Safer barebacking

If you decide not to use condoms but want to reduce the chance of HIV being picked up or passed on, these can lower the risk. None are risk-free. And the more often you do them, the more chance HIV will sooner or later be passed on. You might want to talk these over with the guy(s) you want to bareback with.

Choose from:

• PEP
• Sex with men with the same HIV status as yourself
• Sex when viral load is low
• Deciding who tops or bottoms
• Pulling out before coming
• Avoiding bleeding
• No sex if someone has an STI
• Barebaking less and with fewer men
• Taking it easy
• Getting vaccinated against hep A and B

PEP

Maybe you bareback and it turns out to be riskier than you thought. Knowing about the drug treatment Post Exposure Prophylaxis (PEP) is vital, whether you have HIV and want to stop another guy getting it, or you're negative and want to stay that way.

If taken soon after HIV enters the body (within 72 hours at the latest), PEP stands a good chance of stopping the virus before it can permanently infect someone. You can find out more about PEP here.

Sex with men with the same HIV status as yourself

Men may try to only have unprotected sex with men who share the same HIV status. This might cut the risk but there are dangers in assuming someone shares your HIV status or expecting them to tell you what it is without asking.

You could ask, but there's a real chance the answer won't be accurate. He might not tell the truth or might be wrong: maybe he got infected after his last negative test. One in three of us with HIV don't know we have it.*

Testing can make things clearer, as long as you remember that it can take up to three months for signs of HIV infection to show up in a blood test. If someone's recently been infected they'll test negative, even though they have very high levels of HIV in their blood and cum and can be very infectious. A second test three months after the first will pick up a new infection, as long as no new risky sex has taken place since the first test.

Testing before barebacking is less risky than just assuming you both must be the same HIV status or relying on the other guy to take responsibility for protecting you.

'I have HIV and only bareback with other poz men.'

If so, do you know what you need to about picking up more aggressive or drug-resistant strains of HIV? Do you know enough about serious infections like hepatitis C, LGV, syphilis and herpes? Find out the things you should know about other infections.

*Source: Health Protection Agency 2006

Sex when 'viral load' is low or undetectable

Viral load tests measure how much HIV is in the blood of someone with HIV. Some men feel the risk of HIV being passed on is less if viral load is low or undetectable. Studies show that infectiousness is often related to viral load: the lower it is, the less likely HIV is passed on. But these things need to be remembered:

• Viral load goes up and down. A low test result may soon be out-of-date and inaccurate.
• Viral load tests are usually only done on blood, not cum or anal mucus (the lining of the inside of the arse). But HIV is also spread through cum and anal mucus and a man can have higher levels of HIV in these fluids than the level that tests show is in his blood.
• The term 'undetectable' viral load is misleading. It doesn't mean no HIV has been found. HIV is almost certainly there but at levels too low for the test to find. These are still levels that might possibly infect someone.

Deciding who tops or bottoms

An HIV negative man runs a higher risk of getting HIV if infected cum or pre-cum gets in his arse. So during bareback sex with a poz guy there's more risk if the poz man is the fucker, less risk if the HIV negative man is the fucker.

That's not to say HIV can't be passed on if the roles are reversed. Poz bottoms can pass on HIV and HIV negative tops can pick it up. How? Fucking often causes bleeding, so infected blood can get onto the fucker's dick and through the delicate skin of his foreskin, head of the cock or urethra (piss pipe). The same can happen with the mucus lining of the poz guy's arse, which can also have lots of HIV in it.

It's less likely HIV is passed from poz bottom to negative top but it happens, as many men who top have found out. And of course, millions of straight men around the world have got infected from fucking women, (and vaginas are less likely to bleed when fucked than arses).

Pulling out before coming

If a poz guy tops, pulling out before he comes reduces the risk of him passing on HIV - if he has that level of control, which many men don't. But HIV can be in pre-cum, so it's possible HIV can be left in the other man's arse even if the fucker manages to come outside him. All in all, it's safer if cum ends up on him, not in him.

Avoiding bleeding

Fucking that causes bleeding gives HIV the best chance of being passed on, whoever's bleeding (top or bottom, HIV positive or negative). If you see blood, stop and think again about condoms. These make bleeding more likely:

• The bottom sniffing poppers. It could cause blood vessels lining the inside of arse to open, fill and possibly break. Viagra has the same effect.
• Fisting before fucking; because fisting is more likely to make an arse bleed. There's less risk if you fuck first, fist after.
• Fucking that's rougher or longer lasting.
• Not using lube or enough lube. Keep adding lube to cut down on friction and the chance of bleeding or sore skin. Spit's no good as it quickly dries up. Avoid lubes with Nonoxynol-9; it irritates the arse lining, making it easier for HIV to get through it and into the bloodstream.

No sex if someone has an STI

Having a sexually transmitted infection (STI) increases the chance of HIV being passed on, regardless of who has the STI. (Find out why and how in the Clinic). So if you think or know either of you has symptoms of an STI, it's much better if you wait until it's gone before having sex.

Barebacking less often and with fewer men

The more times you bareback and the more men you do it with, the more chance HIV will be passed on, especially if some of those men have a high viral load (lots of HIV in their blood and cum). Barebacking less will also lower the likelihood of picking up STIs and give the skin on your cock or in your arse time to heal if it gets damaged or sore.

Taking it easy

Your immune system gets weaker when you're tired, stressed, run down, ill with an infection (especially a sexually transmitted one) or using drugs or alcohol. If you have HIV this can push up your viral load, potentially making you ill and more infectious to men you bareback with. If you're HIV negative it makes you more vulnerable to picking up infections, including HIV.

Getting vaccinated against hepatitis A and B

If you bareback you're at greater risk of getting these liver infections, but you can be vaccinated free against both at sexual health clinics and by some GPs. But there's no vaccine against hepatitis C, which is a very serious infection spreading among men who fuck without condoms.

Find out more about all three types of hepatitis in our Clinic. If you bareback with lots of men you're at greatest risk of getting STIs, so a regular sexual health checkup at least every three to six months is recommended.

More information

See www.barebackjack.com, a site about safer barebacking.