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

Despite the efforts of educators, public health officials, and HIV/AIDS prevention experts, condom promotion has failed to stop the HIV epidemic in most of sub- Saharan Africa and most researchers and policy makers have focused on risk reductions for interventions for penetrative sex. We consider another HIV prevention option: 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, available data on the practice of oral sex in Africa suggests that the practice is very rare compared to the practice in the United States. This paper reviews some of the existing evidence on the efficacy and prevalence of oral sex, discusses the potential of this safer sex strategy for mitigating the spread of HIV in Africa, and stresses the need for further research.