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Being a Top

Oct 3, 2000

What are the risks from being a top, are the risks the same as a bottom or less? please let me know

Response from Mr. Kull

I'm assuming by "top" you mean the insertive partner in anal sex, and "bottom" means the receptive partner in anal sex. I will also assume that you would like to know the risks involved in unprotected, as opposed to protected, anal sex.

We know that the bottom is at much greater risk for HIV infection than the top in anal sex. The specific data on HIV transmission from a bottom to a top during unprotected anal sex are controversial (see response to and links in Serodiscordant male couple anal sex). The risk is probably higher for the top in this scenario than for someone performing oral sex on an HIV-positive man. The actual degree of risk will vary in each situation depending on numerous variables (viral load, presence of blood, sexually transmitted infections, duration and frequency of exposures, and immunologic factors). The bottom is at much greater risk because the lining of the rectum is more likely to come into contact with more HIV infected fluids and is more vulnerable to infection than the urethra. Unprotected anal sex is risky to the top because the rectum is prone to microscopic tearing that could expose the top to blood, which is highly infectious.

Try not to risk it. Tops do get infected. Use a condom for anal sex.


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