Missing safer sex strategies in HIV prevention: a call for further research

Jason Kerwin, University of Michigan
Sallie Foley, University of Michigan
Rebecca L. Thornton, University of Michigan
Paulin Basinga, Tulane University
Jobiba Chinkhumba, University of Malawi

HIV/AIDS prevention efforts focused on condom promotion have failed to stop the HIV epidemic in most of sub-Saharan Africa. We consider the potential of adding a new option to the menu of choices promoted by safer-sex advocates: female-to-male oral sex (fellatio). Extensive medical evidence indicates that fellatio is roughly as protective against HIV transmission as vaginal sex with a condom, and much safer than unprotected sex, but it is rarely emphasized in HIV prevention curricula. Moreover, while there is little evidence on the practice of oral sex in Africa, available data indicates that it is very rare compared with its prevalence in the United States. This paper reviews the existing evidence on the efficacy and prevalence of oral sex from the literature. We discuss these results and the potential of this safer sex strategy for mitigating the spread of HIV in Africa, and stress the need for further research.