Sex Is Safer With More People

[joreth]

I have been in sort of an ongoing discussion with someone about how safe it is to have multiple sexual partners.  He insists on a very basic math formula that simply says "more people = more risk".  I maintain that there are several variables to the safety probability, and one of the most important variables is how well you know the other person and what their own criteria for taking on additional partners is.

In an open and inclusive poly network, where regular testing is done before a new partner is added, I maintain that more people does not necessarily = more risk, as long as those people do, in fact, require tests beforehand and do, in fact, notify all people when an incidence does come up. 

If you have 3 people in a group, he believes, this is inherently safer than having 5 people in a group because that is two more people who the group has to monitor to ensure they are following the safety rules.

However, if you have 3 people in a group, one of whom is prone to cheating or taking on partners without testing first, I state that this is inherently more dangerous than a group of 5 people who have shown a consistent pattern of testing and notification.  As the number of people rises, at least within a certain range, the risk level does not, in my opinion, significantly increase when all people consistently use regular testing and disclosure.

To illustrate my point, a couple of researchers actually wrote a book about it.  Well, they wrote a book about sexuality and within the book was a segment on HIV risk for a variable number of partners.   It's called With Pleasure: Thoughts on the Nature of Human Sexuality by Paul R. Abramson & Steven D. Pinkerton.  The premise of this math formula is that each person's HIV status is unknown and the partners are randomly selected from the population at large.

 

According to the calculations (which use math symbols that I can't enter here because I write in plain text editors), "the risk resulting from 100 protected [sexual] contacts is about the same as that arising from only 10 unprotected [sexual] contacts".  They go on to say:

"For sexually active individuals with more than one partner, the situation is slightly more complicated.  Although the probability of becoming infected as a result of sexual contact with any one of these partners can be calculated using [this equation], the rules of probability calculus prevent us from simply adding them together to arrive at the overall risk of infection. ...

As might be expected, the probability of infection arising from N one-night stands is greater than the risk from N contacts with a single partner (monogamy).  However, the difference is not nearly as great as one might suppose.  ... the relative risk reduction achieved by engaging in N sexual contacts with a single partner rather than N one-night-stands is greater in the high infectivity condition (a=0.01) and increases as the number of one-night stands gets large, but is less than 40% in any case.  In contrast, the relative risk reduction due to the consistent use of condoms is about 90% regardless of the infectivity or number of partners.  In other words, in this situation even the most dramatic change in the number of sexual partners - from 100 to 1 - provides LESS protection than does the simple expedient of always wearing a condom.

These results highlight the inadequacy of educational programs that focus on getting people to limit the number of sexual partners as a means of reducing HIV risk.  Although there are conditions for which this is sound advice (such as populations with a high prevalence of HIV and other STDs) the simple strategy of always using condoms is usually a superior means of reducing risk.  ...

Finally, to return to the question posed at the beginning of this discussion: is everyone at risk?  Obviously that depends on her sexual behaviour, including who she has sex with, what kind of sex, and whether or not her partners wear condoms for penetrative activities.  For the sake of argument, suppose the infectivity is 1 in 1,000 and she selects 10 male partners at random from a population in which 1 out of every 200 men is infected with HIV.  If she has intercourse 100 times with each of these men and never uses condoms, she faces an infection risk of 0.0047 (in other words, out of 211 such women, we would expect one to become infected with HIV as a consequence of her sexual behaviour).  If, instead, she and her partners used condoms for every act of intercourse, her risk would be reduced by about 90%, to 0.0005 (1 out of 2010)."

The part that really impacts the poly community is that all of these scenarios and formulas are done with choosing a partner totally at random from the entire population without knowing his or her HIV status.  With regular condom use, regular testing, and open and honest communication about status, the probability of becoming infected with HIV drops to a very small number close to zero.  With a known status of HIV-negative, and no exposure to HIV since testing, the probability drops to a small number close to zero even without the condoms. 

This, of course, only affects those STDs that are fluid-borne, like HIV.  The incidence of contact-borne STDs like Herpes is only partially reduced by condom use, not the 90% quoted above.  And for the untestable or hard-to-test STDs like HPV, I assume we cannot significantly lower the incidence rate by changing the variable from "unknown status" to "known status", but none of that was discussed.

 

Anyway, this book sounds pretty fascinating and I plan to pick up a copy sometime soon.  One of the other thoughts they propose in the book is that the primary purpose of sex has evolved to be pleasure and procreation is a by-product.  When I did a search for the title, I didn't find any negative reviews of the book, no blog entries claiming they're hacks and peudo-scientists, so I'm curious to see the research they used to reach this conclusion.  Here's the link to read what I quoted above, just click on the cover image and you will access a preview of the book that you can scroll through: https://amzn.to/2IInG7n

Comments

[prolificdiarist.livejournal.com]

Thank you for writing & sharing this.

I'd heard something reliable about condom usage + lots of partners being safer than inconsistent condom usage + few partners, but I forgot where & it wasn't nearly as detailed as this.

Much appreciated, lots!
Kx

[stacycat69.livejournal.com]

I love numbers and statistics. My personal safer sex practice is to use condoms for intercourse, and to test myself at regular intervals, but not to require tests of my partners. This is the level of risk that I am comfortable with, but I know that differ in this regard with many poly people.

However, part of my issue with testing before bringing partners into my life is the subtle sex negative context in which STIs are treated. Typically, those with testing requirements refuse to have intercourse with those that have an STI, regardless of the level of intimacy within the relationship. And I find this disheartening. It kinda seems like "I wont date anyone who has been arrested, but those that do illegal things without being arrested are fine to date." (Weak analogy, but it kinda works.)

Aka, its okay to be a sex positive slut, but only if you do not contract an STI. Someone with an STI is therefore "less" of a person, regardless of their previous sexual history. If you got herpes from the first person you slept with, somehow you are thought worse of than someone who has 100 partners but has never contracted anything. And requiring tests under the "I will not fuck you if you have anything" tends to irk me.

*end rant* You have stated here previously that even if the odds are against you, it sucks to be that person who gets an STI. Some people have different levels of risk, we all have to select the one that we are most comfortable with. :-)

[joreth]

I can only speak for myself, but when I refuse to have sex with someone who has an STI, it is for two reasons only: so I don't get sick and so anyone I'm sleeping with doesn't get sick. It has absolutely nothing to do with someone being "less" or "dirty" or any other sex-negative moral judgement. I tend to not kiss people who have colds either. I just don't want to get sick. I don't have health care and even if I could afford the treatment, I choose to not intentionally place myself in the position of dying or living with a painful illness. We all do some risky activities, like driving, but I choose to wear a seatbelt when I do it and I don't ride as a passenger with a drunk driver. An ounce of prevention and all that.

This is a self-preservation act, not a "judgement" act. I, at least, am perfectly aware of how easy it is to contract an STI with your first partner. In fact, I contracted HPV when I was 16 and had only had 3 partners ever before, and the person I got it from didn't even penetrate me, so believe me, I have no "moral" judgements about people with STDs. But I don't want to die and I don't want to get sick. I don't even want to get a cold or the flu, and I take measures against that, including keeping my distance when someone has a runny nose and fever.

I think a lot of people who believe that those requesting test results do so out of moral judgement are, perhaps, displaying their own sense of guilt. Maybe not you, but I have heard this from others before, and a great many times, these people are judging themselves and projecting it onto others, as evidenced by those who did accuse me directly of being judgemental when I know good and well that I'm not. Not to say that no one who subscribes to the testing system isn't somehow prejudiced against people with STDs, but certainly no one in my own romantic network thinks that way.

[stacycat69.livejournal.com]

But, you would not dump your partner for being physically sick (I would assume). Would you start a relationship with someone that was immunocompromised for a reason unrelated to an STI? If someone had leukemia, and thus would be sick with colds more often, would that prevent you from starting a relationship? Or continuing one?

What happens if you meet and fall in love with someone, who then says that they will not sleep with you because you have HPV? (Besides pointing out the obvious that it is very prevalent).

the guilt? Ive seen it happen with a lot of friends of mine. Someone tests positive (usually for HSV2), then their network gets tested, and the most sexually active individual gets blamed for the infection in a game I call "blame the slut." I dont want to be in that situation (because, hey, I am kinda slutty), so I tend to only have sex with people with whom I think will not play that game. Which tend to be people who do not require testing, or look at testing more about self knowledge, rather than a sexual or relationship gatekeeper.

[joreth]

First of all, we're talking about contagious illnesses here because the reason is personal safety. And yes, I would limit my contact to an existing partner who came down with a contagious illness that was not related to an STD. I did not say I would not *date* someone with an STD, I said I wouldn't have *sex* with them. Anyone who had a contagious illness of any kind would prevent me from engaging in those activities likely to pass along that infection. It's not about social stigma, I've already said it's about self-preservation. I would absolutely change my relationship with someone if I felt my own health were about to be compromised because of choices they were making. In fact, I have.

I also have met and fallen for people who then said they would not sleep with me because of the HPV. I understand that completely and have no problem with it, as everyone has the right to decide for themselves their own risk assessment. For the record, my HPV no longer shows up, because that's what HPV does after a couple of years and it's been 15 years since I had it.

There are lots of people I will not get into relationships with who have behaviour patterns that are destructive and I don't see choosing partners based on sexual compatibility to be any different, nor do I see anything wrong with people making judgements based on a person's behaviour when choosing a romantic partner. We all have to assess our own risk level, and insisting that people be open to dating someone that they feel is not compatible on a sexual, moral, behaviour, political, any kind of scale just to avoid hurting someone's feelings is just silly. I don't drink alcohol or do drugs, for instance, and I choose not to date people who do. That's a "judgement" of their behaviour. If we didn't judge anyone, we would never have a method for removing destructive, or perceived destructive, elements from our lives.

If a poly network comes up with an infection, the more likely point of entry is, in fact, the person with the more frequent and less safe partners. That's just a fact, whether someone wants to feel bad about it or not. With some STDs, we can actually trace the point of entry, and with others we cannot. HPV, for example, cannot be traced to the point of entry because there is no test for men and because it can lie dormant for a long time, in addition to being transfered by simple contact and not intercourse.

So when an infection can actually be traced back to the point of entry into a network, and the point of entry is a person who tends to have more partners, casual partners, and more lax screening standards, then, in fact, that person is responsible for introducing the infection into the group. Now, when those behaviours are approved by the other members of the group, this isn't necessarily "blame" in a morally judgemental way, but it is, in fact, the result of a single person's behaviour and choices.

What asking for test results does in a practical way is give each member of the group a solid baseline for estimating risk potential. There is no confusion, no misunderstanding, and everyone begins on the same page. Regular testing should be done by everyone, not just poly people, and not to find blame, but for basic health, just as a PAP should be done once a year and a regular physical. So, since we're all supposed to be getting tested anyway, trading the test results only evens the playing field by making sure everyone knows exactly what everyone else is talking about.

continued

[joreth]

I have had conversations with people that go something like this:

"Have you been tested?"
"Sure!"
"For what?"
"I told the doctor to test me for everything"
"And?"
"I'm clean"

When, in reality, that person didn't actually ask the doctor what tests were being performed. Many clinics, for example, only test for 4 STDs and do not give PAPs to women, so when you say "give me everything", the doctor gives you everything they test for, not all tests that exist. So these people were not actually tested for "everything". The test results clearly show which tests were adminstered and what the results were, so no one's faulty memory or misunderstanding can muck up the disclosure process.

It's not about assigning blame or "sluttiness", it's about realizing the very human tendency to not understand and convey information accurately. But test results on paper are clear.

[leora.livejournal.com]

There are other ways for it to play out though. Such as the network talking about which risks they are willing to take.

Some people will get tested and won't have sex with someone who has HIV, and if someone had something treatable won't have sex with them until the treatment is finished (which is just good health and common sense) but are willing to risk herpes and/or HPV. Each network has to make its own rules.

I don't think it's fair for me to expose a current partner to a risk they're not okay with. And I don't want to take on a new partner if it will cost me a current partner; I think that's just good poly and relationship skills. But it's also okay to say: well, here is what we know about the risk as best as we can tell - what level of risk are you willing to accept? And you can pick your partners that pick a level that is roughly the same as yours.

To me, testing is about knowledge and peace of mind. And if anything turned up, then it's about discussion with everyone affected to choose what we will do about it. But it isn't fair to a current partner to increase their risks without their consent.

[joreth]

I totally agree with you here. The testing is a method to reveal information. Each group can then decide what to do with the information. I know that I, personally, tend to choose to not risk losing an existing partner in favor of a new or potential partner, and that's partly what the testing can offer. It's not the only thing, of course, but it is an empirical source of information that is not subject to misinterpretation.

I'm going with the assumption here that all instances of misinformation are due to communication errors and lack of knowledge, not outright malignant behaviour. Although I'm sure that happens, that's not really the point of testing or any other safety measure. Some people feel that they are being discriminated against as "bad people", and these kinds of methods are not meant to indicate who is a "bad person", but to give a starting point for the discussion, to reach an informed consent of all parties involved.

It's the informed part that makes the consent so important. If one is not informed, one cannot reasonably give consent. Trading test results gives plain, unemotional, clear-cut information on which to base one's consent. And that's all it should be used for and that's all I've ever seen it used for in my own experience.

[skyeyedoc.livejournal.com]

It's heartening to see applied mathematics helping us to guide our sexual behavior instead of the usual blunt implements of fear, hearsay, and dogma.

I've explored your other posts, joreth, and am SO impressed with you and your partners approach to coherence and respect for one-anothers' well-being.

Thanks for posting this.

[joreth]

Why thank you