Safer Sex

September 26, 2011

Sexual contact is the most common route of transmission of HIV in women. According to the Centers for Disease Control and Prevention, approximately 50%, or 19.2 million, of the 38.6 million adults living with HIV or AIDS worldwide are women. Furthermore, the majority of women who were reported with AIDS were infected through heterosexual exposure to HIV. Given the importance of sexual transmission in the HIV epidemic, many HIV prevention strategies have focused on identifying and promoting safer sex practices.

Safer sex barriers include male and female condoms and oral barriers such as dental dams. The Surgeon General of the United States and the Centers for Disease Control and Prevention recommend the consistent and proper use of male condoms for personal protection from infection. The clinical and public health importance of consistent condom use was demonstrated in findings from the European Study Group on Heterosexual Transmission of HIV. This study observed that among couples who were serodiscordant for HIV (one partner was HIV negative and the other partner was HIV positive), no seroconversions (becoming HIV positive) were observed among couples who used condoms consistently while among inconsistent condom users, the seroconversion rate was significantly higher, 4.8 per 100 person-years. Thus, consistent condom use can substantially reduce the risk of sexually transmitted HIV infection relative to never or half-time condom use. Although there is substantial evidence that condoms are effective in preventing HIV transmission, the degree of protection afforded by condoms against other sexually transmitted infections (STIs) has not yet been adequately documented. In vitro studies suggest that the latex condom provides excellent protection against a variety of Sexually transmitted infections if it does not break or slip off during use. However, condoms are not likely to be effective if they fail during intercourse. Thus, measures of the rates of breakage and slippage are important indicators of condom effectiveness. To reduce the risk of infection associated with vaginal and anal sex, researchers recommend consistent use of latex condoms in conjunction with water-based lubricants only, while fellatio should be performed with nonlubricated latex condoms.

The female condom, made of two flexible polyurethane rings and a loose-fitting polyurethane sheath, has also been approved for contraception and HIV prevention. Research studies have revealed that the female condom has demonstrated efficacy in preventing leakage of HIV in laboratory testing. Other laboratory studies have shown that the female condom serves as an effective barrier to organisms smaller than hepatitis B, the smallest virus known to cause an STI. Another clinical study incorporating women from the United States has demonstrated the female condom to be at least equivalent to the male condom in preventing gonorrhea, trichomoniasis, and chlamydia. Additionally, calculations within this study, based on correct and consistent use, estimate 97.1% reduction in the risk of HIV infection for each act of intercourse.

The most appropriate barriers that can be employed to reduce the risk of transmission of viruses during oral-vaginal sex and oral-anal sex are dental dams. These square sheaths of latex can be placed over the labia and genitalia, or over the anal area, to facilitate safer sex. Currently, Glyde Dams (Glyde USA Inc.) are the only latex dams cleared by the U.S. Food and Drug Administration for protection against STDs for oral-vaginal and oral-anal (rimming) sex. Yet, very little has been documented regarding the efficacy rates of this barrier method.

Precautions can be taken to greatly reduce the risk of contracting HIV and other Sexually transmitted infections; however, safer sex practices do not completely eradicate risk. For example, using a condom correctly and every time for vaginal, oral, and anal sex greatly reduces, but does not eliminate, the risk for transmission. The most reliable method that can be employed to avoid sexually contracting HIV is abstinence. While abstinence until establishing a monogamous relationship provides the most certain protection against HIV, it is not a pattern that represents the behavior of most young adults. As a result of this reality, consistent condom use and mastery of safer sex practices is greatly encouraged among individuals who are sexually active outside of monogamous relationships.

See Also: Acquired immunodeficiency syndrome, Birth control, Condoms, Hepatitis, Lubricants, Reproductive technologies, Sexually transmitted diseases

Suggested Reading

  • Mcllvenna, T. (1999). The complete guide to safer sex (2nd ed.). New York: Dembner Books.
  • Roth, N., & Fuller, L. (Eds.). (1998). Women and AIDS: Negotiating safer practices, care, and representation. New York: Harrington Park Press.
  • Wingood, G. M., & DiClemente, R. J. (2002). Women’s sexual and reproductive health. New York: Kluwer/Plenum.

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