If you decide not to use condoms, here are some things you might want to think about to reduce risk.
If you’ve barebacked and think you’ve put yourself at risk, you should take Post-exposure prophylaxis (PEP). PEP is a treatment that can stop an HIV infection after the virus has entered the body. Make sure to take it within 72 hours of exposure.
If you’re HIV negative, taking Pre-exposure prophylaxis (PrEP) before sex reduces the risk of getting HIV. Being on PrEP means you don’t have to worry about the status of your partner(s), because you’re protecting yourself. Remember that PrEP doesn’t protect against STIs.
You can get PrEP on the NHS in Scotland and Wales, and on uncapped trial in Northern Ireland. NHS England is running a PrEP IMPACT Trial with limited spaces.
You can also buy it online without prescription.
Sex with men with the same HIV status as yourself
One in five gay or bisexual men with HIV don’t know they have it.
People are most infectious in the first weeks and months after getting HIV, exactly the time when they are least likely to realise they are infected. Assuming anyone’s HIV status is risky. You can protect yourself with PrEP, although it offers no protection against STIs.
Testing can make things clearer, as long as you remember that an HIV test might not detect the virus if you take it within the first four weeks of having HIV (3 months for a self-test at home)
A test after four weeks gives a good indication of whether you have HIV or not. But to be totally certain that an HIV negative result is accurate you would need a second test a few weeks later. Or you can wait three months between your last risk and your test; a negative result after that time will certainly be accurate.
In a monogamous couple just assuming you both must be the same HIV status or relying on the other guy to take responsibility for protecting you is very risky. Testing before you start barebacking and remaining monogamous removes the risk. When casual sex partners assume they’re both HIV negative there is a significant chance of being wrong: thousands of men have HIV without knowing.
Sex when undetectable
The combined PARTNER 1 and 2, and 2017’s Opposites Attract studies have proven that there’s no risk of passing on HIV if you’re undetectable (virally suppressed), as long as you continue taking your treatment.
Many guys with HIV achieve an undetectable viral load by sticking to antiretroviral treatment for at least six months. At this point, the virus will exist in such small quantities that it can’t be detected by standard blood tests.
If you bareback with a HIV positive guy who’s undetectable then there’s no risk of getting HIV.
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 there’s more risk if the poz guy is the top.
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 through the delicate skin of the 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 can happen.
Pulling out before coming
If a poz guy tops, pulling out before he comes reduces the risk of him passing on HIV, though HIV can also be in pre-cum.
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 recently been infected and 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’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.
Last review: 18/09/2018
Next review: 18/09/2021