Unprotected sex
Condoms are the most effective and most reliable way of preventing the spread of HIV if you fuck. There are ways of reducing the risk of HIV being passed on if you don't use condoms when you fuck, but they are not reliable and the risk of catching HIV is still high if you use them. Even when you combine these methods, they will not be as safe as using condoms. In fact most are still risky, and some are only slightly less risky than not using condoms at all. These methods are not enough to stop you from being exposed to HIV and the more often you are exposed to HIV, the more likely it is that you will catch it.
GMFA recommends the use of condoms to prevent the transmission of HIV. We do not recommend the use of these methods as a strategy for ensuring that you remain HIV-negative.
If you are HIV-positive, and you do not tell your partner your HIV status, it is possible that you could be prosecuted for transmitting HIV if you do not use a condom, even if you have made other efforts to reduce the risk.
There are lots of misunderstandings about sex without condoms. Some guys think things are safer than they really are, and some guys do things because they think they are being safe when they really aren't. We have sorted out the facts from the fiction to bring you the hard truth about the risks you are taking if you don't use a condom.
What if I fuck less?
It's true that the less you fuck without condoms, the smaller the chance you will catch HIV. But even if you fuck less, if you don't use condoms when you do have sex you risk being infected with HIV. Some kinds of sex carry no risk of HIV transmission (wanking, rimming) and some are pretty low risk (blowjobs, especially if cum doesn't get in the mouth). Not every gay man enjoys fucking and if you don't want to use condoms you might want to explore other less risky ways of getting your rocks off.
What if I only fuck without condoms with guys with the same HIV status as me?
Some men choose to have sex without condoms with men that they think have the same HIV status as they do. So if a negative guy thinks that the guy he is about to have sex with is also negative, he might choose not to use condoms, but this can be a very risky thing to do, and here's why:
If you're HIV-negative, you would need to only have sex with other HIV-negative men to avoid HIV, but this is not easy to do. It's estimated that one in seven gay men on the London gay scene has HIV.1 There are no visual signs or sexual behaviours which will always guarantee someone will be HIV-positive or negative, even if you've guessed right in the past. There are many reasons why someone may not want to tell you their HIV status, and many men with HIV could not tell you because they have not been diagnosed. Around a quarter of HIV-positive men do not know that they are infected,2 and research has confirmed that some men who are HIV-positive believe themselves to be negative.3 If you are sexually active and have taken even small risks in the past, the only way to be sure of your status is to have an HIV test.
Consequently men who are HIV-negative cannot safely or reliably choose partners who are also negative from men they have just met in a bar or through internet sites.
Some HIV-positive men use online dating sites to find other HIV-positive men for condomless sex.4 There is a risk that an HIV-positive man can be reinfected with a different strain of the virus. We now know that this can happen, although we don't know how often it happens or what all the consequences are, but it is possible that reinfection with a drug-resistant strain of the virus may reduce your treatment options. Having sex without condoms will also leave you vulnerable to other sexually transmitted infections (such as syphilis, NSU, gonorrhoea, herpes and some forms of hepatitis) which can be harder to treat in men with a compromised immune system.
What if I want to stop using condoms with my boyfriend?
If you've slept with someone a few times, or you're starting a relationship, condoms might not seem as important. However, lots of guys have got HIV because they stopped using condoms with a partner who thought he was negative. It's difficult to know the exact fuck that led to someone getting HIV, but doctors have asked HIV-positive men when they thought they became infected. Roughly a third of recently-infected gay men thought it was from fucking with a regular partner.5
If you want to stop using condoms with a partner, and you both want to avoid HIV, it will help you to stay safe if you come up with a plan first. This could include how to cope with slip-ups and what your boundaries are for having sex with other guys.
This first step is to have the right facts. So before you go ahead, you need to be sure that you are both HIV-negative. If either of you has never tested, or if you have taken any sexual risks (such as fucking without condoms) since your last test, you should go for an HIV test to avoid any doubt about your HIV status.
If you and your partner take an HIV test at the same time, it helps you make an informed decision about the sex you have, and avoid guesswork. If you both test negative, you can decide if you want to rely on the trust and security of a relationship to stay HIV-negative. Many gay guys use this safer sex strategy with a long-term partner and, if you both test negative and don't fuck without condoms outside the relationship, it can work.
The decision to abandon condoms in a relationship can be tricky. There are lots of things to think about and you both need to be happy with the decision, without either of you feeling under pressure.
A healthy relationship is based on mutual trust and respect. We're all responsible for our own health and the health of our partners. So as part of your plan, you should agree whether you are both going to be monogamous or have sex with other guys. Either way, you need to be able to trust each other so neither of you has unprotected sex with other people. This can prevent one of you bringing HIV into the relationship. Talking openly with each other can help build and strengthen this trust.
Many men stick to their agreement with their boyfriend. Some men don't. It can take just one slip-up in the heat of the moment to put you both at risk.
Think about how you might cope if you or your boyfriend made a mistake. If you talk with each other about how you will address it before you ditch the condoms, it will make it a lot easier to own up and get back on track if one of you does fuck someone else without condoms.
If you have agreed to have an open relationship, there is still a risk of you catching other STIs if you use condoms. You might then pass these on to your partner. It is a good idea to go for regular check-ups to test for STIs as part of your plan.
Remember, if you are not sure ditching the condoms is the right decision, don't do it. If you have stopped using condoms and you ever doubt your decision, your HIV status, or the HIV status of your boyfriend, you have a right to go back to using condoms.
What if I go for regular check-ups?
Sexually transmitted infections can make HIV-positive men more infectious and HIV-negative men more vulnerable to infection. It is possible to have an STI without knowing it. Fortunately most STIs can be treated so long as they are detected soon enough. How often you get checked out depends on how many men you have sex with, and the kind of sex that you have. An STI check-up every six months is enough for most gay men but if you do have symptoms, you should get checked out straight away.
Here is a list of clinics where you can get checked out.
Getting tested regularly for HIV will not stop you from becoming infected; it will only tell you if you have become infected.
What about pulling out before cumming?
Pulling out before cumming will reduce the chance of HIV transmission for the guy who's getting fucked, but not for the guy doing the fucking. There is more HIV in cum than there is in pre-cum, in terms of both the quantity of the body fluid and the concentration of HIV in that liquid. However it is still possible to get infected from pre-cum, although it is less likely than if the guy doing the fucking cums inside the arse.
Withdrawing before cumming makes little difference to the chances of catching other sexually transmitted infections. It also makes little difference if the negative partner is the person doing the fucking.
What about HIV-positive guys with low viral load?
The lower the level of viral load that an HIV-positive person has, the less infectious they will be. Viral load is the term used to describe the amount of HIV a person has in their blood, cum and anal mucus. People who have been diagnosed as having HIV will be encouraged to have regular blood tests. Looking at viral load in the blood helps doctors monitor an individual's progress, for example to see if the drugs are working for him. Modern anti-HIV drug therapies mean that many people with HIV have a very low, or even undetectable, viral load. Most doctors believe that viral load has a large impact on how infectious a person is. A person with a low viral load will be less likely to transmit HIV.
Unfortunately it is very difficult to know exactly what your viral load is. Viral load tests usually take more than a week to process, so by the time you get your result the information is already out of date. Viral load can alter dramatically in a short period of time, especially if you pick up any other infections, including the flu. Sexually transmitted infections can make your viral load shoot up, which will make you more infectious.
What's more, the viral load level in someone's blood isn't the same as it is in his cum or anal mucus.6 In some men viral load is usually higher in their blood than in their cum, but in other men it is higher in their cum than in their blood. The prostate gland can harbour HIV, so the level of virus in a man's cum may be increased if he has recently been fucked. HIV treatments have been shown to be less effective at reducing the levels of virus in anal mucus than they are in the blood, so someone with undetectable viral load in his blood may still have high levels of virus in his anal mucus. This means that there would still be considerable HIV risk from fucking a positive man without a condom if his blood viral load was low. Tests at an HIV clinic usually only measure the viral load in blood.
Does it make a difference if you are the top or the bottom?
Gay men are more likely to catch HIV from being fucked (being bottom) than from fucking (being top).7 Men who do not have HIV have less chance of becoming infected if they do the fucking (are top). If you have HIV there is less chance of you passing it on to your partner if he fucks you.
Although there is less risk of catching HIV if you're a top, many men are infected this way. This is because there is HIV in the anal mucus of the person getting fucked which can enter the body of the person doing the fucking through his urethra. Fucking someone without a condom is riskier than giving someone a blowjob, even if they cum in your mouth.
What about hard sex and fisting?
If the lining of your arse is damaged, and you get fucked without a condom, there is more chance of HIV being transmitted. The lining of the arse is very delicate and can be damaged easily. If your arse is damaged, the body's defences will spring into action, and these are the cells that HIV infects. For this reason, fucking someone who has just been fisted, or had sex toys shoved up his arse, makes it more likely that HIV will be passed on. If you take the time to relax someone's arse before fucking them, by gently playing with them, then you are less likely to damage the lining of their arse. It is possible that the lining of your arse may be damaged even if there are no signs of bleeding.
What about poppers?
Poppers (amyl nitrite) has been linked with an increased risk of HIV transmission when used by guys whilst fucking without condoms. In one study, 80% of men who had recently become infected with HIV had used poppers compared with 58% of those who remained HIV-negative.8 Some researchers think that this is because poppers can cause the blood vessels in your arse to dilate. This gives the virus a better chance of entering the bloodstream. It may also be linked to the fact that poppers can relax the arse muscles making it easier for some men to get fucked, and for longer.
References:
1 University College London (UCL), Health Protection Agency (HPA). Gay men's sexual health survey 2009 in 36 gay venues.
2 Health Protection Agency (HPA). HIV in the United Kingdom: 2010 report. Health Protection Agency, November 2010.
3 Williamson LM, Dodds JP, Mercey DE, Hart GJ, Johnson AM. Sexual risk behaviour and knowledge of HIV status among community samples of gay men in the UK. AIDS, 2008;22(9):1063-1070.
4 Velter A, Bouyssou-Michel A, Arnaud A, Semaille C. Do men who have sex with men use serosorting with casual partners in France? Results of a nationwide survey (ANRS-EN17-Presse Gay 2004). Eurosurveillance, 2009;14(47):pii=19416.
5 Jin F, Prestage GP, Ellard J, Kippax SC, Kaldor JM, Grulich AE. How homosexual men believe they became infected with HIV: the role of risk-reduction behaviors. Journal of Acquired Immune Deficiency Syndromes, 2007;46(2):245-247.
6 Zuckerman RA, Whittington WLH, Celum CL, Collis TK, Lucchetti AJ, Sanchez JL, Hughes JP, Sanchez JL, Coombs RW. Higher concentrations of HIV RNA in rectal mucosa secretions than in blood and seminal plasma, among men who have sex with men, independent of antiretroviral therapy. Journal of Infectious Diseases, 2004;189:156-161.
7 Jin F, Jansson J, Law M, Prestage GP, Zablotska I, Imrie JCG, Kippax SC, Kaldor JM, Grulich AE, Wilson DP. Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART. AIDS, 2010;24(6):907-913.
8 Macdonald N, Elam G, Hickson F, Imrie J, McGarrigle CA, Fenton KA, Baster K, Ward H, Gilbart VL, Power RM, Evans BG. Factors associated with HIV seroconversion in gay men in England at the start of the 21st century. Sexually Transmitted Infections, 2008;84(1):8-13.
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