Risk of HIV infection from breeding while being a top.

Question

Hi. I know this is rather blunt, but I can't seem to get a straight answer from the medical pro's I've asked. My situation is kind of odd. I am a 47 y.o. gay man who has been in long term relationships since my mid 20's. I have been single for about 8 months and the reality of what is available today with our computer age is staggering! I've been kind of the virtual 'kid in a candy store' these past several months. I have been hooking up from time to time with men who want to be breeded, as in fucked without a condom and ejaculate inside them. WHAT is the risk to me if I have anal sex as the top(giver)? I have been tested very recently and am ddf as of April of this year. If I have anal sex with a guy who is positive and I am the top, what is my risk? Very low? Medium? WHAT ARE YOU THINKING? Please help me with this. Thank you. I am SO sincere. I've tried getting the answer to this from local health care professionals, but all they can tell me is use protection. Yes, I realize that would be the wise thing to do, but what if I haven't? Help! AJK

Answer

Hello AJK,

Top or bottom, unprotected anal sex is risky behavior; very risky. The CDC's estimated per-act risk for acquiring HIV from unprotected insertive anal sex with a partner confirmed to be HIV infected is 6.5 per 10,000 exposures. This is a very high relative risk. Actual risk would also depend on additional factors involving the virus (viral strain, viral load, etc.) and the host (immune integrity, concurrent STDs, trauma during sex, etc.). As for the level of risk, it would definitely qualify for "WHAT ARE YOU THINKING?!" In addition to HIV, there is a host of other STDs that can be acquired via barebacking.

If you're wondering if top guys can contract HIV the answer is a resounding "of course they can!"

If you've placed yourself at risk for HIV/STDs by having unsafe sex, I would suggest you get STD screened now plus get an HIV-antibody test at the three-month mark.

Finally, cover your rocket or keep it in your pocket, OK?

Good luck. Stay safe. Stay well.

Dr. Bob