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Differing statuses. HIV+ and HIV- gay men
Aug 6, 2002

What do you do to protect yourself the best way when having sex with a positive man when you are a negative man?

Response from Mr. Kull

In order to protect yourself from HIV infection when having sex with another man, you need to know some basic concepts:

1) Having mucous membrane (in men, the lining of the rectum, urethra, or mouth) contact with your partner's semen or blood poses a risk for transmission.

2) Having unprotected receptive anal sex with ejaculation inside your body poses the greatest risk for infection. Having receptive sex without ejaculation and unprotected insertive sex also poses a significant risk.

3) Performing oral sex on a man poses a lower risk for infection, but remember, transmission is possible. For more information, see my response to Oral sex.

4) You are not at any real risk for infection when he performs oral sex on you, kisses you, when you masturbate with him, etc. HIV is known to be transmitted through anal and vaginal sex, and to the person performing oral sex.

5) Condoms are very effective in preventing HIV transmission. Studies do show that when condoms are used all of the time and correctly that the infection rate in mixed-status couples remains extremely low. Studies show that many mixed-status couples don't use condoms all of the time. Many factors can contribute to these lapses: safe sex fatigue, false confidence in antiviral treatments, depression, drug/alcohol use, denial, wanting greater intimacy, and the in-the-heat-of-the-moment slip. Failure to use condoms consistently (or ever) probably explains the majority of seroconversions.

6) Your partner's viral load (the level of virus in blood) may have an effect on transmission. In many HIV infected people, the use of antiviral medications greatly reduces the viral load in blood. Recent reports out of the XIII International AIDS Conference in South Africa give some information on viral load and it's role in sexual transmission. This is a complicated issue that requires further investigation because there is also evidence that the amount of virus present in a person's blood does not necessarily correlate to the amount of virus in their semen. So medications alone should not be relied upon as a way of preventing HIV transmission.

Yu can stay HIV negative when having sex with an HIV positive partner. Using latex condoms and water-based lubrication (WITHOUT nonoxynol-9) for sex greatly reduces the risk of transmission, and negotiating boundaries around sex and the risks involved is important in maintaining a psychological sense of safety.

RMK



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