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Pozitively Healthy: A Gay Man's Guide to Sex and Health in Canada

2009

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An HIV Positive Guy's Guide to Safer Sex

Many of us worry about passing on HIV or becoming re-infected with a different strain of HIV. That worry might never go away completely. But you can have great sex without passing on HIV or becoming re-infected with HIV. Great safer sex starts with an understanding of the risks involved in sex.

Figuring Out the Risk of HIV Transmission

When experts figure out the risk of passing on HIV during sex, they ask two questions:

  1. Is there a potential that HIV can be transmitted from one person to another during a sex act?

    • An HIV positive man's blood, cum, pre-cum and ass fluids can contain enough virus to infect another person with HIV.
    • Blood, cum, pre-cum or ass fluids that contain HIV must get directly into the other guy's bloodstream.
    • Or the cells lining the inside of other guy's ass, piss hole or mouth must absorb blood, cum, pre-cum or ass fluids that contain HIV.
  2. Is there evidence that HIV has been transmitted from one person to another during that sex act?

Based on the answers to these two questions, experts have developed four different categories of HIV transmission risk for sex:

  • High risk sex (potential for HIV transmission and evidence of HIV transmission).
  • Low risk sex (potential for HIV transmission and evidence of HIV transmission under certain circumstances).
  • Negligible risk sex (potential for HIV transmission but no evidence of transmission).
  • No risk sex (no potential for HIV transmission and no evidence of transmission).

Condoms Can Prevent HIV Transmission

Great safer sex starts with an understanding of the risks involved in sex.

Some gay guys, no matter what their HIV status, are tired of hearing about condoms. But condoms work. When they are used properly, condoms are the single best way to prevent HIV transmission when guys have anal sex or oral sex. Condoms can also prevent you from becoming re-infected with a different strain of HIV. And condoms can protect you against many other sexually transmitted infections (STIs).

The HIV Risk Table for HIV Positive Guys

Use this table to figure out your risk of passing on HIV to a guy during sex. The information in this table is only about HIV. For information about other STIs, see Other STIs can increase the risk of passing on HIV. Most other STIs are spread more easily than HIV. Some of the information in the table will apply to you if you are a gay or queer transman. For more information about safer sex for gay and queer transmen read Primed: The Back Pocket Guide for Transmen & The Men Who Dig Them. For detailed information about your legal duty to disclose your HIV status, sex and the law, read HIV disclosure: a legal guide for gay men in Canada.

The sex Your risk of passing on HIV Some important details

You fuck him (anal sex) without a condom.
You are the top.

High risk

HIV can get into his body through the lining of his ass, even if the lining is not damaged HIV can get into his ass even if you don't shoot your cum inside him. Your pre-cum contains HIV, and you can leak small amounts of cum before you have an orgasm. So sticking your cock into the other guy's ass just a little, for just a short time (sometimes called "dipping") or pulling it out before cumming is high risk. Rough sex can damage his ass and your cock. This increases the risk of passing on HIV.

He fucks you (anal sex) without a condom
You are the bottom.

High risk

Inside your ass there are fluids that contain a lot of HIV. HIV can get into his body through tiny cuts or open sores on his cock, through his foreskin or through the lining of his piss hole (urethra). Rough sex can damage his cock and your ass. This increases the risk of passing on HIV.

You put a sex toy in him after it has been in you.

High risk

 

You fuck him (anal sex) or he fucks you with a condom on. If you are the top or the bottom.

Low risk

 

He sucks your cock without a condom on it.

Low risk

 The risk of passing on HIV is increased if he gets your cum or pre-cum in his mouth.

You suck his cock with or without a condom on it.

Negligible risk

 

He sucks your cock with a condom on it.

Negligible risk

 

You rim a guy's ass, he rims your ass, you finger his ass, he fingers your ass, you stick the head of your cock into his foreskin "docking", he sticks the head of his cock into your foreskin, cock and ball torture.

Negligible risk

 

You fist a guy's ass, or he fists your ass.

Negligible risk

 

You piss or shit in a guy's mouth or on his damaged skin.

Negligible risk

If there is blood in your shit or piss this can increase the risk of passing on HIV to him. Getting shit on open skin carries a high risk of bacterial infection and can lead to blood poisoning. This is true whether or not the shit comes from someone who has HIV.

You piss or shit on his skin that is not broken or damaged.

No risk

 

Kissing, jerking off each other, playing with sex toys without sharing them.

No risk

 

Your HIV Viral Load Can Make a Difference

You can still pass on HIV during sex even if your viral load is "undetectable."

If you are taking HIV medications and you have an "undetectable" viral load this means that your medications are doing a good job controlling the HIV in your body. But you can still pass on HIV during sex even if your viral load is "undetectable."

Most HIV experts and community groups believe HIV positive people who have undetectable viral loads should continue to use condoms when they fuck. Here are some medical and legal reasons why:

  • Studies have not looked at how a man's viral load affects the risk of passing on HIV to another man during sex.
  • Even if HIV is undetectable in your blood, high levels of HIV may still be present in your cum, pre-cum and ass fluids.
  • Your viral load might have gone up since the last time you had a viral load test.
  • Even if your viral load is undetectable, you still have a legal duty under the criminal law to disclose your HIV status before you expose someone to a significant risk of HIV transmission.

Other STIs Can Increase the Risk of Passing on HIV

If you have an untreated STI you are more likely to pass HIV on to another guy during unprotected sex. And if an HIV negative guy has an untreated STI, it is easier for him to get HIV during sex.

Cut or Uncut

Not many studies have looked at whether circumcision (having a cut cock) can protect gay men from getting HIV or reduce their risk of passing on HIV. The results from these studies don't provide any clear answer.

Slip-Ups, Mistakes and Condom Breaks

Condoms sometimes break or slip off when we are fucking. And some of us might fuck without a condom, even though we didn't intend to and afterwards we wish we hadn't.

An HIV negative guy who is exposed to HIV can take HIV medications to try to stay uninfected. This medical treatment is called PEP -- short for "post-exposure prophylaxis." Scientists believe that PEP reduces the risk that someone will become HIV positive after being exposed to HIV.

A doctor must prescribe PEP. Go to a hospital emergency department. But doctors and other staff at medical clinics and emergency rooms may not know about PEP. Or they may not have a clear policy on who can get PEP. If a guy has problems getting PEP he should insist on seeing an infectious disease specialist doctor.

If you're on HIV medications, you may think it is a good idea to give the guy some of your medications. That's not recommended. Your HIV medications may not be an effective PEP treatment. And it may leave you short on medications later on.

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This article was provided by Canadian AIDS Treatment Information Exchange. Visit CATIE's Web site to find out more about their activities, publications and services.
 
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