ANSWERS TO QUESTIONS FROM SCHOOL STUDENTS IN INDIA

SEXUALITY AND TRANSMISSION THROUGH SEX

by Rajan Gupta

  • What is sexual intercourse?

  • The common definition of sexual intercourse if the act by which the penis of a male enters the vagina of a female. Relevant to sexually transmitted diseases, sexual intercourse is used in its most general sense to also include the penetration of the anus/rectum of a man or a woman by the penis of another man.

  • What is oral sex and why do some people enjoy it?

  • Oral sex is the act in which the mouth of a person comes in contact with the genitals of another person. In other words one person uses his or her mouth to play with the genitals of their partner so as to provide sexual excitement. Many people enjoy it because they find it very exciting and it gives them an orgasm.

  • Why is oral sex risky?

  • During oral sex the semen of a man, or the vaginal secretions of a women, enter the mouth of the partner. Hiding in these fluids is HIV which can enter into the blood system through the mucus membranes of the mouth. The risk of transmission from oral sex is small -- much smaller than either anal or vaginal sex. However, most people who have oral sex also have anal or vaginal sex (at the same time or on other occasions) which increases the risk a lot. The risk from only oral sex increases if there are sores or cuts in the mouth or there is bleeding in the gums, or gum disease in general. Putting on a condom even when having just oral sex, or by not putting the penis into the mouth (avoiding contact with all seminal fluids) reduces the risk by a large amount.

  • What is anal sex and why do some people enjoy it?

  • Anal sex is when the penis of a man enters (penetrates) the anus/rectum of another man or a woman. Many people enjoy it because they find it very exciting and it gives them an orgasm. Men who have sex with other men are called homosexual.

  • What is homosexuality?

  • Homosexuality is a term used for describing sexual attraction to a person of the same sex. In India the word homosexual is used for a man who is either attracted sexually only to other men or has anal sex with other men. Men who are only attracted to other men and openly admit their sexual orientation are called "gay". In India homosexuality is also referred to by the words "musti", "gandoo", "londae baaz".

  • What is bisexuality?

  • Bisexuality is a term used for describing sexual attraction to persons of both sexes. Both men and women can be bisexual.

  • What is lesbianism

  • Lesbianism is sexual attraction between women. Women who are attracted sexually only to other women are called lesbians.

  • What is wrong with homosexuality or lesbianism?

  • There is nothing wrong with homosexuality or lesbianism. Many people are born with a strong sexual attraction to persons of the same sex as them. We must consider this diversity of human behavior and sexual orientation very similar to the fact that some people are left handed whereas the majority are right handed. Just as people who are left handed do not become left handed because someone tells them to do so, but are born with a natural dexterity that is left handed, similarly homosexuals are born with an attraction to same sex people. These people are perfectly normal, they only have a sexual attractions that is different from the majority. In almost all societies that have been studied, roughly one in twenty persons (5%) are homosexual. Unfortunately, because of their sexual orientation, homosexuals are often made fun of or punished or beaten. People need to become aware and sensitized to not inflict this pain on homosexuals who are simply living their lives according to their natural feelings and emotions.

  • Can homosexuals (gays) get AIDS?

  • Yes homosexuals can get HIV/AIDS. Men and women who enjoy anal sex (or are subjected to anal sex) are at highest risk for HIV as the walls of the anus and rectum are thin and there often is bleeding during anal sex. It is also suspected that because the walls are made up of different cells and thinner the virus can penetrate them more easily and get to the blood (host) cells.

  • Can lesbians get AIDS?

  • Yes lesbians can get HIV/AIDS. Lesbians are usually at very low risk for HIV unless they share a dildo to stimulate each other.

  • After risky sex, how long does it take to get infected?

  • If, after risky sex with an HIV infected person, the virus in the semen (or vaginal fluids) enters the blood stream through the mucus membrane of the partner and starts reproducing, that signals the start of the infection. Infection begins if the virus survives this process, which usually takes a couple of hours. Thereafter, the infection is life long as we do not yet have a cure for it, and the human immune system is proving incapable of completely destroying it.

    Sometimes, in hospitals, when, by mistake, doctors or nurses get pricked or poked by contaminated needles or come in contact with contaminated blood say during surgery, they take a course of the anti-retroviral drugs. These drugs, if taken early enough (within hours of a couple of days of the incident), can succeed in destroying all the virus before it has had a chance to replicate significantly, develop many mutations, and invade a number of different host cells in which it can stay dormant for years. Such prophylaxis treatment is not possible after risky sex as these drugs are very toxic and are not to be given unless the risk for infection is very high which, unfortunately, cannot be established in the case of risky sex.

  • Can we have HIV without having sex ?

  • Yes, you can get HIV/AIDS without having sex if the blood of an infected person comes in contact with your blood (enters your body through a needle prick, cut, laceration, or wound).

  • Can we get AIDS without sex?

  • YES. You can still get HIV/AIDS even if you do not have sex with anyone. This can happen if the blood of an infected person enters your body in any one of the following ways. (i) Contaminated needles: a needle that has been used on a HIV/AIDS person is used again on you without proper sterilization; (ii) you, by accident, prick yourself with a needle or a sharp object that has previously been in contact with an infected person's blood. This is a risk especially for nurses and doctors. (iii) Sharing Needles: this is a risk seen mainly in intravenous drug users. (iv) Tattoos: the needle used to put ink under your skin, thus coming in contact with your blood, was previously used on an infected person and not sterilized. (v) Mother to child: when a women gives birth, there is a lot of bleeding, and the child comes in contact with the mother's blood. (vi) Breast feeding: an infected mother can give it to her baby through breast milk as the virus is present in breast milk. (vii) transfusion of blood during surgery, child-birth, after an accident, and to malaria, thallesemia, etc., patients. (viii) use of unsterilized instruments by doctors, surgeons, and dentists.

  • If you refrain from having sex (abstinence), can you still get AIDS?

  • YES. You can still get HIV/AIDS even if you do not have sex with anyone. This can happen if the blood of an infected person enters your body in any one of the following ways. (i) Contaminated needles: A needle that has been used on a HIV/AIDS person is used again on you without proper sterilization; (ii) you, by accident, prick yourself with a needle or a sharp object that has previously been in contact with an infected person's blood. This is a risk especially for nurses and doctors. (iii) Sharing Needles: this is a risk seen mainly in intravenous drug users. (iv) Tattoos: A needle is used to put ink under your skin, thus coming in contact with your blood. (v) Mother to child: When a women gives birth, there is a lot of bleeding, and the child is in contact with this blood. (vi) Breast feeding: an infected mother can give it to her baby through breast milk as the virus is present in breast milk.

  • If a girl has sex with an HIV infected person with the use of condom, can the girl get affected?

  • Latex Condoms prevent the exchange of semen from man to woman (or man in case of homosexual sex) or vaginal fluids from the woman to the man (or woman). The virus is present in the semen if the man is HIV+ and in the vaginal fluids in the woman is HIV+. Risk arises, because sometimes the condom can come off during sex or can tear or is not put on the penis early enough (or inserted into the vagina if a female condom is being used). Any of these failures can lead to exchange of bodily fluids during foreplay and during sex. Thus, while condoms are our only means of making sex safer, they are NOT 100% safe. If couples (married or unmarried) are going to use condoms, it is very important they discuss this matter carefully before getting into an intimate situation and practice using the condom so that they feel comfortable with it.

  • Is condom 100 percent safe against AIDS?

  • Latex Condoms prevent the exchange of semen or vaginal fluids in which the virus is present. However, sometimes the condom can come off during sex or can tear or are not put early enough and there is exchange of bodily fluids during foreplay. Thus, while condoms are our only means of making sex safer, they are NOT 100% safe.

  • Will using two condoms help protect you from AIDS more than using one condom?

  • The only way in which two condoms work better than one is to reduce the risk of virus going through the latex. On the other hand, unless a person is very careful and the condoms are the right kind, the chances of both of them coming off during sex or getting nicked while putting on (and then tearing during sex) are high. Our best advise is to use a good quality latex condom, and learn how to put it on correctly and at the very beginning of sexual activity -- even before foreplay. Also, one should not use petroleum based lubricants on the condoms as they weaken latex condoms.

  • Does masturbation give AIDS?

  • Masturbation does not give HIV/AIDS. Here it is worthwhile for explain what masturbation is. It is the process by which a boy (or a girl) stimulate themselves sexually and have an orgasm. Since only one person is involved, there is no transmission of HIV. Sometimes two people can carry out the same acts as in masturbation and excite each other. This is called mutual masturbation. This behavior does carry a small risk of HIV infection if bodily fluids of one person (who is infected with HIV) are rubbed against or come in contact with the genitals or mouth of their sexual partner.

  • Will having sex with a HIV infected person always give you AIDS?

  • No. Having sex with an HIV infected person does not always give HIV/AIDS. The risk of transmission depends on how much bleeding takes place during sex, how much virus is present in the infected person (it is highest within weeks of the start of the infection and during the AIDS stage), if there are cuts, sores, or lesions on the genitals (these are common if either person has one of the other sexually transmitted diseases like syphilis, gonorrhea, herpes simplex, human papilloma virus), and the immune response (in particular the CTL response) of the uninfected person. There is no way to tell before hand if someone will get infected the first time or after five times. What we do know is that many people got infected after just having sex ONLY ONCE with an infected person.

  • Girls who were abused at age 6/7 and are now 17/18, can they be infected?

  • It is very very unlikely that a girl who was sexually abused at age 6/7 would be HIV+ and not know it or show any symptoms of characteristic opportunistic diseases after 11 years. Almost all such people who are infected would show a pattern of physical problems (opportunistic diseases) that would indicate HIV infection.

    Even though the risk of HIV is essentially zero if a person is showing no symptoms after 11 years, sexual abuse is an extremely serious problem that leaves acute emotional and mental trauma and scars. Anyone who has had such an unfortunate experience should talk about it with a parent or doctor they trust and love, and seek medical help even if a long time has passed since the last occurrence of abuse.

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    Rajan Gupta