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Dec 8, 2002

my boyfriend is a top and hiv- and i am a bottom hiv+, he wants to have sex with me without a condom and he wants to know how high of a chance he has getting infected?

Response from Mr. Kull

If your boyfriend tops you without a condom, he will be at risk for infection with HIV.

There is a popular conception that the top in anal or vaginal sex is not at risk for HIV infection; this is not true. It is possible to become HIV infected as the insertive (top) partner during anal sex without a condom. Unprotected insertive anal sex poses a smaller risk for transmission than unprotected receptive anal sex, but the risk is there.

HIV infected fluids coming into contact with the urethra could lead to infection. There is also evidence that uncircumcised men may be at greater risk for infection during unprotected insertive sex than circumcised men (the interior lining of the foreskin contains cells prone to infection).

The main concern for the insertive partner during anal sex is that trauma to the rectum during anal sex can lead to bleeding. Blood can be highly infectious.

While the risk for transmission is lower, maybe even much lower, for the insertive partner, transmission is possible and does happen. The more times a person has unprotected insertive anal sex with an HIV positive partner, the odds for transmission increase.

Talking about odds or chances is complicated and difficult to measure; besides, this isn't a casino. If you and your boyfriend decide to not take a gamble and use condoms, great. If you decide to not use condoms, there needs to be an explicit discussion and understanding about the real risk for HIV transmission and how that would affect the two of you.


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