to penetrative intercourse?

Is HIV transmissible though oral sex?

I really would like to know the facts; so that I can understand how much risk I have exposed myself to.

Healthcare professionals have always been asked the question of risk of exposure for unprotected intercourse.

In reality, it is difficult to offer a precise numeric answer; as such research is nearly impossible to do. Imaging asking couples to have intercourse repeatedly and then calculate the transmission rates – all in the name of science!

The truth is, HIV transmission is hugely variable and dependent on several factors such as if the source was known to be HIV positive, the stage of the disease and the virulence of the strain. Other factors also include the general state of health of those involved, the presence of other sexually transmitted infections, and quantity of the infectious bodily fluids transmitted and of course, the type of sexual acts performed.

One fact is for sure. HIV cannot be transmitted through kissing, hugging or sharing the toilet, crockery or bed linens. The virus is also not passed on by spitting, sneezing and coughing. After so many years, one would think such myths are all understood and buried. It is sad to see ignorance and taboos as the main barriers when seeking treatment for HIV.

In recent years, studies have outlined the likelihood of HIV infection per exposure of sexual contact. The risk figures outline the risk of infection for individual incidence during which HIV transmission could have occurred. For example, the risk of female-to-male transmission during vaginal intercourse in high-income nations is 0.04% and 0.4% in low-income nations. The reciprocal risk of male-to-female transmission is 0.08% and 0.3%. (Yes, female-to-male transmissions are higher in low-income nations)

Oral sex has been shown to be less risky but not totally risk-free. The estimate range of infectious risk is between 0.01 to 0.04% (around 1 in 2,500). However, the infection is dependent on the viral load and dental health of the parties involved. It is also is important to emphasize that other diseases such as syphilis, herpes, gonorrhoea and chlamydia can easily transmitted be via oral sex.

The risk of HIV transmission is also analysed in men having sex with men, dependent on the position of insertion or reception. The figures can range from 1 in 123 and reduces to 1 in 666, with the use of barriers during intercourse. It is not surprising the simple use of a condom is so important to reduce transmission.

Although such statistics may be useful, it can also be misleading. The “per-exposure” measure of risk may cause activity seem less risky, as some may assume a one in 100 chance per exposure does not seem too bad. The reality is that repeated exposure clearly will have cumulative effects on the final outcome. So, how lucky do you feel every time you are naughty?

When it comes to taking risks in sexual encounters, I agree with the Canadian rapper, Drake. He said; “I have never been reckless, it’s always calculated. I am mischievous, but I am calculated”. I also agree with Warren Buffet; “Risk comes from not knowing what you are doing?”

Now you know all the stats, how mischievous will you be, and far are you willing to risk your life during sex?