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Hiv risk for a top?
Jun 22, 2005

My boyfriend is negative, and I'm positive. He's mostly a top, and I'm mostly a bottom.

He says he is comfortable having unprotected anal sex only when he is the top, but I am not sure I am comfortable with it. He says that there is little or no risk to him if he's the top. I love him and I am scared of infecting him.

I plan on talking to my doctor about this... but I want to get as much information as possible. How risky is unprotected anal sex, if he is the top?

I have been poz for 3 years, I am also on meds and undectable, and otherwise very healthy.

Response from Dr. Frascino

Hi,

I don't know whether to label this a QTND (Question That Never Dies) or a MTCKY (Myth That Could Kill You). Either way, I've addressed this "dangerous liaison" multiple times in this forum over the years. But there is an old proverb that says "repetition is the mother of learning," so the message bears repeating. There is a significant risk a negative top could contract HIV by having unprotected anal (or vaginal) sex with a positive bottom. The estimated per-act risk for acquiring HIV form unprotected insertive anal sex with an infected partner is 6.5 per 10,000 exposures. I'm confident your HIV specialist will corroborate this risk. It is true that having an undetectable viral load may decrease the risk somewhat, but not to the "little or no risk" category your boyfriend claims to be comfortable with. Your fears are justified; his nonchalance is not.

Stay well. Good luck to you both.

Dr. Bob



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