This edition of Straight, No Chaser is a keepsake, whether for your own reference or as a conversation piece/teaching guide for others. I suspect that due to the volume and wealth of information contained within, you’ll refer to this post time and again (or so I hope). For additional information, refer to the U.S. Center for Disease Control and Prevention and/or the National Institutes of Health websites.

STAYING STD-FREE
The best ways to stay STI free is to confirm it and then avoid it. If you want to reduce your risk of acquiring HIV and other STIs (sexually transmitted infections) through sexual contact, here are your options.

• Abstain from sex.
• Be monogamous.
• Prove both you and your partner(s) are negative. Get yourself and your partner(s) tested, preferably prior to engaging in sexual activity and subsequently every three to six months, especially if you and/or your partner have more than one sexual partner.
• If and once you establish that you’re STI-free, learn how to use condoms and do so every time you have sex.

A special note about protecting yourself from HIV
HIV can be spread by having unprotected sexual contact with an HIV-positive person. “Unprotected” means any vaginal, anal or oral sex without barrier protection, like a condom or dental dam. Some of the ways to reduce your risk of getting HIV through sexual contact include the following:

• Don’t have sex. Abstinence is the best way to be certain that you won’t contract HIV. Although HIV is occasionally transmitted in other ways, vaginal, anal and oral sex are the most common ways that HIV is transmitted.
• Be monogamous. To be clear, this means you are in a sexual relationship with only one person and both of you are having sex only with each other. For the purposes of contracting HIV, sex includes vaginal, oral or anal sexual activity. Monogamy is optimally effective if you also confirm early and often that both you and your partner are not infected with HIV.
• Get yourself and your sexual partner(s) tested: Knowing your own status is important for both your health and the health of your partner. Talking about your HIV status likely will be difficult and uncomfortable, but it’s important to start the discussion BEFORE you have sex.

FRANKLY, “DON’T ASK, DON’T TELL” IS JUST DUMB WHEN IT COMES TO STIs.
This is actually quite simple. No excuses. You need to ask your sexual partner(s) and any possible future partners the following questions.

• Have you been tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
• When was the last time you were tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
• If you’ve been tested, what were the results of your tests?

SAFER-SEX ACTIVITIES
These activities carry no risk of HIV transmission:

• Non-sexual massage
• Casual or dry kissing
• Masturbation (without your partner’s body fluids)
• Frottage—also known as “dry humping” or body-to-body rubbing

You can still contract other STIs, like herpes, HPV, or pubic lice (“crabs”) if you have bare skin-to-skin contact with your partner.

CONDOM USE
Here are two questions for both males and females.

• Have you ever learned how to safely and appropriately use condoms?
• Do you use condoms consistently?

To maximally reduce your risk of getting HIV or other STIs, you must use a new condom with every act of vaginal, anal or oral sex. If you don’t use them for oral but do for vaginal and anal, you have still lowered your risk, just not as much as you could have. Also, you must use condoms correctly, as depicted in the above diagram, to appropriately reduce your risk. Learning correct usage also will keep condoms from breaking or slipping off, which reintroduces the risks.
I also want you to understand that all condoms are not created equal. Latex condoms are highly effective against HIV and other STIs. Do you or your partner have a latex allergy? If so, the next safest condom choice is a polyurethane or polyisoprene condom. Just tell your pharmacist at the drug store that you’re allergic to latex, and s/he’ll take it from there. On the other hand, lambskin condoms do NOT protect against HIV. The particle size of the virus allows it to maneuver and slip through lambskin.
Condoms alone have never been enough. Did you know that you should always use a water-based lubricant when you use a condom for either vaginal or anal sex?  I want to restate this: that’s water, not petroleum jelly. Water-based lubricants reduce friction and help keep the condom from breaking. Do NOT use an oil-based lubricant (such as petroleum jelly, hand lotion or cooking oil). Oil-based lubricants can damage condoms, making them less effective.
Both male condoms and female condoms will help protect you against HIV and other STIs. If you’ve learned to enjoy sex with a male condom, you can learn to enjoy it with a female condom or a dental dam. Additionally, there are many of you who have contracted STIs. If you wish to continue to enjoy a variety of sexual activities, learning to use the full range of barrier protection may be a better option for you and your partner than abstaining.
Condoms do not provide 100% protection against all STIs, but you are always safer using a condom than not. You can get certain STIs, like herpes or HPV, from contact with your partner’s bare skin, even if one of you is wearing a condom, but condoms lessen the risk. Take the time to explore and inspect each other if you’re confused or concerned about the possibility of your partner having an STI.
Spermicides only serve the purpose of reducing the risk of becoming pregnant. They are ineffective in preventing contraction of HIV and other STIs. They actually irritate rectal and vaginal walls, in effect increasing the chances of HIV infection, should infected fluids come into contact with these areas.

ABOUT SEX TOYS
This is pretty straightforward. Using sex toys can be safe, but think of staying clean and “not sharing.”

• It is important that you use soap and water to clean your toys after each use. If the instructions allow for a stronger disinfectant, you may do so.
• As a rule, don’t share your toys. The nature of how toys are typically used likely increases the risk of vaginal or anal irritation, which increases the risk for HIV or other STI transmission.
• If you “must” share your toy with your partner while still trying to be safe, use a condom on the toy before you use it, and change the condom before your partner uses it.

CIRCUMCISION
We’ve discussed circumcision at length in Straight, No Chaser. (Click here for a dedicated post on circumcision.) There has been ongoing interest and research over the past few years about circumcision and its effect on preventing HIV infection. The bottom line? In 2007, the World Health Organization reported that male circumcision reduced the transmission of HIV by 60% from women to men in three randomized, controlled studies in Uganda, Kenya, and South Africa.
There is much less available data for men who have sex with men and how circumcision might affect HIV transmission through anal sex. In addition, recent studies show that circumcision does NOT protect women from contracting HIV from male partners.
Let’s be careful in interpreting the results of these findings.

• Circumcision is only additionally effective when earlier preventative efforts have not been taken. Advocating circumcision is not an appropriate substitute for any of the numerous safety measures and habits previously discussed to reduce one’s risk for HIV and other STIs.
• Failure to have a circumcision does NOT increase one’s HIV and other STI risk in the presence of appropriate safe-sex activities.

So there you have it. Knowledge is power. We appreciate that this posting was not balanced by the human decisions and passions that come into place with sexual activity. We recommend that you adopt a posture of “safety first” to create that balance! Good luck, and feel free to ask your SMA expert consultant any questions you may have on this topic.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
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