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Session 2: Continuum of risk

Overview
A person’s risk for HIV may be high or low depending on one’s lifestyle and sexual behavior. It is
important for service providers to know the different types of risk exposures in relation to
HIV/AIDS that they may be able to provide appropriate information and guidance to their clients/
patients.

I. Objectives
After completing the session, the participants are expected to know certain behaviors that can
facilitate the transmission of HIV.

II. Methodology:
This session will make use of group discussion.
III. Preparation
Three large sheets of Manila paper will be prepared with the words HIGH RISK, LOW RISK, and NO
RISK written on top. Three sets of meta cards on which the various behaviors are written will be
prepared prior to this session. One meta card will contain one behavior. Other materials needed to
be prepared include masking tape and scissors.

IV. Time allotment

One hour will be allotted for this session.

V. The Learning Process

1. The facilitator will provide a brief overview of the activity. The output of this session will be three
sets of Manila paper posted on the wall where various behaviors will be placed under three
categories namely NO RISK, LOW RISK and HIGH RISK.
2. The participants will be divided into three groups with equal number of members.
3. The facilitator will distribute the Manila paper and the meta cards evenly among the three
groups.
4. The facilitator will explain the following directions for this exercise:
a. Members of the group will discuss each behavior written on the meta card and decide
whether it can be classified as NO RISK, LOW RISK and HIGH RISK.
b. Members will then place the meta card under the heading that describes the level of risk for
HIV infection that the behavior represents.
5. The facilitator will explain the following concepts:
a. HIGH RISK behaviors involve the exchange of blood, semen, breast milk or vaginal secretions
and pose a definite risk of transmitting HIV.
b. LOW RISK behaviors usually involve a barrier such as condom but there are activities during
which exchange of body fluids may occur that can pose a risk of transmitting the virus.
c. NO RISK behaviors involve no exchange of blood, semen, or vaginal secretions and thus pose
no risk of transmitting HIV.
 Listed below are examples of behaviors written on the meta cards. (for metacards)

Smucking Fellatio (penis-mouth) Tribadism (vulva to vulva)

Hugging Cunnilingus (penis-vagina) Phone sex
Mutual masturbation Penile- vaginal sex without condom Deep kissing (French kiss)
Penis-anus insertion Use of sex toys Body rubbing (massaging)
Necking and petting Intrafemoral sex (penis in between thighs) Penile- vaginal sex with
condom
Digital sex (finger sex) Cyber sex Watching sex videos

6. The facilitator may clarify some terminologies that the participants are not familiar during group
discussion.
7. The three groups will be given 20 minutes to discuss and place the meta cards under the three
categories of NO RISK, LOW RISK and HIGH RISK written on top of the Manila paper.
8. After 20 minutes, each group will be given a chance to discuss their output and the facilitator will
validate whether the group was able to place the behavior under the right category.

FACILITATOR’S NOTES

The risky behaviors written on the meta cards can be described as follows:
a. Kissing is considered as low risk behavior. For HIV transmission to take place, 8 gallons or
32 liters of saliva need to be exchanged during kissing. .
b. Rough sex act can result to break in intact skin that can lead to exposure to more than one
type of body fluids, namely blood, semen and vaginal fluid. This behavior poses high risk of
HIV transmission.
c. There is one documented case of HIV from sharing of sex toys (female to female). It is
important that sex toys are not shared or condoms must be used when using sex toys.

Other behaviors and their risk level can be found in the table below.

Table 1. Continuum of Risk

Practice Risk Remarks

(to be written in the
meta cards)
Abstinence No risk Abstaining from sexual contact is still the
best option whenever possible.
Masturbation No risk There is no risk because there is no
exchange of body fluid with another
person.
Sex with a monogamous No risk Sex with one partner, especially if the
uninfected partner who partner doesn’t have any history of blood
doesn’t have any history transfusion, promiscuous sexual activity
of blood transfusion, and intravenous drug use in the past,
promiscuous sexual poses no risk of HIV transmission.
activity and intravenous
drug use
 Practice Risk Remarks
(to be written in the
meta cards)
Shaking hands and No risk This activity poses no risk because it
hugging an HIV positive does not involve exchange of body fluids.
person
Sitting in a public toilet No risk Even if the toilet seat has been spilled
with vaginal/urethral secretions, the HIV
virus cannot live long outside the body of
the host. This activity poses no risk.
Getting bitten by a No risk This poses no risk because HIV virus
mosquito cannot live inside the body of the
mosquito even if the mosquito has bitten
an HIV infected individual.
Sexual stimulation of Low risk/No risk The risk is very low if the skin is intact
genitals using hands and there is no contact with
urethral/vaginal secretions and
menstrual blood.
Deep (tongue or French) Low risk/No risk There is a risk if the gums are bleeding or
kissing there are open sores or cuts in the buccal
mucosa. However, there is no risk of
transmission with saliva.
Oral sex with condom Low risk/No risk There will be a risk if condom is not used
properly and consistently.
Vaginal sex with Low risk There will be a risk if condom is not used
condom properly and consistently
Vaginal sex without a High risk This poses high risk of HIV transmission
condom because there is exchange of vaginal and
urethral secretions.
Withdrawal of penis High risk Semen may be discharged even prior to
prior to ejaculation ejaculation. Therefore this activity poses
high risk.
Anal sex with condom Low risk The risk of condom breakage is greater
during anal sex than during vaginal sex.
Therefore anal sex even with condom use
poses low risk of HIV transmission.
Anal sex without High risk One of the activities presenting the
condom highest risk of HIV transmission. The
receptive partner is at greater risk
because the tissue lining the rectum is
highly prone to lesions and tears because
it does not produce secretions that can
act as lubricants like the vagina. The risk
rises with an increase in the number of
partners with whom unsafe sex is
practiced.
Massage No risk As long as there is no exchange of body
fluids during massage, this activity poses
no risk.
 Practice Risk Remarks
(to be written in the
meta cards)
Helping someone with No risk As long as there is no break in the skin
nosebleed and hands do not come in contact with
blood, helping someone with nose bleed
poses no risk.
Vaginal sex using High risk Contraceptives and IUD can prevent
contraceptives, IUD, etc., pregnancy but it is only condom that is
but not a condom proven to be effective in preventing HIV
transmission by acting as a physical
barrier.

Using sharp instrument High risk If the instruments have not been
to cut skin (e.g., tattoo, properly cleaned and or sterilized, HIV
body piercing, etc.) and other blood borne infection can be
transmitted using these instruments.

Sharing of needles, High risk HIV and other blood borne infection can
syringes, or other drug readily be transmitted from an infected
paraphernalia person by using and sharing of needles,
syringes and other drug paraphernalia.
Vaginal sex during High risk Risk is even higher because of contact
menstruation without not only with vaginal secretion but also
condom use with menstrual blood.

Breastfeeding by an HIV- High risk The risk is high but the possibility of
positive mother MTCT can be decreased by intake of ARV
drugs by the mother and the infant.

Donating and receiving Low to High Risk Donating blood should not pose any risk
blood if the equipments used to collect blood
are disposable and or properly sterilized.
Receiving blood should not incur any risk
if the blood to be transfused has been
properly screened for blood borne
infections including HIV. However, the
risk is still there even if the screening
showed a non-reactive test result
because of the window period.
Labor and delivery Low to High Risk MTCT is most likely to occur because
there is exposure of the baby to maternal
secretions during labor and delivery.
However, the risk can be decreased by
proper management of labor and
delivery of an HIV-infected mother and
ARV prophylaxis.
Occupational exposure Risk varies, HIV and other blood borne infections can
to blood depending on be transmitted through accidental
 Practice Risk Remarks
(to be written in the
meta cards)
type of exposure exposure to blood such as needle prick
especially with large bore needle. The
risk of exposure can be minimized if
universal precautions are observed by
health workers.
Vaginal/ anal sex using High risk Oil based lubricants can damage the
oil based lubricants and condoms and therefore increase the
condoms likelihood of breakage during
intercourse.
Using the same condom High risk Condoms should only be used once and
twice should be properly disposed. Using it for
the second time is not hygienic and it
also increases the likelihood of breakage
and slippage.
Telling each other sexual No risk It can increase intimacy and pleasure
fantasies with no risk of infection as long as it does
not lead to unsafe sex practices.
Swimming in public No risk This poses no risk because this activity
pool does not involve exchange of body fluids.
Besides HIV virus cannot live long
outside the body.
Going to the dentist No risk There is no risk provided that the dentist
uses properly cleaned and sterile
equipments.
Cleaning up blood spill No risk This activity poses no risk especially if
using latex gloves the gloves are intact.