A guy who’s HIV-negative might hit up another guy whose online profile says he’s HIV-negative, so they have sex without a condom. Or perhaps when a guy says he’s negative, that acts as a green light to fuck without a condom. When it comes to reducing HIV, choosing to only have sex with other HIV-negative guys does not work very well in practice.
Here’s what we know about when HIV-negative guys try to sero-sort:
When it comes to reducing your chances of getting HIV, choosing to only have sex with other HIV-negative guys does not work very well. This is because, in Ontario, about 11% of people who have HIV have not been diagnosed with HIV. They may think they are HIV-negative, but sometime since their last HIV test, they acquired HIV.
Additionally, if a guy’s HIV is untreated, his viral load – the amount of HIV virus in their body – is probably really high, and high viral load makes the transmission of HIV much more likely. For these reasons, two guys who think they are HIV-negative may have a very high likelihood of transmitting HIV if they choose to fuck without condoms or without using another strategy such as PrEP.
The evidence is showing that many new HIV infections between guys are happening when one of the guys has HIV but has not yet tested positive for HIV. If you have condomless sex, how certain are you of your HIV status? It’s better for your health and for the health of the guys you play with that you know your status as best you can.
Why might guys not know that they have HIV? There are lots of possible reasons.
- They may assume they do not have HIV, because their most recent test came up negative.
- People who have recently acquired HIV may experience no symptoms, or may not recognize the symptoms they experience as HIV infection.
- It is common for guys to underestimate the likelihood of HIV infection.
- It may be because they haven’t tested since they got HIV, but have had condomless sex.
- They may be so afraid of the stigma they might face if they test positive for HIV that they just don’t get tested. We all have a role to play in fighting stigma, so we can all stay healthier.
So some guys don’t know they’re HIV-positive, and it can be difficult to be certain of an HIV-negative status. Because of this, the practice of guys who think they are negative choosing only to hook up with other guys who think they are negative without using condoms or PrEP has not been a reliable way to prevent HIV transmission. Research has shown that this kind of sero-sorting is less effective than when guys combine other strategies: condoms, PrEP, and having sex with HIV-positive guys who have low and undetectable viral loads.
This kind of sero-sorting also plays a role in creating stigma against guys who know they are HIV-positive. In 2020, 97.8% of positive guys on treatment in Ontario were undetectable, but 11% of HIV positive guys didn’t know their status. Guys who have an undetectable viral load can’t transmit HIV through sex, but guys who haven’t been diagnosed, and therefore think they are HIV-negative can. Even so, some HIV-negative guys avoid HIV-positive guys regardless of their viral load or the kind of sex they’re having.
Guys who are sero-sorting and not using condoms are also more likely to be exposing themselves to other sexually transmitted infections. Some STIs can be hard to manage, especially if they are untreated. HIV transmission can also be more likely if either guy has an STI, and isn’t undetectable or on PrEP.
If you are an HIV-negative guy who only has sex with other guys who believe that they are HIV-negative, there are a few things you might want to think about:
Getting tested regularly for HIV and other STIs.
Our testing page can help you figure out how often you should be getting tested. Testing helps to reduce rates of HIV and other STIs in the community. We know today that the best thing you can do for your health if you do have HIV is to diagnose it as early as possible, so you can get connected to care fast and make decisions about treatment. Getting connected to care as soon as possible after acquiring HIV is best for your long-term health.
Is PrEP right for you?
If you have condomless sex, even occasionally, talk to your doctor or HIV test counselor about whether PrEP is a good option for you. PrEP is extremely good at helping guys avoid HIV if they are exposed to the virus, when taken properly. Adding condoms to your routine also protects against STIs. When guys are taking PrEP, they have to do HIV and STI testing every three months. That way, if they do acquire an STI, it will most likely be caught early and they can access treatment.
PrEP is also a great way to manage HIV related anxiety. Taking PrEP means you can chill out about the possibility of HIV transmission, which some guys find helpful.
Having a conversation.
Talk about HIV status, sexual health, and strategies with your sex partners. HIV status can change. Talking about your status is better than guessing or making assumptions. Still, remember that a lot of guys may believe they are HIV-negative because they haven’t been diagnosed with HIV. If you and your partner are sero-sorting based off of being HIV-negative, you might still want to talk about how often they test and whether they’ve had condomless sex since their last test. You might choose to also use condoms, or decide whether to top or bottom, as ways of lowering the chances of HIV. Some guys entering a relationships will go get tested together before making a decision about condoms or making a relationship agreement .
Every time is unique.
Even if you’ve hooked up with him without using condoms before, you may feel differently this time. You can let him know that you’d be more into it using a condom, topping rather than bottoming, or changing something else about the sex you’re having this time.
Intimacy can impact our decisions.
It’s very possible for HIV transmission to occur when two guys are falling in love, getting close, or experiencing really intense intimacy. These feelings may, for example, lead somebody to stop using condoms before being certain of HIV status. If you choose not to use condoms or PrEP, but one guy has undiagnosed HIV, the chance of HIV transmission is high. However, some couples or sex partners may choose to go get tested together to be sure that they are HIV-negative before choosing not to use condoms with each other. It’s a good idea to talk to your doctor about the “window period” where testing might not yet detect HIV. Check out our section on testing to learn more about this.
There are times when you can be more certain of your HIV-negative status.
If you always use condoms, you don’t have anal sex, or you and your partner have been tested and share an honest, monogamous or negotiated relationship, you may be more sure about your HIV-negative status.