关于口交感染艾滋病风险的medhelp外文专著——客观判断口交HIV风险

作者：大鹏（翻译）来源：Medhelp 发布时间：2013年10月05日点击数：

题记：十月来临，首先祝福恐友们国庆节快乐，不知道各位恐友有没有在十月按时的规律生活，因为咱们都知道，第二天没有上班，或者当天没有上班，很多人生活都无法规律。特别是在大半夜还有恐友给老师短信或者微信的，老师看到挺心痛的，老师不怕大家因为特比特别急的问题麻烦老师，老师只是希望大家生活规律，学会养生之道，将心放松。因为只有心理得到最大程度的放松，您才能离自然越近。曾经老师的老师李子勋教授来成都讲课，就说到过悟求，可是做学生的一直没有办法理解。只有当您静心于自然，顺其与自然的时候，您才发觉会与自然相通，接受灵魂的呼唤。也许有的恐友觉得老师很不可思议，接受了这么多的负能量还能尚存。是啊，回望这么几年的恐艾干预工作，看着一个又一个或志愿者，或专家或疾控的开通了咨询，结果又在短时间里一个一个的消失殆尽。轮回旋转，就这么来来回回，存在消失，存在又消失。唯有恐艾干预心理网一直尚存，甚至还发展迅速，不仅成为成都心理协会会员，四川性病艾滋病防治协会会员，还获得了腾讯新浪认证，加入了云公益组织，办公地点迁至成都市团委。其实这一切都在于老师能够合理的调整自己的心态，尽可能的将恐友负能量转化。然后给恐友们传授更多的经验，帮助其恢复。在此，老师再次给大家明确，不乱搜，不乱问，不乱查。如果相信谁就在谁那里进行刻苦的学习而不要多问问西问问，这对自己是百害而无一例，所以老师希望大家记清楚老师的话，方能更好的恢复，加油。

以下是一篇选自恐友从世界知名恐艾网站medhelp上翻译的关于口交的文章，大家看了再针对国内一些因为某些原因导致的言论矛盾，希望能够增加大家的一些高度。感谢系统预约恐友大鹏为中心所做的如下空闲。

Hiv 与口交：真实情况

我想讨论下口交这个话题。这是在hiv论坛上最具争议的几个话题之一。对于口交行为，很多评论都是“没有风险”。但是人们却一直没有理解为什么说没有风险。你必须明白科学真理，并了解相关统计资料。以下是我对这些内容的解释。在我阐述为什么口交行为没有风险之前（同时平息有些人争论说的一些专家说“理论的”或“微不足道的”危险）先考虑下其他一些事实，从而降低感染的可能：

1 、大部分人不是hiv携带者，感染人数占总人口的百分比远低于某些人想象的值。举例，在美国，感染者有120万，而美国总人口3.116亿人。

2、假如你设法寻找一个感染者，他们必须曾经被暴露在大量被hiv感染的流体里面，而不是一两滴。而且不同特定体液中其病毒性也有所不同，生殖器体液当中，精液最高，其次是阴道分泌物，再次是pre-seminal fluid（我猜是前列腺液）

以下是本文的具体内容。

1，统计报告

从普通人的立场看待这个问题。Medhelp上的所有专家医生都无数遍的说过他们当中没有一个人见过确切的因为口交导致感染hiv的案例。他们同时还说他们那些在hiv相关领域的同事同样没有见过这种案例。而且，在过去的几十年中，他们从来没有听到过或者读到过因为口交引起的案例。

再者，作为一个拥有18年经验的护士，我与许多专门从事hiv方面工作的注册医生很熟悉，许多都在医学领域拥有30年以上的经验，专门从事传染病工作。他们的观点也是相同的。虽然他们经常表示果断的说“不可能”会让他们感觉不舒服，但是他们还是认为口交行为没有风险。我与工作过的医生和这里其他的医生从来没有建议过一个口腔接触者进行hiv检测。

另外，让我们说说口交有风险。哪里有这种报道的案例？尽管某些东西是低风险的，我们都会确切的看到相关的确切数据时间、地点、如何发生的等被报道出来。CDC一直在收集与hiv相关的细节信息，因为hiv在美国是必须强制上报的疾病。关于口交行为的数据从来没有，这些可能导致一个人认为类似的报告没有被报道。但是举个例子，职业暴露被认为是低风险的，占报告比例数很小，但是确实有相关的数据被记录时间地点和如何被感染的。

找到口交感染的确凿数据是不可能的。其他的传播途径，因为他们确实被报道了，都有百分比。

CDC可能会说有一些案例。有一些？那一些就是只3个左右，在过去的25年中只有3个？，根本不值得相信。（原文 All the CDC can say about oral is there have been a "few cases". A few cases? A "few" generally is assumed to mean THREE. So, THREE cases in over 25 years? NOT very convincing.这里有一个英文的语言习惯， few用于可数名词，且只小于等于3个时候，当更多时候用some，本文没有用some）

如果真有新感染的案例是因为口交感染的，可以打包票，CDC会迫不及待的警告公众其中的风险。目前，CDC只有一个很软弱的声明是关于口交的。他们是一个保守的机构，他们不会告诉公众这是没有风险的。如果某人声称他通过某种方式感染了，那么神会阻止其他人再通过这种方式感染的。如果真有这种情况，CDC会出现不小的骚动。这是他们的责任。你会发现他们从来不会摆出“没风险”姿态，但是你要明白那确实是没有发生过的。

那些被口交感染的人在哪里？如果真有风险，25年来应该有不少案例，对吧？如果口交有风险，那感染比例就会远远高于现在的值。试着想一下，外面现在有多少人在进行无保护的口交行为。那个数量我们是无法估计的。也许，在一个特定时间里，整个地球上，有成千上万的人在进行口交活动。如果会导致hiv，甚至某些时候一个月有至少3起（a few）案例，即便不多，也是会被报道的。

一些有趣的关于口交的案例

年龄段在18-39岁的女人其中有一半多的人在过去的90天中给与别人或被别人给予过口交行为。（NSSHB 2010）

。。。。。。。

http://www.kinseyinstitute.org/resources/FAQ.html

这个网址里有列表显示一年中有多少人在进行口交行为。太多了！

二、科学角度

现在从科学角度解释为什么口交行为不会感染hiv。在口交行为中有以下几种因素造成不可能传播hiv。

1、组织/粘膜结构，首先，只有少数的几个点及脆弱的组织允许hiv侵入。大体来说，是粘膜和实际的血流（比如，注射一针管的带有hiv的血液进入静脉很容易被感染，这是人们所谓的病毒直接进入血液中）。Hiv不能通过完好的皮肤或者浅表伤口进入。为什么？因为不存在血流环境，而血流环境是hiv感染的条件。然后，回到粘膜问题上。你身体上好多地方都存在粘膜。然而不是所有的粘膜都一样。比如，在鼻子、眼睛里、口腔里、直肠里、子宫、阴道壁等。

无需太专业，粘膜中有目标接受细胞，这些细胞可作为病毒的攻击对象起到承载病毒的作用，从而允许病毒通过血流。嘴里的口腔黏膜的组成与其他粘膜（直肠、阴道、男性尿道口）不同，是不允许病毒传递的。口腔中，目标细胞的数量远远低于其他粘膜中的数量，而且存在于很深的皮下。在其他比如直肠、阴道等脆弱粘膜处，目标细胞存在于很浅的表面且数量很多。通过对比，你可以发现，hiv病毒在口腔中找到载体并感染是很困难的。

2、病毒的弱点：科学研究表明，hiv是一种极弱的病毒，在体外不能维持其活性和传染性。在无保护刚交过程中，治病流体是在肛门内部，没有暴露在空气当中。

当hiv暴露于空气当中（温度、酸碱度、酸性、水分、氧气），它就基本上被击溃了，变得没有活性（或者某些人说的病毒已死亡），病毒的外壳会瞬间被破坏。返回上面所说的粘膜的问题，还记得我说的目标载体细胞吗？，病毒的外壳中包含着那部分可以使目标载体细胞感染的病毒。外壳只要有一丁点的破坏，里面的病毒就会丧失传染的能力。

多久？暴露多久？好多人都会问这个问题，想得到一个确切的时间来确定这个病毒是否已死亡。但是，这个是没有答案的。有很多因素可以起到灭掉病毒活性的能力（周围环境、温度、酸碱值、等等），不要纠结于这个问题，最重要的是，一旦病毒外壳被破坏，所有的可能性都排除了，游戏结束。所以，这个普遍问题的回答是——没必要问多久。病毒没有必要完全失活才能失去传染性。（言下之意，病毒一离开宿体就没有传染性了。）

因此，结论，很明显，口交行为不会使病毒留存于体内，因为这个行为会导致病毒失去活性。

所以，如果你关注这件事很长时间，你必须知道，要想感染，必须病毒具有活性，去攻击载体细胞从而进入人体血液环境。目前为止，我已经向你解释了这种病毒是多么脆弱的容易被抵抗。

当然，我们可以假设这里有一连串的很难搞的病毒。这些家伙是就像超人拥有所有的hiv病毒，而且他设法不被暴露在外而被破坏。而且他很幸运找到了载体细胞来依托在上面。现在，那怎么办？好，这就是后面要发生的，另外一个因素会破坏hiv病毒的传播过程

2、艾滋病毒的蛋白质/酶抑制剂：有好多研究都描述过唾液中的蛋白质/酶是如何抑制艾滋病毒的。对于病毒来说，这是一个坏消息，研究表明唾液中的蛋白质/酶对hiv病毒有明显的抑制作用。有些研究推导得出结论唾液中的蛋白质/酶可以抑制超过50%的活性。这是难以置信的（真他妈厉害），所以当我们说唾液抑制hiv时，我们不是在空穴来风，这是事实。以下是一些资料来证实这个事实。（哈，要是在实验室的人穿上一大桶唾液，真cool!）

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2199189/
http://www.ncbi.nlm.nih.gov/pubmed/11355444
http://online.liebertpub.com/doi/abs/10.1089/aid.1990.6.1425
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC185219/pdf/jcinvest00013-0472.pdf

总之，以上说的总结到一起，你应该能明白传染是如何发生的吧？也能从你脑海中擦去口交行为了吧，很明显，说白了，对于hiv来说，口腔就是地狱。

当然，总有人会出来唱反调或调整这个结论。当一些问题涉及到hiv的时候，底线就是人们的舒适程度。有些人，无论我们如何证明我们上述所说的东西，他都不买账，对于这些人，我只能说，好吧，你去用避孕套就ok了。或者干脆放弃这种行为。如果你已经发生了口交行为，而且恐惧感染，我们是可以理解你的那种痛苦的。那就只能。。。如果你确定要去做检测来平复你的情绪的话，请相信，你的结果肯定没有问题。不要让你的思维胡乱做梦以为结果是错的。

如果你的焦虑到了一定程度，那你就需要用专业的方法解决。我一生都充满了焦虑，所以我会告诉你紧张惊慌焦虑通常不会自己就消失了。这是需要专业介入的。我们不严格建议，但是我们见过很多没有控制好焦虑情绪的每天困在hiv问题里的人，也见过好多人焦虑逐渐变的越来越糟无视建议不寻求帮助的人。没多久，这些人开始疯狂的幻想他们会在哪有风险感染hiv。这是很可悲的。

最后，某些人可能还是会说“但是，医生说的“低风险””。我告诉你，你去看他们说的每一句话，从5段话中随便挑一两句。不要深度思考他们的话，只看表面。如果他们告诉你你被感染的可能就像是你正好被一颗陨石砸中，你可以认为他的意思是“没风险”。如果他不建议你做检测，甚至他说“低风险”，那明显意味着根本没什么好担心的。许多医生，由于科学在不断发展，很少习惯用“绝不、不可能、总是、零”这种词汇，他们就是不习惯用这种词汇。我们引用一下Dr. HHH说的话，对于所有的观点来说，“低风险”和“无风险”是没有区别的。我敢给你打包票。Tea看列出了一个很长的单子，是从Medhelp上所有的医生对口交行为无风险的阐述。你可以自己去看。

事实上，hiv是一个很难传染的病毒。非常难传染。由于人们过于膨胀的思绪，他们不能从这个问题上转过弯来。你只要明白，该病毒是很难传播的，（与口交有关时）当你把所有原因都考虑进去的时候，你会发现传播途径已经被切断了。你就能明白这种行为是“无风险的”。

最简单的事实就是没有任何一粒由于口交问题被感染hiv的案例。我现在将我知道的这些分享给大家。我希望至少能帮助一部分人明白为什么我们给您这样的建议。

任何健康问题都应该找医生咨询，网上的论坛永远不能取代真实的医疗机构。

原文

HIV AND ORAL SEX: THE FACTS

HIV and ORAL SEX: The Facts


I want to  discuss the great oral sex debate.  This is probably THE most common topic we see on the HIV forum.  We get criticized a lot for stating that oral sex is "no risk".  What people fail to understand is HOW we came to that conclusion.  You have to look at the SCIENTIFIC facts, along with the statistics.  I'm going to try to explain them to you...

**Before I even go into the reasons why oral sex is not a risk (and to appease the people who will argue that other experts say it's a theoretical or negligible risk)...consider for a moment the other FACTS that would further decrease the chances of infection:

ONE..most people don't even HAVE HIV.  The % of the population who are infected is actually a lot lower than most people assume.  In the U.S. for example, 1.2 million people, out of a TOTAL population (in 2011) of 311,591,917 people.  I hope that puts things into a better perspective.

TWO...if you managed to FIND an infected person, there would have to be exposure to a substantial amount of infectious fluids, not just a drop or two.  Further, the infectiousness of certain bodily fluids varies in it's viral content, with semen being the highest among genital fluids, then vaginal fluids, then pre-seminal fluid.

Now...down to the nitty gritty....

FIRST: THE STATISTICS:

Look at it from a common sense standpoint.  ALL of the expert docs on MedHelp alone, have said time and time again that none of them have seen a convincing case of HIV being caused by oral sex.  They also have said that none of their COLLEAGUES specializing in the field of HIV have either.  Further, they have never heard about or read a convincing case of HIV caused by oral sex in the combined DECADES they have been working in this field.

Too add to that, in 18 years of being a nurse, I've worked closely with several wonderful ID docs, also specializing in HIV/AIDS, most for quite some time...some with 30+ years in the medical field, specializing in infectious diseases.  Their comments were the same.  While they often said they wouldn't be comfortable saying something was impossible (that's a doctor thing), they all said that oral sex carried no risk.  Also, a doctor isn't going to NOT recommend testing for a situation where they feel someone is at risk.  It speaks volumes that both the docs I've worked with, and the docs here never recommend HIV testing for an oral exposure.

Additionally...let's say oral sex is a risk.  Where are the reported cases?  Even if something is a LOW risk, we would certainly see some kind of consistent statistics indicating where, when, how often these cases were being reported.  The CDC collects very detailed HIV related data all the time, as HIV is a mandatory reportable disease in the U.S. The info about oral is just NOT available, which would kind of lead one to believe that's because cases aren't being reported.  For example. occupational exposures overall are considered low risk, and account for a small number of reported cases, but there is data out there about who got infected, where, when and how.

That data leads to statistics being born. It's nearly impossible to find a SOLID number-based statistic about oral sex infections.  Other transmission routes, because they are constantly being reported, generate % figures.  All the CDC can say about oral is there have been a "few cases".  A few cases?  A "few" generally is assumed to mean THREE.  So, THREE cases in over 25 years?  NOT very convincing.

If there were new infections being reported with oral sex listed as the cause, you better bet your bottom dollar the CDC would be more passionate in warning the public about the risks.  Presently, the CDC has a very wishy-washy statement about oral sex on its site.  They are a conservaticve agency, and they are NOT going to tell people it is not a risk, God forbid someone finds a way to get infected that way tomorrow, or much MORE likely, someone CLAIMS they were infected that way.  They could make some serious ruckus for the CDC in that situation.  It's a liability.  You'll never see them commit to a "no risk" stance, but you have to think of the info that ISN'T there.

Where are all the people who have been infected by oral sex?  Surely there should be more than a handful of questionable cases in 25 years if it is a risk, right?  If oral sex was a risk, overall infection rates would be MUCH MUCH higher than they are.  Try to imagine how many people have unprotected oral sex out there.  It's impossible to imagine how many, how often. Probably, at any given moment accross the globe, there are tens of thousands of people doing the oral deed.  If HIV was resulting...even SOME of the time,  there would at LEAST be a few cases a month, if not more...being reported.

A few fun factoids about oral sex:

~•Half or more of women ages 18 to 39 reported giving or receiving oral sex in the past 90 days. NSSHB, 2010
•Receptive oral sex is reported by more than half of women who are in a co-habitating relationship between the ages of 18 and 69. It was also reported by more than half of women cohabitation between ages 18 and 49, and more than half of married women ages 30-39.NSSHB, 2010
•A similar pattern was found for women performing oral sex. NSSHB, 2010

~(Info courtesy of The Kinsey Institute)
http://www.kinseyinstitute.org/resources/FAQ.html

(Check out the above link, there is a table that indicates the % of people engaging in oral sex in a year...LOTS of oral sex going on!)

NEXT: THE SCIENCE

There are SCIENTIFIC reasons to explain how oral sex wouldn't be a risk for HIV.  I'm going to try to explain all of the reasons, in detail.  There are several factors that in an oral sex situation, would not allow for transmission.

1.)  Tissue/Mucous Membrane Structure:  First, there are only a few "points of entry" that contain the vulnerable tissue that allows for HIV transmission.  Generally speaking, that would be mucous membranes, and the actual bloodstream itself (for example, injecting the contents of a syringe with HIV+ blood into a vein could easily lead to infection, as a person is introducing the virus DIRECTLY into the bloodstream.)  HIV cannot get through intact skin, or even superficial cuts.  WHY?  Because it doesn't allow for access to the bloodstream, which HAS to happen for infection to occur.

Anyway, back to the mucous membranes.  There are alot of locations where you would find a mucous membrane.  HOWEVER, not all mucous membranes are created equally.  As an example, there are mucous membranes in the lining of the nose, the eyes, the oral cavity, rectum, lining of the male uterus, vaginal wall.

Without getting too technical, there are target receptor cells in the mucous membranes that are the ones responsible for "latching on" to the virus from the partner...allowing it access to the bloodstream.  The oral mucosa of the mouth is not comprised of the same celluar makeup and structure as the mucous membranes in areas that commonly allow for transmission (rectum, vagina, male urethral lining).    In the oral cavity, the receptor cells are far reduced in number than those of the rectum, vagina, etc...and are located much "deeper" in the tissue.  In the susceptible tissues of the rectum and vagina, those target receptors are very superficial, and found in MUCH higher numbers.  There alone, you can see how the virus would have a MUCH harder time finding a receptor cell, then getting to it.

2.)  Vulnerability of Virus:  It's a well known SCIENTIFICALLY STUDIED fact that HIV is a very weak virus that cannot maintain it's virulence and infectiousness OUTSIDE of the body.  During unprotected anal sex, for example, any infectious fluid is INSIDE the anus, not exposed to the elements.

When HIV is exposed to the elements (temperature, pH, acidity, moisture, oxygen), it begins to basically "break down" and become inactive (or, as some people say, "die").  The outer shell of the virus immediately becomes damaged.  Referring back to the mucous membrane topic...remember I mentioned those target receptor cells?  Well, on the virus, it's the outer shell that contains the part of the virus that "latches on" to that receptor cell.  Even with a slightly damaged outer shell, the virus loses its ability to do that.

HOW LONG?  HOW LONG?  We get questions ALL the time from people wanting to know the EXACT amount of time it takes (down to the millisecond) for the virus to "die".  There is no one, uniform answer.  There are a lot of factors that go into the inactivation of the virus (agaion, environmental factors, temperature, pH, etc).  The important thing to remember is, that as soon as that outer shell becomes damaged, all bets are off, game over.  So, to answer that common question...it doesn't matter "how long".  The virus doesn't have to be completely inactive to lose its infectiousness.

Therefore, in conclusion, obviously, oral sex doesn't involve the virus remaining INSIDE the body, which leads to the virus becoming inactive.

SO, if you've been paying attention thus far, you would know that, in oral sex...in order for it to cause infection it has to stay active...and attach to receptor cells to get it to the bloodstream.  So far, I've showed you the challenges that poor little virus is up against.  So...for fun, we'll assume that we're talking about one HECK of a tough virus.  This guy is the "Superman" of all HIV viruses...and he's managed NOT be become damaged with exposure to the elements...AND, his lucky butt found a receptor cell to latch on to.  Now what?  Here's what...yet another factor that would interrupt the HIV transmission process....

3.)  Proteins/Enzymes as HIV Inhibitor:  There have been NUMEROUS studies researching how the proteins and enzymes in the saliva affect the HIV virus.  Guess what?  Bad news for the virus.  The results of the studies show that just about every protein and enzyme in the saliva...from enzymes produced by the parotid glands, to the salivary glands...to others...significantly inhibit the HIV virus.  A few of the studies deduced that the virus was inhibited by more than 50%!  That's pretty incredible!  So, when we say that saliva inhibits HIV, we're not just blowing smoke up your hind end...it's a FACT.  Here are just a few studies I've cited where real SCIENTISTS found this to be fact (yep, guys in white lab coats with vats full of spit, cool job, eh?).:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2199189/

http://www.ncbi.nlm.nih.gov/pubmed/11355444

http://online.liebertpub.com/doi/abs/10.1089/aid.1990.6.1425

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC185219/pdf/jcinvest00013-0472.pdf

IN SUMMARY, hopefully the above information, ALL put together in terms you can understand...taking into consideration HOW transmission happens, will ease some of your minds about oral sex, as obviously, to put it lightly, the mouth is a horribly hostile place for HIV.

Now, there will always be the naysayers and people challenging this.  That's FINE.  The bottom line when it comes to anything relating to HIV is that people's comfort levels vary.  Some people, no matter how much "proof" we present, will still not buy it, that's fine!  Then, for those people, I say...use condoms for oral sex, or simply abstain from it all together.  If you've already had oral sex and fear infection, then get tested if you just can't get past it.  We would never recommend testing for an oral sex exposure, but we also understand that anxiety can be a rough thing.  Thing is...if you DO decide to test to put your mind at ease, BELIEVE your results and move on.  Don't let your mind dream up ways that the test results could be wrong.

If you get to THAT point, then the anxiety may need addressed with a professional.  I've lived with anxiety all my life, so I can say with conviction that severe or chronic anxiety won't typically just "go away" on its own..it's going to require profressional intervention.  We don't recommend that to be mean, but rather because we see people with out of control anxiety every day on the HIV forum, and we also watch that anxiety get worse and worse as people keep posting and ignoring the suggestions to seek help.  Before long, those people are dreaming up all kinds of crazy scenarios where they could be at risk for HIV.  It's actually very sad.

Lastly, for those of you who are going to say, "but, but...the DOCTORS say *low risk*!!"..I say to you...look at EVERYTHING they are saying to you, don't cherry pick one or two words from a 5 paragraph response.  Don't read with tunnel vision.  If they're telling you you have as good a chance of getting hit by a meteorite as you do from getting infected from oral sex...you can take that as a "no risk".  If they are not advising you to test, then even if they say "low risk", it's obviously not sufficient enough to worry about.  MOST docs, due to the fact that science is ever changing, will seldom use words like, "never, impossible, always, zero", they just won't.  We have quoted our Dr. HHH plainly saying that, for all intents and purposes, there is NO difference between THEIR use of "low risk" and our use of "no risk".  I think you can pretty much take THAT to the bank.  Teak has comprised a LONG list of quotes from our MedHelp docs talking about oral sex not being a risk.  You'll see us post that a lot.  It's a nice reflection of different oral sex scenarios.

The fact of the matter is...HIV is actually a very difficult virus to transmit.  VERY.  Because of people's overinflated views of HIV, they just can't wrap their heads around that.  It only makes sense that if a virus is that hard to transmit, and you then add in all the factors it would have to overcome (in relation to oral sex) to allow for transmission, you can then see how we get our assessment of "no risk".  It comes from FACTUAL information and the simple fact that there are just NOT cases of HIV from oral sex being reported with any regularity.  I've now shared that information with all of you, as best I can.  I hope it helps at least some of you understand why we give the advice we do.

As always, you're free to believe whatever information you wish, and take whatever advice makes you comfortable.  It also needs to be said that ANY health concern should be addressed with your own personal physician.  An online forum should NEVER be substituted for real, in-person medical care.

Thanks for reading!

Wishing you all Peace,
Nursegirl6572