Anonymous
Hello

This is with reference to your post regarding hand jobs.
http://helpline.aidsvancouver.org/what-we-do/helpline/online/will-receiving-handjob-transmit-hiv

I read in some sites that the inner foreskin and the glans are ALSO considered mucous membrane and are permeable to HIV just like the urethra. However your post above mentioned that the fluids containing the virus must come into contact with the urethra, and you did not mention the shaft and inner foreskin. During a handjob, the masseur retracts the foreskin and massages the area beneath.

Please could you confirm that this area is not as susceptible and permeable?

Regards

Vikram
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Anonymous
Hello Vikram and thank you for your question.

You are correct in that the glans and the inner foreskin are considered mucosal membranes.

I'm just going to provide a little bit of information on mucosal membranes. Mucosal membranes are areas of the body that are selectively permeable to certain things such as nutrients (in the intestine). The outermost surface of mucosal membranes is a keratin layer that helps prevent entry into the skin, some areas have a thicker layer of this than others. Below the outermost surface of mucosal membranes are immune cells that help prevent infection from unwanted bacteria/viruses. Unfortunately, the mechanism under which HIV colonises is through these very immune cells.Those HIV targeted immune cells are all over the male genitals such as the shaft, inner foreskin, glans, and urethra. However, the most permeable areas are the inner foreskin and the urethral mucosal membranes as the layer of keratinized skin is the thinnest. The glans and the outer foreskin have a much thicker layer of epithelial cells preventing HIV from entering the immune cells that lie underneath. There are circumstances under which acquiring HIV in these area's with a thicker layer of keratinized skin is increased such as having a sexually transmitted infection; STI's may break down the protective layer thereby exposing the immune cells to HIV.

As previously stated by Jon in the post, even if there was blood on the masseuses hands (which there wasn't any blood apparent) the virus would have died within seconds of exposure to air. Despite the fact that the mucosal membranes can potentially put you at risk of acquiring HIV, the circumstances by which the activity is defined (hand job) do not provide an environment that would allow for transmission to occur. As a result there is no risk of acquiring HIV.

For more information on the HIV transmission focusing on the biology of the penis you can visit the following website for [Canadian AIDS Treatment Information Exchange ](http://www.catie.ca/fact-sheets/prevention/hiv-transmission-overview)

This study also provides an in depth look at the areas of the penis more susceptible to HIV infection and why.
McCoombe SG et al. Potential HIV-1 target cells in the human penis. AIDS 20: 1491-1495, 2006

I hope this addresses your concerns,

In health, Johannah AIDS Vancouver volunteer

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