Risks of Oral Sex

V1, N2, March 1991

A Case Study

Julio, a gay, 25-year-old man who engages in oral sex frequently, is frustrated at what he has been told by his antibody test counselor. The counselor has suggested that to reduce his risk of infection, Julio and his partner should use condoms duing oral sex.

Julio replies that he tried wearing a condom on one occasion but found it unnatural. He said he has eliminated unprotected anal intercourse, rimming and other behaviors in recent years, but he is unwilling to eliminate oral sex because he sees little evidence of infection from oral sex. Julio also said that because he has not been infected up to this point from oral sex, he believes he is not at risk.

Counseling Intervention

The counselor should begin by empathizing with Julio about not wanting to change a behavior that gives him a great deal of pleasure. It is understandable that Julio, who has already changed many of his sexual behaviors to make them safer, would believe he has meade sufficient changes and resist making further change.

The counselor should then express concern that Julio may be putting himself and others at risk by engaging in unprotected oral sex. To counter Julio's resistance that there is little evidence of HIV transmission by oral sex, the counselor can review recent reports of seroconversion through unprotected oral contact and state that these reports present credible and growing evidence that oral sex is a risk to be considered seriously.

Julio says that the does not believe he is at risk for infection because he has not become infected so far. The counselor must state clearly that Julio is at risk and that he may not have been infected earlier for a variety of reasons. Julio may have avoided infection simply because of luck, which may leave him at any time. The counselor can state that in the 1980s, many men who escaped infection for several years without changing their unsafe sexual practices later became infected from these same behaviors.

The counselor should also attempt to work with Julio in discussing ways to make safer sexual practices more enjoyable. The counselor can develop strategies with Julio about making oral sex with a condom more erotic, and can reduce barriers to condom use during oral sex.

If Julio objects to these attempts, the counselor must state that at the very least, Julio and his partners must be conscious of oral hygeine, and the possibility of cuts or abrasions in the mouth or on the penis that may be present even if Julio doesn't detect them. Julio should see a dentist regularly to have his gums and mouth examined, and he should be tested every six months for sexually transmitted diseases (STD).

Joining a support group may be one of the most helpful actions for Julio. The counselor should emphasize the value of a support group to Julio, and state that in such a group he can be with others who have shared some of his concerns and beliefs. The counselor should provide Julio with support group referrals.

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