I’m a Bottom
Bottoming (putting a penis in your anus) is a higher risk activity than topping (putting a penis in a guy’s anus). The sensitive cells in the ass are easily torn and very susceptible to the HIV virus and other STIs.
HIV-negative bottoms are at risk of picking up HIV if they are having sex with someone who is HIV positive with a detectable viral load (read more on viral load and undetectability below). The risk of infection increases if the bottom takes semen in his ass or has an STI. The risk also increases if the HIV-positive top is newly infected, not on treatment, or has an STI.
Research suggests that guys who don’t know they are HIV positive transmit a significant proportion of new HIV infections. Of course this risk can be reduced by having sex with someone who knows their HIV status to be the same as yours, also known as sero-sorting (this requires both partners to get tested regularly).
The best way to reduce your risk of picking up HIV is to use condoms during anal sex.
If you are going to bottom with a partner who isn’t wearing a condom, there are some things you can do to reduce your risk:
- Negotiate that he will not ejaculate inside you.
- Don’t douche just beforehand.
- Use lots of lube, be relaxed and do not force it.
- Sero-sort (find a partner whose HIV status is the same as yours).
- If he is HIV positive, talk to him about his viral load.
- If he is on PrEP, talk to him about it and what kind of sex you want to have.
It is possible for HIV-positive bottoms to pass HIV to a negative top, especially if they are newly infected, have another STI or are not on treatment. Both negative and positive bottoms are also at risk of acquiring other STIs such as gonorrhea and syphilis.
Reduce Your Risk
Condoms are still an effective tool to reduce the risk of picking up or passing on HIV is to use condoms when having anal sex, particularly with guys whose HIV status you don’t know or are unsure of or with guys whose status is not the same as yours.
When using condoms, it is a good idea to use lube. Take your time; do not rush it! Rushed or aggressive anal sex can increase the likelihood of condom tears and other problems.
In reference to HIV transmission, pre-exposure prophylaxis (PrEP) refers to a prevention strategy in which HIV-negative individuals take an anti-HIV medication once-a-day. While PrEP is a relatively new prevention tool, studies have shown that an individual who is on PrEP and adheres to treatment guidelines is risk-free from contracting HIV in the occasion that they are exposed to the virus. British Columbians can access PrEP without cost as of January 2018.
Check out HIM’s getpreped.ca for everything you need to know about PrEP.
It’s important to remember that while PrEP effectively protects from HIV, it does not protect from other STIs, so you might want to consider using PrEP along with some of the other risk-reduction tools outlined in this page.
Knowing your HIV status and that of your partner will allow you to make decisions about how to best reduce sexual risk-taking (this requires regular HIV testing).
Limit Your Partners
Another way to reduce your risk is to limit your number of partners, or establish friends-with-benefits, or regular partners who you communicate with and trust.
Sometimes guys forget that semen can be on their hands or faces. Try not to get semen in your eyes. Using someone else’s semen as lube when you masturbate can also be risky. If a finger goes in your anus, make sure it doesn’t have someone else’s semen on it.
Harm Reduction (may be less risky, but not risk-free)
Guys reduce the spread of HIV in several other ways:
- having less risky sex (hand jobs, oral sex, etc.)
- sero-sorting (looking for partners with the same HIV status)
- strategic positioning (putting the negative guy on top)
- not ejaculating inside each other (pulling out or withdrawal)
- ensuring that both partners are free of other STIs by getting tested
Undetectable Viral Load
The BC Centre for Excellence in HIV/AIDS and other HIV/AIDS research institutions have found that the risk of HIV transmission for sero-discordant couples (one is positive, the other is negative) is nonexistent if the HIV-positive partner is on treatment, has an undetectable viral load and is free of STIs.