BDSM, SAFER SEX, HIV AND HEPATITIS C
By Mistress Marry
Human Immuno-Deficiency Virus is the virus that causes AIDS (Acquired Immune Deficiency Syndrome).
In 2003, the AIDS epidemic claimed an estimated 3 million lives world wide and an estimated 5 million people acquired the human immunodeficiency virus (HIV), bringing to 40 million the estimated number of people globally living with the virus. HIV is present in vaginal fluids, semen, blood and breast milk. HIV is also present in urine, sweat, tears and saliva but not in quantities sufficient for transmission.
Hepatitis C is also caused by a virus. The hepatitis C virus (HCV) can cause damage to the liver. HCV testing is recommended for anyone who is HIV-positive. About 33% of all people with HIV also have HCV. An estimated 3.9 million (1.8%) Americans have been infected with HCV, of whom 2.7 million are chronically infected. Hepatitis is not considered a sexually transmitted disease (STD), because it is primarily transmitted through blood-to-blood contact.
With these statistics, which are usually under reported, it’s very possible within the BDSM community that you may encounter the opportunity to play/scene with someone who is HIV positive or Hepatitis C positive. They may or may not be aware of their status. It is up to you, while in basic negotiations, to determine what you and your play partner’s risk factors for exposure to either one of these viruses have been and to take the appropriate precautions. A good rule of thumb when you don’t know someone’s status is to use universal precautions.
"Universal precautions," as defined by the Centers for Disease Control (CDC), are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and other blood borne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all people are considered potentially infectious for HIV, HBV, HCV and other blood borne pathogens. To put it in more simple terms, if it’s a bodily fluid and its not yours, don’t touch it with your bare hands or genitals!
It is amazing to me when I ask, just how many people still do not use a barrier to protect themselves from HIV or any other STD. For those of us in HIV Prevention it is frustrating indeed to know that people still do not understand that it is imperative to include safer sex discussions during your negotiations with a potential sex partner or BDSM partner. Basic safer sex discussions can be handled and discussed in the same manner that you use when negotiating a scene. For play partners where sexual contact or genital manipulation will be part of the scene, you must ask yourself and your partner a few questions. When was the last time you had an HIV test? Have you had any high-risk behavior since your last HIV test? Have you ever been tested for HCV? Have you ever had a blood transfusion, worked in the health care field or been an IV drug user? Have you ever gotten a tattoo or a piercing? Have you ever had unprotected sex with someone? Chances are that one or both of you are going to answer yes to several of these questions.
At this point, depending on answers given, you can do one of two things: you can shelve the sexual contact and any blood sports until each of you has had testing for HIV and Hep C or you can negotiate how far each of you is willing to go using barrier methods to avoid transmission of any STD. Please remember that a negative HIV test is only good on the day that the sample was drawn. One must have two HIV tests at least three months apart, with no high-risk behavior in between to really know their status. In 99% of the general population, a test will be positive within three months of exposure to the virus.
If you are already in or entering into a mostly monogamous relationship with someone, you may decide to use the concept of “fluid bonding”. Fluid bonding means that you have both consciously decided that you will only have unprotected sexual contact with each other after all tests have come back negative. If either party chooses to have sexual contact with someone outside of the primary relationship, barriers will be used 100% of the time. This works well within the polyamorous community where more than one sexual partner is the norm.
The HIV virus is a very fragile virus when it is outside of the host (the body) and dies within approximately two minutes. HCV on the other hand has been know to live outside of the body for as long as two weeks.
In order for HIV to pass from one body to the next there must be a route of transmission. A route of transmission is usually through a break or tear in your body’s best defense: the skin. The skin that is at highest risk for microscopic tears are the mucus membranes. These include the vagina, the anus, the mouth and the nose. Sexual intercourse via the vagina or anus without a barrier presents a very high risk for infection with the anus being the most fragile and risky for transmission. The vagina, and the mouth have naturally occurring lubricants which help to protect the skin from tears during normal or vigorous use. However, one should always pay close attention to the lubrication factor when introducing objects into the vagina or anus.
A good rule of thumb when playing with the anus is to use a lot more lubrication than you think you will ever need. Reapplication is essential to protect these tender tissues especially when using butt plugs, strap-ons or with fisting activities. A barrier (condom or glove) is crucial to avoid unnecessary transmission of a variety of germs that are naturally within the anus. Be very careful to use a butt plug or dildo that has a flange at the base and if possible, use a large condom and wrap the condom around the base to avoid either dildo or condom getting “lost” inside the anus.
The same is true with vigorous insertion of toys or fisting in the vagina. Always be sure that fingernails are short and smooth or that the hand is covered with a latex glove. Condoms and generous amounts of lube should always be used with insertion toys being mindful of any possible sensitivity to latex which is more common that you might think. Another good rule of thumb is to have toys that are owned and used by one recipient only.
Lubricants should be water or silicone based only. Do not use oil based lubes such as butter, Crisco, Vaseline, or baby oil with condoms. If you want to see for yourself what happens, blow up a condom and smear some baby oil on it. Within one minute, your condom will break. Do not use lambskin condoms. These condoms do NOT protect against the HIV virus. If you or your partner has a sensitivity to latex, there is a good alternative called AVANTI.
The Avanti condom has several advantages over the typical latex condom. They're larger, and a bit loose, which increases sensation. The polyurethane that they are made of transmits heat much better than latex, which further enhances the "it doesn't feel like I'm wearing a condom" feeling. They don't taste like anything, which is great for oral sex. As a woman with a latex allergy, I can attest to the fact that they feel very different and they are a nice option to latex. Additionally, there is the female condom which can be used like a regular condom and is much less restrictive around the penis. One can also purchase non-latex gloves through any medical supply company.
Oral sex without a barrier is considered a medium to low risk activity for transmission. There have been very few documented cases of oral transmission of HIV, however a few things need to be considered when choosing to go down on your partner. Oral sex should be avoided when you have open sores in or around your mouth or if you have recently been to the dentist. Routine teeth cleaning will result in microscopic tears in the mouth. More invasive procedures will obviously cause more wounds in the mouth. Oral sex w/o a barrier within 48 hours of a dental visit can be risky. If you are performing oral sex on a man you should be aware that the highest concentration of HIV is contained in the “pre-cum”. Oral sex with a female who is menstruating is risky and a barrier (dental dam) should be used. A dental dam is usually a square piece of very thin latex that is laid across the entire vagina to create a barrier. You can make your own dental dam by taking an unrolled condom and cutting the tip. Once the tip is removed, insert the scissor and cut the condom so the circle is broken. Unroll the condom and you have a “dental dam”. You can also purchase dental damns at most sex stores and medical supply stores. The ones that are truly “dental damns” i.e. the ones your dentist uses are made of thicker latex and not as nice. You may want to try to find the ones that are now being produced specifically as a barrier for oral sex.
Blood sports: Sometimes we draw blood intentionally and sometimes its unintentional. In either case, you need to be prepared for this event. By having those negotiations and your HIV testing done, your risk factors can be reduced. That is certainly the most optimum situation but hardly likely. Something as benign as using vampire gloves on a warmed bottom can cause a break in the skin and increase the risk of transmission of HIV or Hep C. I cannot stress the point enough that you must clean your equipment after each use! Things like vampire gloves, knives, canes or other instruments with pointy parts to them are perfect for transmission of the Hepatitis C virus. Additionally, if you enjoy shaving your partner’s genitals please always use a fresh blade that is not shared and if there are tiny cuts to the skin, which is likely, be mindful of a possible exposure.
Watersports are generally safe because there is no risk of transmission with urine unless the person has an unusual health condition which could cause blood to be in the urine.
Sources:
http://www.unaids.org/en/resources/epidemiology.asp
http://www.thebody.com/cdc/
http://www.thebody.com/cdc/hepcfact.html
http://www.cdc.gov/ncidod/hip/BLOOD/UNIVERSA.HTM
http://www.blowfish.com/catalog/guides/Avanti.html