Written on : 2012-08-24
Good for you. Fucking is one great way to have sex. And sex not only feels good but it’s good for your health.
And, as in most parts of our lives, there are also risks to having sex. Sexually transmitted infections (STIs) are one of those risks. Some STIs are relatively harmless. Some STIs can seriously harm your health.
- Take the time to educate yourself about HIV and STIs.
- Think about how you can protect yourself and the guys you play with while getting the sex you want.
- Plan for it.
- Have great sex!
Take care of yourself and each other. Be safe.
DID YOU KNOW?
There is an increase in sexually transmitted infections (STIs). This makes it easier to give or get HIV.
Syphilis rates are 18 times higher among gay and bi guys in Toronto now than they were in 2001. There is some good news. There was a decrease from 2009 to 2010 of 11%. Because this is so recent we don’t know if it’s going to stick, but it is encouraging. About half of syphilis cases are in guys with HIV. Syphilis and HIV can seriously complicate your health and make it easier to pass on or get HIV.
Chlamydia infections have increased every year in Toronto since 2004. In 2004 there were just over 6000 cases. By 2010 there was just under 9000. The highest numbers of infections are in young women, but there is a significant number among gay or bi guys.
What about HIV? Overall in Ontario there have been about 740 HIV infections every year since 2003. This is better than the early 1980s when we saw as many as 1500 HIV infections in a year, but not as good as the lowest year, 1996, when there were about 438 infections. In Toronto, HIV rates among women have gone down since 2009, but have remained unchanged in guys. About 85% (347) of men diagnosed with HIV in Toronto in 2010 were gay or bi guys.
There is more gonorrhea (an STI) in Ontario that is harder to treat because it is drug resistant. Untreated gonorrhea can cause serious health problems and can be fatal.
In 2011, 11% of gonorrhea cases in Ontario were of a type that is harder to treat. There were no cases of this strain in Ontario in 2005.
There are many drugs (antibiotics) to fight gonorrhea. But gonorrhea can change so that the drugs can no longer kill it. And there is only one kind of antibiotic or drug that can kill this newer type of gonorrhea. This means it is now harder to treat. If this type of gonorrhea changes so that the final antibiotic cannot kill it, there will be no drugs left to cure it.
Untreated gonorrhea can cause a painful condition in the balls and can make it impossible to have kids. It can cause a scar inside your cock so it is hard to piss and can affect the prostate. It is rare, but gonorrhea can cause other serious complications that can be fatal and these complications are more likely in people who have weaker immune systems.
In Toronto, there are more cases of gonorrhea in men than in women. About half of the cases in men are in gay or bi guys. Between 2007 and 2009, cases of gonorrhea in Toronto started to come down. But, between 2009 and 2010 the rates of gonorrhea went up 12%.
There is a large increase in the transmission of HIV that is 'resistant' to some HIV treatments. You can get these strains even if you already have HIV. This may reduce HIV treatment options.
HIV has the ability to become resistant to HIV drugs. This means it can change in a way that it becomes more resilient against HIV drugs, and they are less able stop it.
This resistance normally happens when someone is taking HIV drugs and doesn't take their medication in the way that will work best to fight HIV. But HIV that has resistance to an HIV drug or many HIV drugs can be passed from person to person. Researchers call this 'transmitted drug-resistant' HIV (TDR).
There have been two recent studies to look at how common TDR is in Ontario. Both found that overall, about 13-14% of people were first infected with a drug-resistant strain of HIV. In the first study, TDR increased from about 10% in 2005-2007 to about 15% from 2008-2011. In the second study, there was a tripling of TDR from 10% in 2002-2007 to 27% in 2008-2009. The increase occurred amongst gay men as well as other people with HIV. The evidence is strong that TDR has gone up in Ontario.
TDR is a complicated issue. There are different kinds of TDR and some have more of an impact on HIV treatment options than others. The choice of HIV drugs can be guided by information about treatment resistance, so that people can choose a treatment that will work against HIV. But the concern is that TDR can reduce the treatment options that a person with HIV has.
There is concern about sexually transmitted hepatitis C, especially with guys with HIV. Hep C is difficult to treat, makes it harder to live with HIV, and can be fatal.
Since about 2000 there has been growing concern about the sexual transmission of Hepatitis C (Hep C) amongst gay men. Hep C is an infection in your blood and liver. Because it has not been found in cum it has been very difficult to catch from sex. Most people with Hep C got the virus from blood products (in the past) or from sharing needles or drug equipment when they used drugs.
An increase in sexual transmission of Hep C in gay men has been noted in the US, Europe, the UK and Australia. The little information we have suggests that so far, there is some sexually transmitted Hep C in gay or bi guys in Ontario but not as much as what is being seen in these other countries.
Undetectable viral load = less chance of HIV transmission not no chance. Condoms + undetectable viral load = almost no chance of HIV transmission.
When someone with HIV takes HIV treatments and the amount of HIV in their blood (called viral load) becomes very low or ‘undetectable’ they are less likely to transmit HIV to their sexual partners. This has been exciting and welcome news for all gay men, but especially for guys with HIV.
Some guys think that as long as a guy has a low or undetectable viral load he cannot pass on HIV or the risk is about the same as when he uses a condom. This has led some guys to fuck without condoms because they think it is highly unlikely they will pass on or get HIV as long as the guy with HIV has an undetectable viral load.
The proper use of a condom when we fuck is still the best tool we have to stop HIV. Together, condoms and HIV treatment could drastically reduce new HIV infections. Imagine that.
Every major HIV organization and scientific body in the world still recommends that gay men continue to use condoms when they fuck with their casual and anonymous sex partners.
When a guy fucks without a condom and has an undetectable viral load there is still a risk of exposure to HIV. ‘Undetectable’ viral load means that the amount of virus in the blood or other body fluids is low enough that the test used to measure viral load cannot find the virus. It does not mean the virus is not there. An exposure to a fluid that contains an undetectable amount of HIV is less likely to result in HIV transmission because of the smaller amount of HIV in cum or ass fluids.
A condom is a barrier. When you use a condom there is usually no exposure and that is why condoms are so good at stopping HIV.
There are a lot of STIs out in the community. And it’s not uncommon for a guy to have an STI and not know it. When a guy has an STI it is much easier to pass on or get HIV, even if the guy on HIV treatment has an undetectable viral load. A condom is a barrier to STIs. Having an undetectable viral load is not.
It is much easier to get HIV through the ass than through the vagina. In fact, it is up to 20 times easier! The thin lining of cells inside the ass is much more likely to be damaged when you fuck and this damage increases the risk that HIV can get into your body.
Most of the research that shows that HIV treatment prevents HIV infection has been done with heterosexual couples who mostly have vaginal sex. Because it is so much easier to get HIV through the ass, even if treatment is really good at reducing the chances of HIV transmission, the risk may still be higher for anal sex than for vaginal sex.
The viral load test that guys with HIV use to monitor their health is a blood test. It does not tell you how much HIV is in cum or in the fluids inside the ass. Although guys with an undetectable amount of HIV in the blood generally have an undetectable amount in the other body fluids, a guy can have more HIV in his cum or ass fluids than he does in his blood.
Some research suggests that when viral load is detectable in cum and ass fluids (and it is undetectable in the blood) it is still very low. But, there is also research that shows that the viral load in cum or ass fluids can be much higher than the viral load in blood.
An STI makes it more likely that a person with an undetectable viral load in the blood has a higher viral load in cum and ass fluids. One of the reasons that an STI makes it easier to pass on HIV is because when a guy has an STI in his dick or his ass it can increase his viral load in that part of his body making it easier to pass on HIV.
A lot (maybe as much as half) of new HIV infections come from guys who recently got HIV and have not been tested yet to tell them they have it. They have a very high viral load at this time and are probably fucking without condoms, thinking they do not have HIV. If you fuck without condoms and you think you do not have HIV, get tested for HIV several weeks after each time you fuck without a condom.
It is likely that a smaller (but not insignificant) number of HIV infections happen with guys who are on HIV treatment. Other HIV infections could be happening with guys who have had HIV long enough that they are not in the ‘acute’ stage (ie. early infection with a very high viral load), who may or may not know they have HIV, and are not yet taking HIV treatments.
HIV infections happen because two guys choose to fuck without a condom – a guy with HIV and a guy who does not have HIV. If we are going to stop HIV, each of us has to take action to prevent new infections.
The bottom line is this:
HIV treatment is good at reducing the effects of HIV, and reducing the chances of HIV transmission. It means guys with HIV can look forward to a long life, something we have been fighting for since HIV hit our community. It also means guys with HIV on treatment can feel secure knowing that they are less likely to pass on HIV to other guys, especially if they fuck with a condom.
Because we fuck in the ass and because of STIs it is very likely that HIV treatment will not stop HIV as well as a condom will.
Condoms are nearly 100% effective when used properly because they create a barrier from HIV and STIs. Condoms can fail when they break, slip off, or leak. This is more likely to happen if you don’t use condoms properly.
- If a condom breaks or slips off while you are fucking, consider post-exposure prophylaxis or PEP. PEP is using HIV treatments to prevent HIV infection when you have been exposed to HIV. Go to an emergency department right away (no later than 72 hours after exposure) and talk to them about whether you should try PEP.
WHAT CAN WE DO WHEN WE HAVE CASUAL OR ANONYMOUS SEX?
Use a condom and lots of lube when you fuck.
Don’t be pressured to fuck without a condom. You may disappoint one guy or lose one opportunity, but there are lots of guys out there and most of them have no problem fucking with a condom.
Get tested regularly for STIs. You should include a swab in your throat for gonorrhea if you suck cock. If you fuck without condoms – especially if you have HIV – you should also get tested for Hep C.
If you fuck without a condom, and you think you are HIV-negative, get an HIV test. If you have signs of HIV infection after you have fucked without a condom (fever, sore throat, headache, muscle pain, rash) get an HIV test right away. If not, get the test about three weeks after you fucked without a condom. For more info on HIV testing Click Here
Get motivated to use condoms consistently. Think about how much better you will feel the morning after when you don’t have to worry as much about HIV or STIs. Condoms can reduce all that stress and anxiety.
Take care of your mental health. If you feel depressed or anxious or you are concerned about your use of drugs or alcohol, seek out support. Talk to a friend or seek out professional help. When guys struggle with mental health or their use of drugs and alcohol they are also more likely to fuck without condoms.
FUCK WITHOUT CONDOMS?
If it’s important to you to fuck without condoms or you find condoms make it more difficult to have or enjoy sex, think about ways you can get what you want without the high risk that you will pass on or get HIV:
- Only fuck without condoms in a regular relationship. A good strategy for guys who want to fuck without condoms is to only do it with one boyfriend or regular partner. For other guys they fuck with, they always use condoms. If something happens with those other guys (like they don’t use a condom), they tell their regular partner right away and use condoms until they can get tested for HIV. This strategy can also work for a guy with HIV, who has an HIV positive regular partner, to avoid STIs.
- Use your imagination. Talk dirty. Tell him you’re gonna stick it in ‘raw’ but slip the condom on before you fuck. You can imagine you are fucking without a condom without actually taking the risk. Talk to someone in the leather/BDSM community. They may have lots of experience using their imagination to experience risky sex without actually having risky sex.
- Find a condom that you like. There is a huge variety. There are condoms that are ultra thin and it can feel much less like you are using a condom.
- If you lose your hard on when you put on a condom, talk to your doctor about drugs you can take. There are drugs that really work to help get your dick hard when you are turned on.
For more info on condoms, checkout “Condoms Unwrapped”
Some guys want to fuck without condoms even when they understand all the risks. If you plan to fuck without condoms take action to reduce risk for you and the guys you play with.
The strategies below have been tried by guys as a way to reduce the chance they will pass on or get HIV. They will not work as well as a condom and they will not protect you from STIs. They may reduce the risk of passing on or getting HIV more than if you had done nothing at all. Your risk for passing on or getting HIV increases over time if you use these strategies over and over again. When guys use these strategies they are more likely to pass on or get HIV than when guys use condoms.
For example, in one study of gay men in Australia, when guys fucked without condoms but chose the top position (when HIV negative), or chose partners they believe to also be HIV-negative, or had the guy fucking them take his dick out before he shot his load, they were three times more likely to get HIV than guys who used condoms when they fucked. Another way of saying this is that condoms were three times more effective at protecting guys from HIV than these other strategies. Men who fucked without condoms and did not use any of these strategies were 10 times more likely to get HIV. This is only one study. But, it is important to understand that it is much more difficult to stop passing on or getting HIV if you fuck without a condom.
Still, some guys will fuck without condoms and so these other strategies may be better than taking no steps to lower the risk. It may increase the chance these strategies will work if you combine more than one strategy at the same time.
Strategies guys try have included:
Fuck with guys who have the same HIV status that you do. To increase the chance this will work to prevent HIV infection:
Talk about your HIV status before you fuck without condoms. Don’t assume the other guy has the same HIV status as you
If you do not have HIV, this is a riskier strategy because it is harder to be certain of your HIV status if you fuck without condoms. You can:
- Get tested for HIV three weeks after each time you fuck without a condom.
- If you have signs of HIV infection (fever, sore throat, headache, muscle pain, rash), especially if you recently fucked without a condom, get tested for HIV right away.
- Choose to top when you fuck (the guy who sticks his cock in).
- Choose to bottom (the guy who gets the dick in his ass) if you have HIV.
Find a buddy or a partner who also wants to fuck without a condom and save that sex for just the two of you. When either of you fuck with other guys use a condom.
Reduce the number of different guys that you will fuck without a condom with. When you have riskier sex with more men you increase the chances you will catch or pass on an STI and/or HIV.
Only fuck without a condom if you have an undetectable viral load. You can increase the chance this will work by taking your HIV meds exactly as prescribed and combining this strategy with other strategies.
Avoid poppers if you get fucked without a condom. Poppers more than double the risk of HIV infection for the guy getting fucked.
Get tested for STIs regularly.
For a good discussion of the issues around choosing to fuck without a condom Click Here