Dear Needs the details,

Ranking the risks of getting HIV infection by type of unprotected sexual behavior is common, as you mentioned in both Alice's column and the AIDS factbook. The details you're asking about are much less common; in fact, because calculating the percentages is almost impossible. Think about it -- it is rare that we engage in only one type of sexual activity with a partner; therefore, how do the scientists know exactly when and how the transmission occurred? Not even the Centers for Disease Control and Prevention (CDC), which keeps statistics on HIV transmission, compiles information on the relative riskiness of different acts.

Things to remember in making your decisions without the statistical numbers: transmission of HIV can occur without contact to the non-infected person's mucous membranes, if there is direct access to the blood stream (i.e., a cut or a sore). In the case of torn cuticles, if they aren't healed and there is some access to your bloodstream, and your fingers come in contact with infected vaginal secretions or blood in a person's rectum, the possibility of transmission exists. This seems a highly unlikely mode of transmission however, unless you consistently have severely torn cuticles.

Again, as far as performing unprotected oral sex on a woman when she's not menstruating, thus far there have been no documented cases of HIV transmission solely from this route. It is impossible to tell, however, because, as mentioned earlier, most people engage in a variety of sexual activities. On the scale, it seems to be an extremely low risk activity.

When Alice says to process the information and then make your decisions, you also have to take into account your personality. If you're the type of person who wants to consider every single possibility in a given situation, and would get uptight if there was even the smallest chance of something happening and you didn't know about it, then you should always use condoms and oral dams. On the other hand, if you're the type of person who is more generally a risk taker, and if you're given too much information, you're likely to say, F- it and just forget the condom for all sex, then you should only use condoms for the high risk activities and use them consistently in those situations. Many of us fall somewhere in between on this spectrum, but it's important to know yourself and the risk factors, and then make responsible decisions about sex. Get it? Got it! Good.

Alice

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