I’m a Top
Some guys think that they cannot get HIV by topping (putting your penis in a guy’s anus). While topping is lower risk than bottoming (putting a penis in your anus), there is still risk involved in topping . . . especially since a lot of tops also bottom (see I’m Versatile).
Tops are at risk for HIV and other sexually transmitted infections such as gonorrhea and syphilis.
For HIV-negative tops, HIV could be passed from the cells in the lining of the bottom’s anus through the head of the penis, or sensitive cells in the foreskin. Tops are at a greater risk if the bottom is HIV positive and not on treatment (possibly because he is unaware of his HIV status), in which case he may have a very high viral load, making it more likely for him to pass on the virus. Having an STI can also make both tops and bottoms more likely to pick up or pass on HIV.
Tops who are HIV positive are at risk of passing HIV to an HIV-negative bottom, if they are not on treatment (possibly because they are unaware of their status) or have another STI.
Both negative and positive tops have to watch out for gonorrhea, syphilis and other STIs.
Some recent research suggests that uncircumcised tops are at a higher risk for HIV infection than those guys who are circumcised, due to specialized cells in the foreskin that bind more easily to HIV. Other studies have shown that both uncut and cut tops are at risk for HIV infection, regardless of foreskin. Either way, tops are not immune to HIV . . . especially since a lot of tops also bottom (see I’m Versatile).
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.