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Table of Contents
The term 'safer sex' usually refers specifically to practices designed to minimize the risk of transmission of diseases during sexual contact, and particularly the transmission of HIV. This source sheet will eventually provide background information on protecting against a wide range of diseases when engaging in common BDSM activities, including generally known as sexually transmitted diseases (STDs). So far only HIV/Aids, which is arguably the most serious common STD and is still incurable, is covered in detail. Remember, though, that safer sex practice aimed at preventing HIV infection will often be effective against other infections too, especially syphilis, gonorrhea, and to a limited extent hepatitis.
Transmissible diseases (those that can be transmitted from one person to another) are usually the result of infections, where an external organism has taken up residence in someone's body to live and reproduce there. Some infections are caused by fairly developed creatures visible to the naked eye: examples are crabs (pubic lice), worms in the gut and so on. Many are caused by simpler, much smaller organisms visible only under a microscope. These include yeasts and fungi, bacteria and viruses. Bacteria are single-celled organisms of which there are many millions of different species. Some bacteria are benign and even beneficial: we all have bacteria in our stomachs that aid in digestion. Others cause diseases like syphilis, gonorrhea and a host of minor infections such as urethritis and sore throats. Bacteria are usually easily and effectively treated with antibiotics provided the infection is caught early enough. Viruses are very simple forms of life, little more than a few molecules of chemical with the ability to reproduce, and are even more diverse than bacteria. They are responsible for colds and flu as well as serious STDs like Aids and the various forms of hepatitis. Drug treatments for viral infection are still complex, expensive and of limited effectiveness, although great progress has been made in recent years. Most infectious organisms are highly adapted to survive only in certain conditions and can only be transmitted through certain kinds of contact in certain conditions. Safer sex involves preventing those conditions from being satisfied. HIV, for example, cannot survive for long outside certain kinds of bodily fluids: it can't live on the skin surface, for example. If you make sure that the contact between your body and someone else's doesn't involve contact between bodily fluids, then you practically eliminate the possibility of transmitting HIV. Safer sex is about reducing risk: remember that accidents and flukes can happen. Obviously the only way to totally eliminate risk of transmitting diseases sexually is to become celibate, but since for most people this would seriously undermine their enjoyment of life, a rational approach to risk reduction has to be adopted. It is also statistically undeniable that if you reduce the number of partners then in theory you reduce the risk of encountering an infected person, but you will reduce the overall risk much more by taking precautions with all your partners, and the difference in risk between having safer sex with one partner and having safer sex with a thousand is minimal. There is no rational basis for monogamy -- much better to play with who you want, so long as you play safely. It should also be noted that, whereas most 'vanilla' sexual activities, such as fucking and oral sex, involve intimate body contact and are therefore more likely to transmit infections unless carried out with certain precautions, there are many BDSM activities that carry only a very minimal risk of STD transmission. Of course, when activities such as fucking and sucking are incorporated into an SM scene the partners should take exactly the same precautions as their vanilla counterparts.
Acquired Immune Deficiency Syndrome (Aids) is a disease of the immune system, the body's natural defense against infections. With the immune system undermined, the body is unable to fight off certain infections, known as 'opportunistic infections', which normally would cause no problem at all. Many people with Aids eventually die when their bodies are worn down by constant attacks of infections. It is now widely accepted that the major, if not the sole, cause of Aids is the Human Immunodeficiency Virus (HIV). HIV enters certain cells known as CD4 cells (previously called T-helper cells) that play a role in the immune system, and turns them into factories for reproducing itself, destroying them in the process. The opportunistic infections can themselves be treated as they appear, and preventive measures taken against the most common ones, but with the body's own defenses undermined, it becomes progressively more difficult to fight the infections. A total cure for Aids would mean being able to rid the body entirely of HIV. In recent years the development of treatments using anti-viral drugs such as saquinovir and AZT in various combinations has gone some way towards accomplishing this aim, and the prognosis for Aids patients is not as bleak as it was. It should still, however, be treated as an eventually terminal disease; the treatments available are inconvenient, expensive, of unproved effectiveness and can have unpleasant side-effects. Prevention of transmission is still by far the best course. Reliable blood tests are now available that can identify whether someone is infected with HIV; people who test positive on these are known as HIV-positive (HIV+), and those that test negative as HIV-negative (HIV-). The tests look for antibodies that the body has formed against the virus, rather than the virus itself (the virus itself can now be detected, but the process is expensive and usually used only on HIV+ people to gauge the stage of development of the infection). Being HIV+ is not the same as having Aids: many HIV+ people stay healthy for many years, though it seems likely that eventually the effects of the virus on the immune system will being to show. Anyone who is sexually active and runs the risk of coming into contact with the virus should practice safer sex both to prevent being infected themselves and to prevent possible transmission of the virus to other people. If you have tested HIV-, you should still act on the assumption that you could transmit the virus to others, even if you haven't had any form of sexual contact since the test was taken. Though it is now very, very rare, test results can be wrong, and it can take three months or more after infection for the presence of HIV to show up in the test. If you are already HIV+ it is still advisable to avoid being repeatedly infected, since there is still some evidence that repeated infection can be a factor in going on to develop Aids. Fortunately, HIV is not a very hardy organism and has very limited routes of infection. Minimizing the risk of transmission is therefore fairly easy.
Blood and Blood Products HIV can be passed through blood or blood products taken from an infected person. When HIV first appeared in the United States, many thousands of people, including a large number of hemophiliacs, were infected through contaminated transfusions of blood and plasma. Today effective screening has almost entirely eliminated this risk. Another group that has been susceptible to the fast spread of Aids through blood transmission are intravenous recreational drug users, such as those that inject heroin and speed, who would often share their needles and syringes. A local policy of zero tolerance of illegal drug users in Edinburgh in the early 1980s, which included limiting easy access to injection equipment, led to the current situation where drug users are by far the most widely infected group in that city. If you inject drugs, make every effort to keep your own set of works and use a fresh sterile needle each time. However, note that although you should take care to avoid it, a one-off needle stick injury -- accidentally jabbing yourself with a needle that has been in someone else -- is unlikely to transmit the virus. Sexual Transmission Sexual activity is the other primary method of transmission for HIV. The virus is found in semen as well as blood (and in menstrual blood too), and if infected semen finds a route into someone else's bloodstream, as may most commonly happen through cuts and grazes in the vagina or asshole during intercourse, then HIV can be transmitted. All safer sex guidelines follow the principle of reducing or eliminating the risk of such fluid transfers occurring. If you find any activity uncovered here, apply this general principle and use your common sense.
A condom (Durex, French letter, rubber, rubber johnny, sheath) is a thin membrane that sheaths the erect penis and prevents the passage of semen and other fluids between sexual partners. An alternative, the female condom (Femidom), lines the inside of the vagina. They are mainly intended as a contraceptive device but are an essential aid in safe sex too. Male condoms are made of latex, 'lambskin' or polystyrene. For safer sex, a lambskin condom is absolutely useless. It will not prevent the transmission of HIV. However, either a latex condom, or a polystyrene condom (sold under the 'Avanti' label) will prevent transmission. Polystyrene condoms became available only recently, but studies have shown that they, as well as the traditional latex condom, are effective in combating HIV. Condoms come in a variety of thicknesses and the thicker ones are safer because they are less likely to break. Bear this in mind in particular if you intend to use the condom for anal intercourse, which will put more pressure on it than vaginal intercourse. For safer sex, only use condoms that have some recognized local standard for use as a contraceptive: some novelty condoms, especially those with oddly shaped heads, are only intended for fun, though a number of others, particularly some of the colored and flavored varieties, are suitable for safer sex. Unfortunately most countries do not have standards that guarantee condoms for anal intercourse, which is why even the extra strong ones are often marked 'for vaginal use only'. You will have to use your judgment here and seek the advice of help lines and so on local brands. Some condoms include in their lubrication a contraceptive substance called Nonoxynol-9, which has been shown to kill HIV -- but only in laboratory conditions. So it might be an additional precaution, and you might want to use it (if you are not allergic to it), but don't count on it to save your life. Always put on a condom before you engage in any sort of potentially risky activity -- not only ejaculated semen but precum too can contain HIV (and also sperm, which has caught out many an unprotected heterosexual couple involved in coitus interruptus). To put a condom on, first pinch the end (if it has a 'reservoir tip') to prevent air from being trapped inside, which could cause it to fail. Place it on the head of the erect penis, and unroll it so that the penis is completely covered. Do not 'double up' condoms, as this actually increases the risk that the condom will break, due to friction between the two barriers of latex. If you lose your erection and the condom falls off, discard it and use another one. Once off they are impossible to get back on. When you remove the condom, do so while the penis is still fully erect to prevent semen from leaking. Discard it -- don't attempt to reuse it. Knot the end, wrap it in tissue paper and put it in the dustbin (trashcan). Don't flush it down the lavatory pan -- they have an awkward habit of floating and can block plumbing. The female condom, sometimes known by the name of the original brand, Femidom, is a recent invention, preferred by some because of its sensation and also because women do not have to rely on men for contraception and safer sex. It's much bigger than the male condom and made of thin but very tough polyurethane in the shape of a slightly tapered cylinder. There is a ring of tougher plastic at each end; the larger end is open but the smaller end is closed. The condom is inserted by gripping the smaller end, pushing the ring together with the fingers and, using lubricant, sliding it into the vagina as far as it will go. When the fingers are removed, the ring should spring back into shape, and then fingers are placed inside the condom to work it further up until the ring at the other end holds it in place at the vaginal opening. The condom is designed to move about a lot during sex but if properly inserted it should not come loose. Remove it simply by gripping the ring on the larger end and pulling gently: if there is come inside, then remove carefully, keeping the ring tightly squeezed to prevent leakage. As with male condoms, knot it, wrap it up and throw it away rather than flushing it. Again, each condom is designed for one use only: do not attempt to reuse. Also note that the female condom is designed only for use in the vagina -- no equivalent for the rectum is available! Lubricants that contain oils, whether animal vegetable or mineral, actually destroy the molecular structure of latex and plastic. They weaken it, and greatly increase the odds of condom failure. Therefore you should always use a water based lubricant. Lubricants to use include: K-Y, Wet, Astroglide, or other lubricants specifically designed for sexual use. If in doubt, ask your pharmacist or leather shop. Either one would be able to recommend a safe product, and sell it as well. You may consider lubricants with added nonoxynol-9 -- see under Male Condoms above. Lubricants not to use include: Crisco, hand or body lotion, butter, baby oil, massage oils, or anything else containing oil.
Anal intercourse is by far the most risky sexual behavior, followed closely by vaginal intercourse, since both are likely to cause small cuts inside the body that infected semen can come into contact with. It doesn't matter whether you pull out before ejaculation. During sex, even trace amounts of precum, which might not be detectable, can leak into the body orifices. And the risk is not borne solely by the receptive partner -- HIV can enter the urethra from the rectum as well, infecting the insertive partner, and although the environment of the vagina is more hostile, there is a definite risk that this can happen during vaginal intercourse too. If you fuck, always use a condom .
To date, fellatio (cocksucking) has not been shown to transfer HIV. There has never been a single indisputable case of HIV traced to it. Nevertheless, it is believed to be theoretically possible, especially if semen is taken into the mouth or ingested. Therefore, oral sex should be considered 'possibly risky' but probably safe. You and your partner must decide for yourselves whether you are willing to accept that risk. If you do suck, you should certainly be aware of oral hygiene: the risk will be increased by bleeding gums (gingivitis), mouth ulcers and other conditions that expose the bloodstream. You might consider wearing thin, flavored condoms. Cunnilingus (cunt licking) carries a relatively lower risk, with the possible exception of menstrual blood being infected and coming into contact with cuts or ulcers in the mouth. HIV has been found in vaginal secretions and saliva but there is no hard evidence of its having been transmitted this way. If you really want to be sure, use a dental dam, a latex barrier available from pharmacies and STD clinics. Alternatives can also be improvised by cutting up surgical examination gloves or using cling film. This will also protect you against other STDs that certainly can be transmitted via this route.
Many SM activities carry very little risk of infection with HIV. Some, however, deserve special consideration. Scat (playing with shit) carries little risk, unless there is blood in the shit from a strained bowel movement or some other cause. Of far more concern is hepatitis, especially B, which can easily be transmitted this way, as can other bacterial infections and parasites. While HIV has been found in saliva, there is not evidence of it being transmitted through kissing, so there is no special reason to regard playing with spit (gob) as risky. Piss is sterile when fresh and healthy -- the only risk is from blood traces if there has been infection or trauma in the urinary tract. Douche only with clear, clean fresh water. Never use detergents or other additives -- they are likely to damage or irritate the membranes of the rectum, facilitating the passage of HIV. Never share douching equipment such as hoses or douch bags. Disinfect them between each use. Also keep in mind that your intestines are home to millions of bacteria which are necessary for normal digestion and other bodily processes. For this and other reasons, douching too often can cause digestive problems including constipation and enema dependency. Eventually, it can even cause damage to the intestinal wall, which can increase the odds of HIV transmission. The only risk of HIV transmission in surface play (nipple and genitorture, abrasion, whipping/flogging and CP) is the transfer of semen or blood into an open wound, or the transfer of blood from that wound to the partner. If your play is heavy enough to cause bleeding (even the subtle bleeding that might not be visible), do not come over the area you have worked, and do not use your mouth on that area. Remember that the skin of certain areas like the nipples is easy to tear or abrade, so be very careful in these areas. If the bleeding was caused by a toy, for example a flogger or whip, avoid letting that toy come into contact with abrasions or cuts on anyone else, including yourself, and do not use it on another person until it has been thoroughly disinfected. When Fisting HIV can be passed through small cuts or abrasions within the rectum, and on the fister's hands, especially the cuticles which are sensitive, easily torn and hard to disinfect. The odds of this happening are not great, but they are real. Therefore, for utmost safety, wear latex gloves. Disposable gloves are available at the drug store, and elbow-length gloves designed for reuse are available at some sex shops and leather shops. I have also seen a few people use calving gloves for fisting. Any of these is acceptable. You must never insert a glove (or an ungloved hand) which has been taken from one ass into another ass. HIV could be transferred from one bottom to another. If you must move from one ass to another, switch to a new, clean glove first. Piercing Tattooing and Shaving For both permanent and play piercing and tattooing, the same rules apply. All these practices should be carried out under the most hygienic conditions, using equipment that is sterile and disposable and is discarded after use on one person, or which has been thoroughly sterilized in an autoclave. Until the wound has healed completely (which can take from a few weeks to a few months), it cannot be exposed to another's semen or blood. Shaving without injury is next to impossible. The abrasions are usually very small, even microscopic, but they are there and they can provide routes for HIV transmission, so be careful what you do on the area shaved, as for surface play. Use disposable blades or reserve a blade for a single person, and allow a good few days for the area to heal completely before it is exposed to semen or blood. Improper use of toys such as dildos, butt plugs, specula, whips and floggers will transmit the HIV virus. These items sometimes cause bleeding, and when this occurs they must be treated as potentially HIV infected. The safest way to use toys is never to share your toys with anyone else, and especially never to borrow someone else's toys. Using a condom to cover someone else's dildo or butt plug makes shared use far safer. If you must share toys, you are only as safe as your sanitation procedures, as explained in Killing HIV below.
Heat, alcohol and bleach kill HIV, but getting them to the HIV in enough quantity can be difficult. Leather is particularly difficult to disinfect because of its porous nature; however, effective techniques do exist. Hard rubber and metals are much easier because their hard, shiny surfaces provide the virus nowhere to hide. Boiling will kill HIV, but it takes quite awhile to be completely effective. I have heard times as low as 15 minutes are safe. However, to be safe, boil them for 30 minutes or so if you possibly can. Alcohol (at least 70%) kills HIV on contact. It's making contact that can be the hard part. Porous, absorbent materials such as leather will not soak up enough alcohol to be completely effective. Also, alcohol will damage your leather, making it brittle. Rubber will also become brittle over time when soaked in alcohol. Bleach (0.1% solution, approximately 1 cup bleach to 10 cups water) works the same way as alcohol. Soak for at least 10 minutes and rinse well, including the insides if applicable. A chlorine soak can rust ferrous metals. Chlorine also kills Hepatitis-B. If you soak in alcohol or bleach, soak at least 15 minutes. Materials which are porous, such as leather, require special cleaning techniques to eradicate any HIV completely.
The experts we contacted while researching this subject, including doctors and the Center for Disease Control, agree that no dangerous amount of HIV or hepatitis virus can survive on the surface of leather exposed to air for a day. The purpose of the initial cleaning is to get the viral particles out of the cracks and onto the surface so air can reach them. No amount of cleaning is sufficient if you immediately seal any remaining contaminants in place under a layer of oily leather conditioner. Obviously, this isn't something you'd want to go through (or put prized whips through) every time you play, and it shouldn't be necessary unless you regularly draw copious amounts of blood (or colorless lymph). Most of the time it's sufficient to rinse the implement with peroxide and water, then hang it up. If you don't come close to breaking the skin, just hang it up before using it again.
This article on HIV and SM has been adapted and expanded by Dirk from the fact sheet on Slakker's ABC of BDSM, which had been edited by Slakker from an original by David Stein. Some of the information was taken from a manual published by PWA Health Alliance, Florida. One excellent source of general information about HIV and Aids on the net is Edward King's Aids page, with lots of links. |
