I’m in a Monogamous Relationship
Many guys who are in monogamous relationships (having sex with only one guy) think they are at low risk of picking up or passing on HIV. This is true, but only if you know your status and that of your partner and neither of you is having sex with other people.
Some guys have a hard time being monogamous. Some guys think they are in a monogamous relationship when they aren’t. Discussing sex outside the relationship may be a way of reducing future risk. For instance, you may decide that if sex outside the relationship occurs, whether planned or in the heat of the moment, it should be as low risk as possible (examples include no anal sex, or 100% condom use with other partners).
Monogamous couples are still at risk of passing on other STIs even after being diagnosed and treated. For example, herpes, genital warts and hepatitis may be present without signs or symptoms. Before you make a decision on whether to use condoms, it’s important for couples to discuss their sexual health and any risks that may exist as the result of a previous STI.
That said, two HIV-positive guys who have sex only with each other and two HIV-negative guys who know their status and have sex only with each other are at no risk of picking up or passing on HIV.
We’re Both Negative
The only way to be sure you are both the same HIV status is for you and your partner to get tested. This can mean waiting up to three months or as little as two weeks after being monogamous, depending on the window period of the test being used (for more information on window periods, please visit Types of HIV Tests. In Vancouver, a unique HIV test is being offered to gay men. Known as the Early HIV test, it is able to detect the HIV virus in the blood within ten to 12 days after infection. This means the window period is reduced, so that guys don’t have to wait three months before knowing their HIV status. It also means that you don’t have to wait three months before knowing your partner’s HIV status. You can find out after only ten to 12 days!
We’re Both Poz
Two poz guys who have been tested for HIV and are sure they are poz have no risk of passing on HIV, so they may decide to have condomless sex. Poz couples should be aware of the risks associated with superinfection. Superinfection can happen when a poz guy acquires a second strand of HIV virus (although evidence of this is low). This can complicate treatment by creating a drug resistance which may make future treatment difficult.
Magnetic Couples (one poz, one negative)
Couples who are sero-different (one is HIV negative, the other is HIV positive) must use caution because there is a high risk of passing on HIV to the negative guy, especially if the poz partner is not on treatment or if either of you has another STI.
Reduce Your Risk
The best way 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 tears and other problems.
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.
For poz guys, proper treatment adherence (taking medication regularly) impacts viral load, which also lowers the risk of passing on HIV.
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-different couples (one is positive, the other is negative) is very low if the HIV positive partner is on treatment, has an undetectable viral load and is free of STIs.