ZONE:

ZONE:

Topping versus bottoming

Topping versus bottoming

Many HIV negative men think it's safe for them to fuck without condoms, even with a partner who is, or might be, HIV positive, as long as they are the top (i.e. the guy doing the fucking). But is choosing to be the active partner a reliable technique for avoiding getting HIV during unprotected anal sex?

Many HIV negative men think it's safe for them to fuck without condoms, even with a partner who is, or might be, HIV positive, as long as they are the top (i.e. the guy doing the fucking).

Similarly, many HIV-positive men think they can fuck without condoms without putting an HIV negative partner at risk, so long as the HIV-positive guy is the one being fucked.

Many men believe this because they have heard that it is easier for HIV to travel from the guy who is fucking to the guy being fucked than the other way round.

Although it is easier for HIV to pass from the top to the bottom, many men become HIV-positive as the top (i.e. active partner) when fucking without a condom. The best way to prevent HIV is to use condoms and water based lube.

Why is the guy being fucked more at risk when fucking without condoms?

The guy being fucked is more at risk during unprotected sex for two reasons:

• HIV is carried in body fluids including semen. When someone comes inside you, if they are HIV-positive then the HIV in their semen is also inside you and can enter your bloodstream through the sensitive lining of the anus.

• The sensitive lining of the anus is more susceptible than the skin of your cock to cuts and abrasions caused by friction during anal sex. These cuts and abrasions in the anus offer any HIV present in cum or pre-cum an entry point into the receptive partner's bloodstream.

Does that mean unprotected anal sex is safe for the top?

No. Choosing to be the active partner is NOT a reliable technique for avoiding getting HIV during unprotected anal sex. Many men have become HIV positive as a result of being the top during unprotected sex.

How can HIV enter the active partner's penis?

HIV in body fluids in the bottom's anus can enter the top's cock through the urethra (i.e. the opening at the tip of the penis through which urine and cum passes). It can also enter the cock through any cuts or abrasions caused by friction during sex, or through sores or other irritations caused by the presence of another STI (Sexually Transmitted Infection).

There are other risk factors.

There are other factors that can significantly affect whether being top or bottom reduces the degree of risk of having unprotected sex. For example:

Whether he tops or bottoms, an HIV negative man is more at risk of getting HIV if he already has another sexually transmitted infection (STI) (e.g. syphilis or Chlamydia). The sores or lesions caused by an STI can create an effective gateway for HIV to pass from one body to another during sex. Even if there are no apparent symptoms, an STI can still increase your susceptibility to HIV. As STI's often don't have symptoms, the only way to know if you have one or not is to get a regular sexual health check.

If an HIV positive man has another STI this further increases the risk to his partner. This is because the increased burden of a second STI on an HIV-positive person's immune system means it is less able to suppress the amount of HIV in the body. This results in a much higher viral load (i.e. the amount of HIV in the body), which makes him more infectious. (If you are HIV-positive, having another STI will also have a more serious impact on you and can progress much faster).

The viral load of an HIV-positive person will commonly fluctuate over time, affecting their level of infectiousness. For example, people have a particularly high viral load when they first become HIV positive, as the body's immune system has not yet begun to fight the virus. This makes them particularly likely to transmit the virus during unprotected sex, especially if they are unaware that they have become HIV-positive.

The rougher the fucking, the greater the risk of HIV transmission during unprotected sex. Rough sex increases the likelihood of cuts or abrasions to either partner, increasing the opportunity for HIV to pass from one person to another via semen or blood.

Is there any safe way to have unprotected anal sex?

The only reliably safe way to have anal sex without condoms is with a long-term partner with whom you have been tested for HIV together, then tested again three months later. For this process to work, partners need to continue using condoms with each other (and with any casual partners) until they get the second test results.

If both partners' test results are still negative the second time, and neither of them has had any risk of exposure to HIV in the period between the two tests, then they can be reasonably sure that they are both HIV negative and stop using condoms with each other.

In order to work, the process requires a high level of discussion and trust between the partners about always using condoms if they have sex with anyone else and being honest with each other if one of them breaks this agreement.

For more details about this process see ‘Negotiated Safety' in the ‘Relationships' menu at www.stayingnegative.net.au

Many HIV-positive men choose to have unprotected sex with other HIV-positive men. Although this puts neither partner at risk of being exposed to HIV for the first time, HIV positive men who choose to fuck without condoms run the risk of getting other potentially serious STIs such as syphilis or gonorrhoea.

This article was first published on http://www.top2bottom.org.au and is republished with permission from the Victorian AIDS Council Gay Men's Health Centre (VAC/GMHC). Top2bottom is a campaign developed and maintained by the Victorian AIDS Council/Gay Men's Health Centre in Melbourne, Australia; and is funded by the Victorian Department of Health.

Reader's Comments

11 years ago
I think whether you are positive or negative , it's best to use a condom to protect your love one / partner. it's both responsibilities to play . not only the tops ,also the bottoms as well.
11 years ago
I cannot fathom that some people still chance losing their lives for the sake of not wearing a condom.
11 years ago
It's easy to get carried away in the moment. It's happened to me a couple of times but I did learn from the experience.
11 years ago
its so much necessary to use condoms, for the sake of our safety
11 years ago
Barebacking might be fun, but it's just simply not worth the risk....
11 years ago
My partner and I have been together for almost eight years. We still use condoms. To do otherwise is just madness.
Comment #7 was deleted by an administrator
Comment #8 was deleted by an administrator
Comment #9 was deleted by an administrator
Comment #10 was deleted by an administrator
Comment #11 was deleted by an administrator
Comment #12 was deleted by an administrator
Comment #13 was deleted by an administrator
Comment #14 was deleted by an administrator
Comment #15 was deleted by an administrator
Comment #16 was deleted by an administrator
Comment #17 was deleted by an administrator
Comment #18 was deleted by an administrator
Comment #19 was deleted by an administrator
Comment #20 was deleted by an administrator
Comment #21 was deleted by an administrator
Comment #22 was deleted by an administrator
Comment #23 was deleted by an administrator
Comment #24 was deleted by an administrator
Comment #25 was deleted by an administrator
Comment #26 was deleted by an administrator
Comment #27 was deleted by an administrator
Comment #28 was deleted by an administrator
Comment #29 was deleted by an administrator
Comment #30 was deleted by an administrator
Comment #31 was deleted by an administrator
Comment #32 was deleted by an administrator
Comment #33 was deleted by an administrator
Comment #34 was deleted by an administrator
Comment #35 was deleted by an administrator
Comment #36 was deleted by an administrator
Comment #37 was deleted by an administrator
Comment #38 was deleted by an administrator
Comment #39 was deleted by an administrator
Comment #40 was deleted by an administrator
Comment #41 was deleted by an administrator
Comment #42 was deleted by an administrator
Comment #43 was deleted by an administrator
Comment #44 was deleted by an administrator
Comment #45 was deleted by an administrator
Comment #46 was deleted by an administrator
Comment #47 was deleted by an administrator
Comment #48 was deleted by an administrator
Comment #49 was deleted by an administrator
Comment #50 was deleted by an administrator
Comment #51 was deleted by an administrator
Comment #52 was deleted by an administrator
Comment #53 was deleted by an administrator
Comment #54 was deleted by an administrator
Comment #55 was deleted by an administrator
Comment #56 was deleted by an administrator
Comment #57 was deleted by an administrator
Comment #58 was deleted by an administrator
Comment #59 was deleted by an administrator
Comment #60 was deleted by an administrator
Comment #61 was deleted by an administrator
Comment #62 was deleted by an administrator
Comment #63 was deleted by an administrator
Comment #64 was deleted by an administrator
Comment #65 was deleted by an administrator
Comment #66 was deleted by an administrator
Comment #67 was deleted by an administrator
Comment #68 was deleted by an administrator
Comment #69 was deleted by an administrator
Comment #70 was deleted by an administrator
Comment #71 was deleted by an administrator
Comment #72 was deleted by an administrator
Comment #73 was deleted by an administrator
Comment #74 was deleted by an administrator
Comment #75 was deleted by an administrator
Comment #76 was deleted by an administrator
Comment #77 was deleted by an administrator
Comment #78 was deleted by an administrator
Comment #79 was deleted by an administrator
Comment #80 was deleted by an administrator
Comment #81 was deleted by an administrator
Comment #82 was deleted by an administrator
Comment #83 was deleted by an administrator
Comment #84 was deleted by an administrator
Comment #85 was deleted by an administrator
Comment #86 was deleted by an administrator
Comment #87 was deleted by an administrator
Comment #88 was deleted by an administrator
Comment #89 was deleted by an administrator
Comment #90 was deleted by an administrator
Comment #91 was deleted by an administrator
Comment #92 was deleted by an administrator
Comment #93 was deleted by an administrator
Comment #94 was deleted by an administrator
Comment #95 was deleted by an administrator
Comment #96 was deleted by an administrator
Comment #97 was deleted by an administrator
Comment #98 was deleted by an administrator
Comment #99 was deleted by an administrator
Comment #100 was deleted by an administrator
Comment #101 was deleted by an administrator
Comment #102 was deleted by an administrator
Comment #103 was deleted by an administrator
Comment #104 was deleted by an administrator
Comment #105 was deleted by an administrator
Comment #106 was deleted by an administrator
Comment #107 was deleted by an administrator
Comment #108 was deleted by an administrator
Comment #109 was deleted by an administrator
Comment #110 was deleted by an administrator
Comment #111 was deleted by an administrator
Comment #112 was deleted by an administrator
Comment #113 was deleted by an administrator
Comment #114 was deleted by an administrator
Comment #115 was deleted by an administrator
Comment #116 was deleted by an administrator
Comment #117 was deleted by an administrator
Comment #118 was deleted by an administrator
Comment #119 was deleted by an administrator
Comment #120 was deleted by an administrator
Comment #121 was deleted by an administrator
Comment #122 was deleted by an administrator
Comment #123 was deleted by an administrator
Comment #124 was deleted by an administrator
Comment #125 was deleted by an administrator
Comment #126 was deleted by an administrator
Comment #127 was deleted by an administrator
Comment #128 was deleted by an administrator
Comment #129 was deleted by an administrator
Comment #130 was deleted by an administrator
Comment #131 was deleted by an administrator
Comment #132 was deleted by an administrator
Comment #133 was deleted by an administrator
Comment #134 was deleted by an administrator
Comment #135 was deleted by an administrator
Comment #136 was deleted by an administrator
Comment #137 was deleted by an administrator
Comment #138 was deleted by an administrator
Comment #139 was deleted by an administrator
Comment #140 was deleted by an administrator
Comment #141 was deleted by an administrator
Comment #142 was deleted by an administrator
Comment #143 was deleted by an administrator
Comment #144 was deleted by an administrator
Comment #145 was deleted by an administrator
Comment #146 was deleted by an administrator
Comment #147 was deleted by an administrator
Comment #148 was deleted by an administrator
Comment #149 was deleted by an administrator
Comment #150 was deleted by an administrator
Comment #151 was deleted by an administrator
Comment #152 was deleted by an administrator
Comment #153 was deleted by an administrator
Comment #154 was deleted by an administrator
Comment #155 was deleted by an administrator
Comment #156 was deleted by an administrator
Comment #157 was deleted by an administrator
Comment #158 was deleted by an administrator
Comment #159 was deleted by an administrator
Comment #160 was deleted by an administrator
Comment #161 was deleted by an administrator
Comment #162 was deleted by an administrator
Comment #163 was deleted by an administrator
Comment #164 was deleted by an administrator
Comment #165 was deleted by an administrator
Comment #166 was deleted by an administrator
Comment #167 was deleted by an administrator
Comment #168 was deleted by an administrator
Comment #169 was deleted by an administrator
Comment #170 was deleted by an administrator
Comment #171 was deleted by an administrator
Comment #172 was deleted by an administrator
Comment #173 was deleted by an administrator
Comment #174 was deleted by an administrator
Comment #175 was deleted by an administrator
Comment #176 was deleted by an administrator
Comment #177 was deleted by an administrator
Comment #178 was deleted by an administrator
Comment #179 was deleted by an administrator
Comment #180 was deleted by an administrator
Comment #181 was deleted by an administrator
Comment #182 was deleted by an administrator
Comment #183 was deleted by an administrator
Comment #184 was deleted by an administrator
Comment #185 was deleted by an administrator
Comment #186 was deleted by an administrator
Comment #187 was deleted by an administrator
Comment #188 was deleted by an administrator
Comment #189 was deleted by an administrator
Comment #190 was deleted by an administrator
Comment #191 was deleted by an administrator
Comment #192 was deleted by an administrator
Comment #193 was deleted by an administrator
Comment #194 was deleted by an administrator
Comment #195 was deleted by an administrator
Comment #196 was deleted by an administrator
Comment #197 was deleted by an administrator
Comment #198 was deleted by an administrator
Comment #199 was deleted by an administrator
Comment #200 was deleted by an administrator
Comment #201 was deleted by an administrator
Comment #202 was deleted by an administrator
Comment #203 was deleted by an administrator
Comment #204 was deleted by an administrator
Comment #205 was deleted by an administrator
Comment #206 was deleted by an administrator
Comment #207 was deleted by an administrator
Comment #208 was deleted by an administrator
Comment #209 was deleted by an administrator
Comment #210 was deleted by an administrator
Comment #211 was deleted by an administrator
Comment #212 was deleted by an administrator
Comment #213 was deleted by an administrator
Comment #214 was deleted by an administrator
Comment #215 was deleted by an administrator
Comment #216 was deleted by an administrator
Comment #217 was deleted by an administrator
Comment #218 was deleted by an administrator
Comment #219 was deleted by an administrator
Comment #220 was deleted by an administrator
Comment #221 was deleted by an administrator
Comment #222 was deleted by an administrator
Comment #223 was deleted by an administrator
Comment #224 was deleted by an administrator
Comment #225 was deleted by an administrator
Comment #226 was deleted by an administrator
Comment #227 was deleted by an administrator
Comment #228 was deleted by an administrator
Comment #229 was deleted by an administrator
Comment #230 was deleted by an administrator
Comment #231 was deleted by an administrator
Comment #232 was deleted by an administrator
Comment #233 was deleted by an administrator