Dear Dr. G,

I am a 28 year-old man who has a conundrum in life I am hoping you can resolve for me.

Since I was a teenager, I have excessive phobia about contracting sexually transmitted infections, especially HIV.

I grew up in the late nineties and heard the horrid stories about HIV/ AIDS. I understand that medical advancement had transformed how HIV is treated these days.

Despite the assurance of how HIV is no longer considered a death sentence, the pessimist in me is still fearful of contracting HIV from someone I am unsure of (their infectious status).

In my previous relationships, I never got round to engaging in any sexual acts. Needless to say, when I asked about HIV status of the partner, the relationship ended rather quickly.

Being an accountant by profession, I am a man making every decision in life with calculated risks.

This week, I would like to put Dr. G on the spot on World AIDS Day about the odds of contracting HIV on various sexual acts.

Can you please tell me the chances of catching the disease with kissing and fingering?

I also would like to find out the likelihood of disease transmission with oral sex, including cunnilingus and rimming.

Lastly, please explain the risk of virus infections through protected and non-protected vaginal intercourse.

I understand the calculated risk of transmission is theoretical, circumstantial and varied between individuals. However, I truly would like to know my odds before diving straight in (No pun intended).

Thanks for addressing my concerns.
The Accountant

The first day of December has been designated and dedicated to raising awareness of the AIDS pandemic. With an estimated 36.7 million people living with HIV in the world, this makes HIV one of the most important global public health issues in recorded history. This year, the World Health Organisation highlighted the theme of “know your status” in order to increase the diagnostic rates and limit its transmission, especially through sexual contacts.

HIV is transmitted through bodily fluids, including blood, semen, pre-cum, rectal fluid and vaginal secretions. As the virus is virtually absent in saliva, urine, sweat, vomit and faeces, the transmission through non-sexual contact is virtually impossible. Touching, kissing, hugging, sharing toilets and foodstuff with an individual who is HIV positive is completely risk-free.

With the needles exchange programmes, stringent screening of donor blood products and early identification of maternal HIV status, sexual intercourse is now the most common mode of transmission for HIV in developed nations. Sexual activities without protection allows for the exchange of blood, semen, rectal and vaginal secretions, which may carry the virus. Therefore, it is crucially important for individuals to know their status and risks before engaging in the sexual acts.

According to the Centre for Disease Control and Prevention, nearly 70% of estimated new infections in 2015 were amongst MSM (men having sex with men). On the other hand, heterosexual infections accounts for 23% of all new HIV infections, mostly from women infected by their male partners.

Studies have categorised sexual acts into high and low risk practices. Oral sex in general is considered low risk, as the practice is not an efficient way for viral transmission. Although penile-oral sex (fallatio) can potentially allow semen to break into sores in the mouth, that is theoretical and rare. Oral-vaginal sex (cunnilingus) is again safe, with only one reported case of female-to-female transmission. Lastly, oral-anal sex (analingus or rimming) may not be considered high risk, but the transmission of other viruses such as Hepatitis is more prevalent.

There has never been a documented case of HIV transmission with fingering (digital-anal or digital vaginal sex), which is the act of insertion of finger for sexual practice. Unprotected vaginal intercourse is reported to be the most common mode of HIV transmission worldwide. It is generally recognised HIV positive men are more likely to pass the virus to female partner through vaginal intercourse, than the other way round. This is thought to be due to larger surface area of vagina and cervical tissues, rich in immune cells susceptible to virus infection.

Mark Zuckerberg once famously said: “The biggest risk is not taking any risk. In a world that changing really quickly, the only strategy that guarantee to fail is not taking risks.”

In life, every decision we embark on is a potential risk, especially in a sexual relationship. Although calculated risk before engaging in any form of sexual practice is healthy, obsessive avoidance of sex due to the fear of infection may also be excessive. Getting to know the partner well to develop trust is often the key for safe sex.

Often times, “diving in” before getting to know someone well enough, as is often the case, causes anxiety. So, using condoms can avoid this stress after the act. Therefore when Dr. G is asked about the calculated risk of HIV transmission, his view is: “The biggest risk in sex is not thinking prior to taking the risk.

“The only strategy that guarantees failure is not wearing the rubber!”

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