The risk is up to you
The name of the game is sex, the aim is to make informed decisions.
Fact: The best way to avoid transmission of HIV is to use condoms and water-based lube.
Fact: Some gay men use risk reduction strategies in order to avoid condoms and somehow still try to reduce the risks of getting or passing HIV. As the phrase ‘risk reduction’ suggests, they are used to reduce the risk of HIV transmission, not eliminate it. Some of them are:
1. Withdrawal: When the top withdraws before cumming.
PROS: In the absence of using condoms, withdrawing before cumming is safer than cumming inside.
CONS: HIV is present in blood, pre-cum, cum and anal mucus. It is possible for transmission of HIV to occur without the positive partner ejaculating inside the negative partner.
If the HIV negative man is the top (and the bottom is positive) it is also possible that HIV can enter through the urethra.
2. Strategic Positioning: Deciding to top or bottom depending on your HIV status. The theory is that if you are negative, it is less risky to fuck without condoms if you are the top.
PROS: In theory it is more effective than withdrawal in decreasing the risk of HIV transmission.
CONS: HIV is present in anal mucous, so tops can still get HIV by the virus entering the bloodstream through the urethra.
3. Serosorting: This is the practice of only engaging in unprotected sex with guys who have the same HIV status as you.
PROS: This strategy allows you to fuck safely without condoms if you can be certain of your partner’s HIV status.
CONS: Transmission often happens when someone who is HIV positive believes he is still HIV negative. In addition, even if you are able to determine that both partners are HIV positive, if you fuck without condoms it is still possible to pass on other STIs such as gonorrhoea, syphilis or hepatitis C.
4. Undetectable Viral Load: When sexual partners with different HIV status decide not to use a condom based on the viral load of the HIV positive partner.
PROS: In theory it is plausible that the less viral load you have, the less infectious you are. Current clinical research is attempting to find out if it is possible for someone to pass on HIV if they have undetectable levels of HIV in their bloodstream.
CONS: There is no evidence about the effectiveness of this technique. It is possible that even if someone has undetectable HIV viral load in their bloodstream, HIV could still be present in pre-cum and semen. In addition, even if you or your partner have undetectable HIV in your bloodstream, if you fuck without condoms it is still possible to pass on other STIs such as gonorrhoea, syphilis or hepatitis C.
By CARLOS SEPULVEDA
Victorian AIDS Council/Gay Men’s Health Centre
INFO: www.protection.org.au
