Tuesday, November 6, 2007

How risky is...?

So this little chart, from a presentation on sero-adaptation you can find here, shows the relative risks of various unprotected sexual acts. I am including a version, below, done by the wonderful Trevor Hoppe who added translations in "gay speak."

What does this chart mean? Well, giving or receiving head is rather low risk, and getting fucked without a condom? Rather high risk. Topping someone without a condom? Significantly lower risk than not using a condom while bottoming. This puts it all together so you can look at relative risk comparing various activities.


  1. Ranking risk of one sexual practice is another harm reduction myth. We don't know before and during sex what might happen next in a moment when the heart is beating faster and the mind is numbed. Generally during sex people don't do one thing and stop. So risk assessment of one sexual practice can be deceptive especially selfdeceptive. The next moment after one sexual practice can be something different and unexpected. The unexpected, spontaneity is part of the nature of sexuality that isn't taken into account in ranking risk of one sexual practice.

  2. I think the myth here is that men can't make rational decisions about sex and sexual behaviors - before or during sex. Many, many gay men since the beginning of the AIDS epidemic have chosen one activity over another, or chosen to avoid one altogether, as a means of harm reduction. The view you espouse likens adults to infants - and sorry, I don't buy it.

  3. You mean like life is rational?... I mean math and science are rational but they aren't a big part of the life of most people because it's hard to do math and science during sex.

    _ _ _ _ _ _ _ _ _ _ _ _ _ _
    > likens adults to infants

    _ _ _ _ _ _ _ _ _ _ _ _ _ _
    Well, we can say two things about that. Well, generally, infants don't do math and science. While infants can be irrational, they generally don't do sex either. When we're talking about sexuality there's another train track of irrationality that runs parallel to it.

    When you think about it during sex you're distracted from it. For most animals sex goes pretty fast unless you're a top predator. You have to think about these things in the long run of history. And sex today is probably safer than when you would be eaten after sex. Living things have to thrown into a state of irrationality where they ignore reality to have sex for the species to reproduce but it's also dangerous and you're presenting twice the target to another individual. Another animal going around looking for something to eat is going to have a real treat. If you look at it from the biological point of view sex is very dangerous because you're subject to being attacked.

  4. Challenged by my ever-critical friends, I hunted down the original
    citation of the comparative risk chart that was included in the MMWR
    in 2003. The chart is at the bottom of this page: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5212a1.htm

    I just think it raises interesting questions:

    Some of these data relate to heterosexual couples-- and though on the
    face of it the gender of the bodies involved wouldn't seem to matter,
    it does show the dearth of information about same-sex couples and/or
    single people with relationship to relative risk.

    The title of the original article, "Comparison of female-to-male and
    male-to-female transmission in 563 stable couples" , and the
    accompanying chart, seem to imply that the "receptive anal sex"
    bodies would be women's bodies. This may or may not be a moot point,
    but it does seem to raise the question about whether receptive anal
    sex works the same in male and female bodies--- but it definitely
    points to the possible need for a footnote on the chart to make clear
    that the gay cultural terms on Trevor's chart are referring to
    heterosexual behaviors... interesting, huh?

    It also raises the point that, at least as far as the MMWR is saying,
    there is no equivalent research of gay men, either single or

    It would be interesting to look at the methodology of the original
    study... how do they sort out couples who are doing more than one
    thing, for example?

    Intuitively, the numbers seem about right--- but it would be
    interesting to hunt down the original study and look at its confidence
    intervals, and the methodology. Regardless of that, I think it is
    crucial to have such a relative-risk chart, and if we are upfront (at
    least with each other) about the nature of the data, I think this is
    all fine.

    But the final take home, is that it is SO useful to have this sort of
    relative risk chart. So thank you both for publicizing it. Thanks to my friends Pat Egan and Bill Heinzen for questioning me about all of this.

    love, Chris

  5. I also would add into the conversation the fact that transmen have entered into gay men's communities and thus have changed our ability to distinguish between what the bodies of self-identified gay men look like - and what kind of sex (anal v. vaginal) gay men are having!

    Thanks for bringing this issue up, Chris!



  6. I really appreciate all the dialogue around this. I agree --- with all the caveats, this chart is still an important tool we can use to talk about risk and what our levels of comfort are with various activities. It's about the discussion, really, more so than hard and fast numbers.




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