Anal sex and risk reduction

The following information is based on a social marketing campaign developed by the AFAO-NAPWA Education Team in 2001, called No Worries, which addressed questions regarding the relative safety of some strategies utilised by gay and other men who have sex with men to reduce the risk of HIV transmission when having anal sex.

Is it safer to fuck than to be fucked?

Yes, but...

This doesn’t mean there is no HIV risk to a negative guy who is the insertive partner (‘top’) when fucking without a condom – there is.

HIV is more easily transmitted from the insertive to the receptive partner but neither position is safe.

During sex, the lining of the arse of the receptive partner (‘bottom’) can get damaged and HIV can enter the bloodstream of the insertive partner either through the eye of the penis or through small cuts on the skin.

If you’re willing to fuck without condoms, remember:

  • HIV risk is greater in the receptive position, but you can still get HIV if you are the insertive partner (‘top’);
  • Many gay men got HIV even though they were in the insertive position.


If he doesn’t cum inside, will this stop HIV?

No.

When fucking without a condom, there is a greater chance of HIV being transmitted if an HIV-positive guy ejaculates (‘cums’) inside.

However, HIV is also present in pre-cum and can be transmitted through the lining of the arse, which is often damaged during sex.

Some gay men believe that if they, or their partners, pull out before they cum, there is no risk of HIV being transmitted.

If you’re willing to fuck without condoms, remember:

  • pulling out before cumming is not an effective way of stopping HIV;
  • many gay men have become HIV-positive even though there was no cum inside.


Can I still pass on HIV if my last viral load test was ‘undetectable’?

Yes.

An ‘undetectable’ test result doesn’t mean you’re HIV-negative – it means the amount of virus in the blood is less than current tests can measure.

Usually this is related to the amount of virus in semen, but not always. Viral load in semen can also change rapidly due to other infections such as gonorrhoea which sometimes do not show any symptoms. A low viral load in semen means that the chance of passing on HIV while fucking is reduced, but this does not mean that there is no HIV risk – there is.

It is not known how much virus needs to be present for HIV transmission to occur.


How do I know if he’s the same HIV status as me?

In most cases you don’t.

Some men who are HIV-positive choose to fuck without condoms with other positive guys.

Sometimes this is talked about and agreed to beforehand, sometimes it’s not. Likewise, some men who are HIV-negative choose to fuck without condoms with guys they assume to be HIV-negative.

Assumptions like this are common. In fact, only rarely do gay men actually discuss HIV with casual sexual partners before fucking.

If you’re willing to fuck without condoms with casual partners, remember:

  • only rarely do gay men discuss their HIV status before they fuck;
  • HIV-positive men may assume you’re positive too;
  • HIV-negative men may assume you’re negative too.
Assumptions are often wrong

 


This page was published on 12 January, 2011

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