What I Do Makes a Difference

In Australia, more than 85% of people who are HIV+ are men-who-have-sex-with-men. Thanks to years of safe-sex campaigns, most Australian men know that condoms and water-based lube are the most effective way to stop HIV from being passed on during sex. However, almost every case of HIV infection in men-who-have-sex-with-men, has occurred as a result of not using condoms during anal sex.

Most men don't use condoms at one time or another. Sometimes the decision is made wisely, with an informed sense of the risk being taken and efforts made to reduce the risk of getting or passing on HIV. At other times, the decision is made in a less-than-informed way, with not a lot of effort being made to reduce risk. Sometimes we’re not really sure how risky or safe what we’re doing really is, or we just don’t want to think about HIV at the time. Often it’s not until later that we start thinking about the risks we may have exposed ourselves to.

What follows here is not an attempt to advise you to not use condoms. It is given in the knowledge that, while condoms and lube are always the easiest and most effective way to stop HIV transmission in casual sex, there are other things we can do to reduce the chances of HIV being passed on when we don’t use condoms. Most of these strategies will reduce risk, but not eliminate it altogether.

Want To Top?

Some men of different HIV statuses (ie, when one man is HIV+, and the other man is HIV- ) fuck without condoms, by having the negative guy 'top' (that is, be in the active, dominant, or insertive position in anal sex), and the positive guy 'bottom' (that is, be in the passive, submissive, or receptive position). Sometimes, this is called 'strategic positioning'.

Strategic positioning is based on the fact that the HIV- man is statistically less likely to become infected during unprotected anal sex if he is the 'top' (ie, the man doing the fucking), rather than the 'bottom' (ie', the man being fucked). This is because it is easier for the HIV virus to get into a man's body through the rectum – especially if the man fucking him comes inside him – than through the tip of the penis.

However, some men have caught HIV even though they’ve used this strategy. Around 1 in 5 men who recently contracted HIV were tops. Strategic positioning reduces the chances of HIV being passed on, but it does not eliminate the possibility altogether. It is important that both men know what HIV status they are.

Strategic positioning can also result in men taking a position in anal sex that they wouldn’t normally choose to take – ie, as a top or a bottom - because they have a different HIV status than their sexual partner. Men who are 'bottoming' for the first time need to take it carefully at first, so as not to injure themselves and make themselves more susceptible to HIV. Men who are 'topping' for the first time should also take care not to injure their partner by being too rough.

I’m Pulling Out!

Some men reduce the chances of HIV being passed on, when they fuck without a condom, by pulling out before cumming. While this might reduce the chances of HIV being passed on, it doesn’t eliminate the chances altogether. Pre-cum (the clear fluid that comes out of your dick prior to cumming) can contain HIV, and little breaks and tears can occur in the lining of the arse when fucking, increasing the chances of HIV being passed on. HIV can also enter the head of the dick from another man’s arse.

Counting Down

Some men use the results of viral load tests to make decisions about unprotected anal sex. Viral load is a test taken by HIV+ men to measure the amount of HIV in their blood. These tests help HIV+ people and their doctors to make decisions about taking HIV treatment drugs. A person's viral load can be affected by a range of factors, including taking HIV treatments, which generally lower the amount of HIV in the blood, and having other sexually transmitted infections or general infections like the 'flu, either of which can increase a person's viral load.

Commonly, people with HIV who are well check their viral load every three months. It is possible for a person's viral load to go up and down quickly, depending on what else is happening to their health, so the results of a viral load test taken weeks - or even days ago - may be very different to what that person's viral load is now.

The lowest viral load results available are called 'undetectable'. This doesn't mean that there is no viral load (only HIV negative people have a zero viral load), it only means that the viral load is below the level detectable by current tests.

Also, viral load tests only measure the amount of virus in the blood: there is no test readily available to measure the viral load in cum.

Many HIV+ men would like to know if having a low or undetectable viral load in their blood means that the viral load in their cum will be equally low. Many experts say that, generally, viral load results can be applied to virus levels in cum, however there is evidence that suggests there can be quite different levels of virus in blood and cum at the same time. For example, the presence of other sexually transmitted infections can rapidly increase the levels of HIV in cum.

Some men assume that having an undetectable viral load means that there is no chance of them passing on HIV during unprotected anal sex. This is incorrect. HIV treatments cannot make an HIV+ man become HIV- again. Once a man becomes HIV+, it will always be possible for him to pass HIV on to someone else, no matter how effective HIV treatment is for him, or how low or undetectable his viral load is.

Remember: a viral load count only indicates what your viral load was at the time of your last test, not what it might be at the moment.

I Don’t Know Anyone With HIV

Some HIV- men don’t use condoms because they think there aren't HIV+ men around the places they go to have sex, like beats, sex clubs, and saunas. They are incorrect. HIV+ people live in all areas of Victoria and Australia, including inner city, suburban, regional, and rural areas. A lot of people still think that HIV is an inner city problem, and that no one in their suburb or town has HIV. It's also important for people travelling not to make assumptions about there being no HIV+ men around. Wherever you are, it's important not to assume that a guy you’re cruising or having sex with has the same HIV status as you.

I Didn’t Think He Was Negative/Positive

In some sex clubs where HIV+ men tend to gather, some HIV+ men don’t use condoms. In such a setting, it’s easy to assume that the other guy is HIV+ as well, if he doesn’t initiate the use of condoms.

Remember: you can never be sure whether another guy has the same HIV status as you.

It’s easy for men with HIV to assume that men who are HIV- will tell them their status, but a lot of HIV- men assume or expect that HIV+ men will tell them their HIV status first. HIV+ men often get rejected by HIV- men when they tell them they’re HIV+: many HIV- men won’t have sex with a guy they know is HIV+. You can’t always rely on HIV+ men to say they’re positive when they know they’re likely to be rejected, or don’t know whether you will respect their right to privacy, and not tell other people. So, when you’re fucking a guy, whether you’re HIV+ or HIV-, don’t assume that he’s going to reveal his HIV status to you.

Not all men know their HIV status, so they couldn't tell you whether they were HIV+ or HIV-, even if they wanted to. A lot of guys who don't know their own HIV status assume that they're negative when they might not be, so you can't assume that what they tell you is accurate.

A lot of men still think they can tell whether a man is HIV+ or HIV- just by looking at him. Men of all ages and all walks of life are getting HIV. There is not one single 'type' of man who is HIV+. HIV+ men look as different from each other as HIV- men do. And a lot of HIV+ men don’t look 'sick'.

Many men make judgments about other men's HIV status by their willingness to use condoms, but different men have different ideas about what wanting to use condoms indicates about a man's HIV status. Some men think that wanting to use a condom means a man is HIV-; others think it means he’s HIV+. Research indicates that men make different assumptions, about what condom use says about HIV status, in different cities and towns across Australia. There's no way to tell whether a man is HIV+ or HIV- from the way he looks, how old he is, or whether or not he wants to use a condom.

I Must Be Immune

Some HIV- men who have had sex without condoms - with men whose HIV status they don't know - have not contracted HIV. Others have had sex without condoms with men who they've even known were HIV+, and have still not been infected with HIV. Sometimes, HIV- men and HIV+ men have knowingly fucked together, and the HIV- man has stayed HIV-. As a result, some of these HIV- men think they are immune to HIV.

No-one is immune to HIV.

HIV only needs one opportunity to pass from one person to another, so the more opportunities you give the virus, the more likely it is to happen. In other words, the more chances you take with your HIV status, the higher the chances of you getting HIV. Just because something has happened to you once or twice, or even many times before, doesn't mean the same thing will happen each time in the future. So the more you fuck without condoms, and the more men you fuck with, the more likely it is you will get and/or pass on HIV.