Safety in Numbers

Chapter 3

Promoting safer sex


41. Martin T Schechter et al. "Can HTLV-III be transmitted orally?" (letter), The Lancet i: 379, 1986.

42. See, for example, Thomas Lehner et al. "Mucosal transmission of HIV", Nature 353: 709, 1991, in which researchers trying to understand how HIV can be transmitted across undamaged mucous membranes adjust their theories to take account of the epidemiological fact that "there is no convincing evidence that HIV particles in seminal fluid ejaculated during oral sex gain entry through the oral mucosa".

43. Gerald M Oppenheimer, "Causes, Cases and Cohorts: The Role of Epidemiology in the Historical Construction of AIDS" in AIDS: The Making of a Chronic Disease, (eds. Fee and Fox), pp.49-83, University of California Press, Berkeley, 1992.

44. In 1988, a team of researchers from Toronto pointed out that "In the [two] studies that have reported elevated risk [from oral sex], the analysis was univariate in nature". (Randall A Coates et al. "Risk factors for HIV infection in male sexual contacts of men with AIDS or an AIDS-related condition", American Journal of Epidemiology 128(4): 729-739, 1988.)

45. Mads Melbye et al. "Seroepidemiology of HTLV-III antibody in Danish homosexual men: prevalence, transmission and disease outcome", BMJ 289: 573-575, 1984.

46. BA Evans et al. "Sexual lifestyle and clinical findings related to HTLV-III/LAV status in homosexual men", Genitourin Med 62: 384-389, 1986.

47. Warren Winkelstein et al. "Sexual Practices and Risk of Infection by the Human Immunodeficiency Virus", JAMA 257(3): 321-325, 1987.

48. Martin T Schechter et al. op.cit.

49. Lawrence A Kingsley et al. "Risk factors for seroconversion to human immunodeficiency virus among male homosexuals", The Lancet i: 345-349, 1987.

50. Roger Detels et al. op.cit.

51. MT Schechter et al. "Changes in sexual behaviour and fear of AIDS" (letter), The Lancet i: 1293, 1984.

52. See, for example, Leon McKusick et al. "Reported Changes in the Sexual Behavior of Men at Risk for AIDS, San Francisco, 1982-84 - the AIDS Behavioral Research Project", Public Health Reports 100(6): 622-629, 1985; SB Puckett et al. "Self-Reported Behavior Changes Among Homosexual and Bisexual Men - San Francisco", MMWR 34(40): 1985; John L Martin, "The Impact of AIDS on Gay Male Sexual Behavior Patterns in New York City", AJPH 77(5): 578-581, 1987.

53. Susan Golombok et al. "Condom Use among Homosexual Men", AIDS Care 1(1): 27-33, 1989.

54. Update, Project SIGMA, London, March 1992.

55. Adam Carr, "Swallowing the evidence - is oral sex (or anything else) "safe"?", Outrage, pp. 50-53, Australia, January 1991.

56. Andrew Hunt et al. "Coming to blows" (letter), Capital Gay, London, 15th November 1991.

57. Ibid.

58. RKW Lau et al. "Trends in sexual behaviour in a cohort of homosexual men: a 7 year prospective study", International Journal of STD & AIDS 3: 267-272, 1992.

59. Lawrence A Kingsley et al. "Sexual Transmission Efficiency of Hepatitis B Virus and Human Immunodeficiency Virus Among Homosexual Men", JAMA 264(2): 230-234, 1990.

60. MT Schreeder et al. "Hepatitis B in homosexual men: prevalence of infection and factors related to transmission", Journal of Infectious Diseases 146: 7-15, 1982.

61. See Edward King, "Is it safe?" The Pink Paper issue 146, London, 27th October 1990.

62. Richard Berkowitz and Michael Callen, op.cit.

63. AIDS and HTLV III - Medical Briefing (second edition), The Terrence Higgins Trust, London, 1985.

64. Ibid.

65. Sex... leaflet, The Terrence Higgins Trust, London, 1985.

66. Maria Ekstrand, quoted in Robin Hardy, "Risky Business: Confronting Unsafe Sex", Village Voice, New York, 26th June 1990.

67. Ed Jackson, quoted in ibid.

68. See Gerald Ilaria et al. "Detection of HIV-1 DNA sequences in pre-ejaculatory fluid" (letter), The Lancet 340:1469, 1992; Jeffrey Pudney et al. "Pre-ejaculatory fluid as potential vector for sexual transmission of HIV-1", The Lancet 340: 1470, 1992.

69. For example, see Andrew R Moss, "Risk factors for AIDS and HIV seropositivity in homosexual men", American Journal of Epidemiology 125(6): 1035-1047, 1987.

70. PC Fox et al. "Saliva inhibits HIV-1 infectivity", Journal of the American Dental Association 116: 635-637, 1988. See also PN Fultz, "Components of saliva inactivate human immunodeficiency virus", The Lancet ii: 1215, 1986.

71. Martin P Levine and Karolynn Siegel, "Unprotected Sex: Understanding Gay Men’s Participation" in The Social Context of AIDS (eds. J Huber and BE Schneider), pp. 47-71, Sage Publications, London, 1992.

72. Keith Alcorn, Briefing Paper, National AIDS Helpline, London, 1990.

73. Alan R Lifson et al. "HIV Seroconversion in Two Homosexual Men after Receptive Oral Intercourse with Ejaculation: Implications for Counseling Concerning Safe Sexual Practices", AJPH 80(12): 1509-1511, 1991.

74. W Chen et al. "Allergy, oral sex, and HIV" (letter), The Lancet 339(8793): 627-628, 1992.

75. Alison B Murray et al. "Coincident acquisition of Neisseria gonorrhoeae and HIV from fellatio" (letter), The Lancet 338:330, 1991.

76. Nicholas Mulcahy, "The Truth About Oral Sex", QW, pp. 37-39, New York, 29th November 1992.

77. W Rozenbaum et al. "HIV transmission by oral sex" (letter), The Lancet i:1395, 1988.

78. Ireneus PM Keet et al. "Orogenital sex and the transmission of HIV among homosexual men", AIDS 6: 223-226, 1992.

79. Alison Murray, St Bartholomew’s Hospital, London, quoted in "Doctors warn against oral sex", Capital Gay issue 514, London, 4th October 1991. Her comments relate to the publication of Alison B Murray et al. "Coincident acquisition of Neisseria gonorrhoeae and HIV from fellatio" (letter), The Lancet 338:330, 1991.

80. However, in Australia the term ‘safe sex’ is also used in preference to ‘safer sex’, but with the understanding that "the term does not and cannot only mean sexual practices which carry absolutely no risk whatever of HIV infection. This definition would define the term out of existence". See Adam Carr, op.cit.

81. For an extreme example, see the discussion of the San Francisco AIDS Foundation’s poster An Important Message For Gay & Bisexual Men..., discussed in Chapter 4.

82. This distinction is well discussed by Nicholas Mulcahy, op.cit.

83. Quoted in Nicholas Mulcahy, op.cit.

84. Michael Callen, op.cit.

85. The Safer Sex Condom Guide for Men and Women leaflet, Gay Men’s Health Crisis, New York, 1987.

86. Robin Hardy, op.cit.

87. Untitled 40-page leaflet for gay men in English and Spanish, Gay Men’s Health Crisis, New York, 1991.

88. Robin Hardy, op.cit.

89. Safer Sex For Gay Men leaflet, Terrence Higgins Trust, London, 1991.

90. Adam Carr, op.cit.

91. Alison B Murray et al. "Coincident acquisition of Neisseria gonorrhoeae and HIV from fellatio" (letter), The Lancet 338:330, 1991.

92. Ernest de Vroome et al. "Overestimating the Risk of a Low-risk Sexual Technique Increases or Decreases Behavioral Risk, Depending on Mediating Factors" and handout "Overestimating the risk of orogenital sex may increase unsafe anogenital sex", VIII International Conference on AIDS, Amsterdam, abstract PoD 5125, 1992.

183. Quoted in Simon Watney, "Re-Gaying Aids", Gay Times, London, March 1990.