Hi doc, I was diagnosed positive in Jan 2008, with CD4 210, doctors have advised me to go for medication. I'm gay and I had numerous sexual relations with other gays, most of the time I had bareback sex with cum shoot inside anal. Realizing I'm positive, I refused to play bareback now. 2 months ago I met a guy and we decided to have sex, I told him I'm positive, and he requested not to use condom (he wanted to feel the skin). Being top I told him he could be infected, and he say when I am close to ejaculating take it out from his anal which we agreed. We had sex and during the point of ejaculation I cum on top of his anal and not inside. We had sex numerous times thereafter and each time I request to use condom he refuse, all he ask me is to fuck him without condom to have the skin to skin feelings and he also remind me to ejaculate the cum outside his anal. Each time after the sex he seems happy and not to worry much however that bothers me so much and I am more worried than him for both of us. Now my question is that - were he was infected with HIV since I didn't cum inside his anal? What would be the percentage of infection when ejaculation made outside the anal? Will there be anything wrong with me when I am having unprotected sex with a negative partner without use of condom?

Hello,

Your sex partner who "wanted to feel the skin" is placing himself in grave danger of contracting many STDs, including HIV. "Withdrawal" (ejaculating outside the anal canal) does decrease the risk of HIV transmission somewhat, but certainly does not eliminate it. HIV can be transmitted via pre-cum (pre-ejaculatory fluid). Consequently, every time your buddy wants to play Brokeback Mountain Bareback Sex, he's essentially playing sexual Russian roulette. Since you obviously have more common sense than your bottom boy, if he refuses to allow you to use a condom, you should refuse to have sex with him. It takes two to do the unsafe sex tango!

Next, you report your CD4 count is 210 and your doctors have advised you to start medication. I strongly agree! Hopefully you've started already, since you were diagnosed in January and it's already May. If you haven't started yet, what are you waiting for??? Your CD4 count is falling into a dangerous range where you are becoming more susceptible to opportunistic infections, such as PCP (Pneumocystis carinii pneumonia). Finally, regarding your personal worries about barebacking, this should indeed be a concern for you. Barebacking, even as a top, places you at risk for acquiring additional, potentially more aggressive, strains of HIV (superinfection, reinfection) and also other STDs, which could significantly worsen your HIV disease. You have multiple reasons to insist on safer sex/condom use. It is not only the right thing to do for your partner; it's the right thing to do for yourself.

Dr. Bob