..Safety Zone

Playing it safe sexually used to mean just playing it smart. Back then, that mostly meant using some form of birth control. But today, playing it safe has a whole new meaning.

That's because HIV (the virus that causes AIDS) and a list of other sexually-transmitted diseases (or STD's) has shifted both the context and meaning of being "safe" sexually. It used to mean staying childless; now it means staying alive.

The "play it safe" message plays to a different audience today, too: married couples as well as singles, gays and lesbians as well as straights.

That's because unprotected sex is riskier today than ever -- at least since the discovery of penicillin took the sting (and stigma) out of syphilis, gonorrhea, and other "social" diseases.

But this time, there's no penicillin on the horizon, and no panacea for the fear that AIDS arouses. And from the best available evidence, a lot of the fear is justified:

• As many as a million Americans may already be symptom-free HIV carriers.
• At least 36 million people around the world are now infected, according to the World Health Organization, and 75 percent of all new infections are transmitted through heterosexual contact.
• New strains of the AIDS virus have been identified in Asia and Africa that may be 50 times more easily transmitted through vaginal sex than earlier forms.

And while the simple fact is that it still isn't easy to "catch" AIDS through casual contact, casual sex seems another matter altogether. And if you're sexually active, your safety zone may be fast disappearing.

What can you do? Lots, if you're sexually active. Even more, if you're not.

Because playing it safe sexually today still means playing it smart. The stakes are just higher, that's all.

..So what is 'safe sex'?

Defining safe sex is tricky -- and it's been part of a highly-charged debate for years. But strictly speaking, the only sex that's guaranteed safe is no sex at all.

That's because there are risks linked to every form of sex, "protected" or otherwise. And the only way to totally avoid those risks is to avoid sex outside of a monogamous relationship with someone you know is HIV-free.

Short of that, though, there are ways for sexually-active people to reduce risk.

Labelled "safer sex" since the early years of the AIDS crisis, these practices lower the risk of contracting HIV and other STD's by reducing exposure to blood, semen, or other bodily fluids that can transmit the AIDS virus.

That's all that it has to reduce, though. Safer sex shouldn't be a hassle or a hindrance. And it doesn't have to stop spontaneity or take the love out of lovemaking. But it does show that you care enough about yourself and your partner to limit your exposure to HIV.

What it does is show that you care enough about yourself and your partner to limit your exposure to HIV.

..I thought AIDS was basically cured. Isn't it?

Not at all.

Even though several drug therapies have been approved for treating AIDS symptoms and restoring immune system function (which AIDS can destroy), none is considered a "cure"-and some don't work at all for many people.

That's why avoiding exposure to HIV is so important.

..What's the connection between AIDS and sex?

AIDS is primarily a sexually-transmitted disease. It's spread by direct contact with the bodily fluids of an infected person.

While gay and bisexual men still account for 42 percent of new U.S. cases (and I.V. drug users 32 percent more), AIDS is hardly limited to those groups. The heterosexual toll is rising -- with some 78,000 U.S. cases thus far in which male-female sexual contact is the only known risk factor.

Women seem particularly vulnerable to heterosexual exposure.

One recent study estimated a woman's risk of infection at 17.5 times that of a man, since the virus passes more "efficiently" from infected males to females.

A main reason for the breakout beyond original affected groups is that there are no immediate signs of infection. In fact, researchers warn that it may take six months to ten years (even longer, in some cases) for symptoms to appear.

But whether symptoms show up sooner or later, most people who are exposed to HIV eventually develop more serious problems associated with infection.

And symptoms or not, all seem able to pass the virus on to others.

And if a million Americans already are symptom-free carriers of the disease, safer sex may be the only way a sexually-active person can keep from finding out who is disease-free -- and who isn't -- the hard way.

..What sexual activities increase the AIDS risk?

This is where things get tricky. Because any sexual contact outside a long-standing monogamous relationship carries at least some degree of risk.

Still, some sexual activities are riskier than others. High-risk activities include:

Contact that causes chafing or tearing of vaginal, rectal, or other body tissues;

Practices that involve direct contact with bodily fluids or broken skin (oral sex and vaginal or anal intercourse without condoms, urination, oral/anal contact).

And even though HIV is also found in saliva, most experts don't consider kissing a particularly high-risk activity. In fact, one recent report labelled even "passionate kissing" a very low-risk activity.

..That doesn't leave much. What's safe in sex these days?

A lot of things. Because sex can be safer -- and still be sexy. It just takes a little planning -- or a lot of self-control.

But since centuries of experience with other STD's have shown how unreliable self-control can be, we're going to pitch planning -- and "safer sex" -- from here on out.

Safer sex is exactly what it's advertised to be: Safer than unprotected sex. Just how much safer that degree of safety is depends to a great extent on the people involved.

Safer sex activities can include all sorts of sexual contact, with one critical exception: Bodily fluids -- especially semen and blood -- aren't exchanged.

..How do you keep from doing that?

By careful, planned use of barrier contraceptives -- especially the condom. In case you somehow missed it, condoms fit over the penis and create a latex barrier against pregnancy, HIV, and other sexually-transmitted diseases. A new plastic condom for women has even been developed which fits inside the vagina.

How good a barrier do condoms provide? Good enough, according to most authorities. In fact, one study found that latex condoms blocked passage of the AIDS virus even after three weeks of direct exposure.

On the other hand, quality is an issue.

In one study of condom effectiveness, the 8 top-rated condom brands revealed no HIV leakage, while lower-rated brands failed 10 percent of the time.

Still, stay away from animal membrane (or "skin") condoms if you want to stay away from HIV. The pores in skin condoms can be so big that they allow penetration by HIV, and so they may not help at all in reducing risk of exposure.

Latex condoms are better, and the new polyvinyl condoms may even be better, yet.

Remember, though, to avoid oil-based lubricants (like baby oil or Vaseline) with latex condoms. Oily lubricants can damage latex, causing condoms to stretch or break -- leaving you holding the bag, literally and figuratively.

No longer recommended is the spermicide nonoxynol-9, once thought to kill HIV on contact. According to research reported in March, 2001 by the U.S. Centers for Disease Control, women using nonoxynol-9 gel actually had a higher incidence of HIV infection than women using no protection at all.

..What else can I do to avoid AIDS?

Aside from giving up sex altogether, the best bet is giving up any illusions you might have about your own invulnerability.

Limit partners, since that reduces the risk of all sexually-transmitted diseases, not just HIV.

Don't mix sex with drugs or alcohol. Drugs may only directly cause AIDS when they're injected with an infected needle, but they can lead to the kind of impulsiveness that can lead to problems.

In fact, both research and common sense tells us that when alcohol or other drugs are added to a sexual encounter, condoms and other good intentions get left out. And one dumb choice is all it takes to undo a lifetime of smart choices.

Don't rush into sexual encounters. Plan ahead if you plan on staying alive and healthy. Keep condoms on hand even if you only think you might need them. And don't be afraid to say no to sex for now if that's what's right for you.

And if all the self-scrutiny and preparation seems like more trouble than they're worth, just consider the three-quarters of a million Americans who've contracted AIDS thus far and the 440,000 who've died and the million or so more who are symptom-free carriers, still.

And draw your own conclusions.

..Sidebar | Safer Sex: Making Love Less Risky

What's safe and what's just-asking-for-AIDS these days is still a matter of some debate. For one thing, no one knows completely all the factors (and co-factors) that play a role in the spread of HIV. For another, moral considerations often make discussing safer sex difficult, if not impossible.

And on top of everything else, there's no guarantee that even following the guidelines presented here will absolutely protect you from HIV and other sexually-transmitted diseases.

Still, while "safer sex" may not be entirely risk-free, a lot of the people who practice it seem to think that it's better than the sexual alternatives.

Safe Sex

• Fantasy
• Sex in an unexposed monogamous relationship
• Mutual masturbation (on unbroken skin)

Possibly Safe Sex

• Vaginal intercourse with latex condoms
• Oral sex with condoms latex condoms (or dental dams)

Unsafe Sex

• Intercourse without condoms
• Oral sex without condoms
• Oral/anal contact
• Violent or abusive sexual contact