HERE IS YOUR NEW ULTIMATE SAFER SEX GUIDE.
- All in one place, everything you want and need to know about gay male safer sex practices, condoms, PrEP, #UequalsU, and PEP!
Lately, the world of HIV prevention and treatment has been given new life as cities, nations, and non-profit organizations have begun to accept and promote #UequalsU and #PrEP as viable and realistic forms of protection from the virus. But stigma and ignorance are still very active and prevalent within our community. From terms like “Truvada whore”, the stubborn belief that PrEP doesn’t work, condoms are the only safer sex method that can be trusted, and that uequalsu is a lie, we have a very long road to walk before every gay man has a complete understanding of what safer sex means.
In the late 1980s, the term safe sex became a mantra to get gay males to use condoms every time we had sex. This was under the belief that latex would protect our partners and us from a deadly illness that was killing off members of our community. There was no cure or treatment for AIDS, so prevention was the most crucial step one could take to keep themselves safe from infection.
During the late 1990’s HIV/GLBT organizations began promoting the new term “safer sex” to replace “safe sex.”
“Safer sex” refers to anything we do to lower our risk — and our partners’ risk — of sexually transmitted infections. Some people call it “safe sex,” but this isn’t accurate — no type of sex with a partner can be guaranteed 100 percent safe. Many people with sexually transmitted infections experience no symptoms, so people are not always aware that they have them.
Let’s look at the current promoted methods of HIV prevention so that we can evaluate their effectiveness for gay males, anal sex, and our reality. We hope you will take in all of this information based on facts and science and decide for yourself which methods work best for you and your real sexual life. These are personal decisions and do not need to be approved by your friends or family because they don’t know everything about your sexual life and what you can handle. What safer sex means has changed, and so should you.
PrEP is for those known to be HIV-negative and generally considered to be in a “high-risk group for HIV infection,” as defined by the CDC. This is a vast net that includes all sexually active gay males. PrEP is a possible medication for you unless you practice an abstinence-only policy. Contrary to much of the (mis)information published about PrEP on the web and in the media, we at GMJ believe that the final decision about this medication should be made by you alone, with the support of your treating physician. We can not say this enough.
Researchers estimate that PrEP reduces the risk of HIV by at least 99 percent when taken daily as prescribed. In fact, due to a high level of “dosing forgiveness,” taking just four tablets per week still likely confers maximum protection.
“Based on the findings in this study, the researchers estimate that taking Truvada four or more days a week is 100 percent effective at preventing HIV. The combined estimated range of four to six days a week dosing and daily dosing is 86 percent to 100 percent efficacy. According to this trial, four or more days a week of PrEP reduces the risk of contracting HIV by at least 86 percent, but that figure may indeed be as high as 100 percent.
By comparison, the original iPrEx study showed a 92 percent risk reduction among those who had any Truvada in their systems, with an estimated 40 to 99 percent efficacy range. A subsequent study of the iPrEx data used statistical modeling to estimate that four doses a week reduced the risk of HIV by 95 percent, with a 90 percent to more than 99 percent estimate range, and that daily dosing reduced the risk by 99 percent, with an estimated range of 96 to more than 99 percent.”
On-demand dosing involves taking a double dose of PrEP (two pills) from 2-24 hours before anticipated sex, and then if sex happens, additional pills 24 hours and 48 hours after the double dose. In the event of sex on several days in a row, one pill should be taken each day until 48 hours after the last sexual intercourse. This method has been proven to be just as effective as traditional dosing.
Currently, of the 100s of thousands of daily users around the world, for over six years, only seven people have contracted HIV while using PrEP; due to a genetic concern or user error.
PrEP and other STD/STIs
PrEP does not protect against sexually transmitted infections or diseases besides HIV.
A SAFER SEX VIDEO FOR GAY GUYS THAT DON’T LIKE CONDOMS
Latex is the gold standard in STI/HIV prevention methods, but it is not 100% effective, even when used correctly.
We have a detailed article about condoms and how effective they are for gay male anal sex, but here we are just going to give the highlights about risk as presented by The San Francisco AIDS Foundation. They use the most recent study by Smith D. K. and others. Condom effectiveness for HIV prevention by consistency of use among men who have sex with men in the United States. JAIDS, 2015.
Effectiveness for gay male anal sex & HIV
“Effectiveness” is synonymous with condoms’ success rate or how well they reduce HIV risk.) She reported that MSM who always use condoms have a 70 percent lower risk of HIV than those who always bareback (condomless/natural sex for those of us who don’t believe in stigma).
NOTE: Smith says she is “very confident” about the 70 percent figure, saying it is “the best estimate we have” of the actual real-world effectiveness of condoms in preventing HIV among MSM who use them consistently and correctly.
Others are less confident. “It is important to highlight that the 70 percent estimate of condom effectiveness is precisely that, an estimate, and is not set in stone,” says Alfonso C. Hernández-Romieu, MD, MPH, a research associate in the department of epidemiology at Emory University in Atlanta, who recently published a study in the journal Sexually Transmitted Infections about the considerable rates of condom failure and misuse among MSM. “As our capacity to measure condom use grows, we will likely revise [the estimate].”
Condom effectiveness if you’re bottoming
- Always use a condom = 72% effective
- Sometimes use a condom = 8% effective
Condom effectiveness if you’re topping
- Always use a condom = 63% effective
- Not more effective than never using a condom
The difference in condom effectiveness for topping and bottoming (72% compared to 63%) was not statistically significant.
Risk of HIV transmission with condom use
In addition to looking at “effectiveness,” you can also look at data on HIV risk. In other words, out of everyone reporting a certain type of condom use, and/or a specific type of sex, how well do condoms work?
Here are those HIV incidence rates (per 100 person-years). You can see that “always” using condoms has the lowest risk for HIV infection for all types of sex.
Risk if you’re bottoming
|EXPLORE study||VAX 004 study|
|Never use condoms||16.2||11.9|
|Sometimes use condoms||12.5||12.5|
|Always use condoms||2.3||4.4|
Risk if you’re topping
|EXPLORE study||VAX 004 study|
|Never use condoms||7.1||6.0|
|Sometimes use condoms||7.7||6.5|
|Always use condoms||1.6||2.7|
Risk if you’re topping & bottoming
|EXPLORE study||VAX 004 study|
|Never use condoms||9.6||6.7|
|Sometimes use condoms||7.4||7.3|
|Always use condoms||1.4||2.7|
Gay male condom usage
“Condom use is declining among men who have sex with men. In a large survey of MSM in major urban areas, nearly two-thirds reported having condomless anal sex at least once during the past year. A quarter said they had receptive anal intercourse without a condom the last time they had sex with a man. But there is also evidence that MSM use condoms at considerably variable rates depending on their HIV status, the status of their partners, whether the partner is a main or casual one, and the sexual position”.
“Regarding their most recent encounter with a male, 14 percent of MSM reported condomless receptive anal sex—the sexual act that poses by far the greatest risk for HIV acquisition—and 9.8 reported both insertive and receptive condomless anal sex, or 23.8 percent total for those reporting receptive condomless intercourse. Men who knew they were HIV positive were more likely to report having had receptive anal sex without a condom the last time they had sex with a male.”
“There has been a long-term decline in condom use by American gay men, researchers from the Centers for Disease Control and Prevention (CDC) report in AIDS. Similar declines have been seen in men whose sexual partners were of the same HIV status and in men who did not know their sexual partners’ HIV status – showing that the fall in condom use cannot be explained by serosorting or other seroadaptive behaviors”.
Moreover, condom use began to fall long before PrEP became available!
The survey data were collected in 2005, 2008, 2011, and 2014 in 21 American cities as part of the National HIV Behavioral Surveillance (NHBS). Between 1100 and 1600, men who have sex with men (MSM) took part in each round. Men were recruited at bars, clubs, social organizations, gay businesses, bathhouses, parks, etc.
In 2015, Dawn Smith, MD, MS, MPH, and colleagues at the Centers for Disease Control published an article in JAIDS analyzing condom effectiveness data for men who have sex with men. Their sample included data from two large studies: VAX 004 (4,492 men) and EXPLORE (3,233 men). These studies were conducted in the late 90s/early 2000s (i.e., before PrEP). Both of these studies included HIV-negative men who reported having sex with an HIV-positive partner.
Among the thousands of men in the two studies, only 16.4% reported “always” using condoms with all sexual partners over the year or more the study lasted. That’s pretty typical. Many times, people will decide to use or not to use condoms based on various outside influences. For instance, some people choose to stop using condoms with longer-term partners. Or, sometimes, people just forget, don’t have access to condoms, or don’t think about it if they’re drunk or high.
In this study, inconsistent (“sometimes”) condom use with HIV-positive partners with detectable viral loads offered “minimal or no protection” from HIV. People in the study having receptive and insertive anal sex who reported “sometimes” using condoms had an estimated condom effectiveness rate of 8%, and that’s really low.
Condoms and other STD/STIs
Condom usage for gay males regarding STDs/STIs is more about risk reduction than total prevention. No reports or studies detail the exact percentages or rates of risk or reductions, but the presence of a condom will provide some level of protection.
Using condoms can reduce your chances of getting or transmitting STDs that spread through genital fluids, such as gonorrhea, chlamydia, and HIV. But condoms are less effective at preventing STDs transmitted through skin-to-skin contact if there are sores or cuts on the skin, like human papillomavirus (HPV, genital herpes, and syphilis.
Condoms do less of a stellar job at lowering the risk of infections that affect the skin and which transmit from skin-to-skin contact because it can be so easy to transmit these STIs from the common rubbing between two guys during foreplay and sex.
Also, you can get almost all the major STIs in your throat or around your mouth. (The exceptions are LGV and trichomoniasis.) And those infections can then transmit to another man’s urethra, in the case of bacterial infections, or to his genital area or anus in the case of ulcerative STIs that infect the skin. But the bottom line is this: Using latex for anal intercourse lowers the overall risk of transmitting STIs; we just don’t know how much.
The reality is that the more you expose each of the three major sites of potential infection—the oral region or throat, the genital area or urethra, or the anus or rectum—to an STI, the more you raise your chance of contracting an infection. This is known as cumulative or overall risk. Condoms, by creating a barrier between the penis and the rectum and anus, reduce such exposure and overall risk.
However, if a guy has a wart on his penis, for example, and he wears a condom for anal sex, this will lower the chance of transmitting the wart to the other guy’s anus. You have to consider that he may very well rub his unsheathed penis against the other guy’s anus before putting on the condom. But by putting on a condom for the actual act of intercourse, he’s at the very least cutting down the time spent exposing the wart to his partner’s body.
Where condoms come in handy is in lowering the risk of acquiring gonorrhea and chlamydia in the rectum from someone with a urethral infection. That’s because these two bacterial STIs transmit through bodily secretions. According to Grulich, having the top (insertive partner) use a condom means the bottom (receptive partner) is three to five times less likely to acquire rectal gonorrhea and about three times less likely to get rectal chlamydia.
How to use a condom
- The first step to using a condom correctly is ensuring it’s still usable. That’s why it’s essential to check the expiration date on the condom package before opening it. Do not use condoms that have expired. Another way to check the freshness of a condom package is to feel for the air bubble. The easiest way is by gently squeezing the packet between your thumb and first finger. If the air bubble is there, the package hasn’t been punctured.
- To open a condom package, carefully tear along the corner or edge. Don’t use fingernails or scissors to open a condom package. The foil packets that condoms come in are pretty easy to tear, and using a sharp object increases the risk of ripping or tearing the condom along with the package.
- Before putting a condom on, you want to be sure of which way is up. Condoms should go on like a hat, not like a shower cap. You know the condom is right side up if you can roll it down easily. You shouldn’t have to stick your fingers inside the condom to unroll it. If you accidentally put the condom on upside down, throw it out and start again. If the condom has come into contact with the head of the penis, it may be contaminated with secretions. This is also why you should wash your hands before putting on a condom if you’ve been touching yourself or your partner intimately.
- The “reservoir tip” of a condom isn’t large enough to hold the amount of semen contained in an ejaculation. You will therefore want to unroll the condom slightly before placing it on the penis. If you use a condom over a sex toy, you do not need to do this step.
- When you put a condom on a penis, leaving room at the tip is essential. If you don’t, there will not be enough space to contain the ejaculate, which could cause the condom to break. It is also necessary to ensure no air is trapped in the tip of the condom, making it more likely to break. Sometimes putting a little bit of lube in the tip of the condom before putting it on can help to avoid an air bubble. If you don’t like that sensation, just check that the air is out of the condom before putting it on. It shouldn’t feel like there is an inflated balloon at the tip.
- Unroll the condom to cover the entire shaft of the penis. Doing this will help reduce the risk of transmission of any STDs that are transferred from skin to skin, such as syphilis. It also makes the condom less likely to slip than if it is only rolled down partway.
- After ejaculation, holding onto the condom at the base while the penis is withdrawn from the anus is essential. This should be done before the penis becomes less erect. Failing to hold onto the condom makes it more likely that the condom will slide off, and it also increases the risk that it will leak. If a condom remains behind in your partner after withdrawal, twist the end of the condom shut before removing it. That will help contain any secretions.
- Condoms go in the trash, not in the toilet. If they do, your next date might need to be with a plumber. When throwing away a condom after sex, it may be a good idea to wrap it in toilet paper or tissue to prevent it from leaking and making a mess. This is particularly true if you’re throwing away the condom in a trash can without a liner.
- Always use a good amount of lube for anal sex. Condoms NEED water or silicone-based LUBE TO WORK!
- Make sure to change condoms for long sessions at least every 20 minutes.
- Always change condoms between partners!
- Never use flavored condoms for anal sex; they are made for oral sex only.
- Make sure to buy and use the proper-sized condom for your dick.
- Never use two condoms for double protection; and this doesn’t work and causes extra friction that can cause tears in the condom.
The conversation about safe and safer sex began with AIDS/HIV. For almost four decades, there has been an increasing amount of fear and stigma around those living with this virus even as treatments have improved and infection is no longer a death sentence. Fear, shame, and ignorance around having sex with a guy that is poz continues, even if you are HIV positive yourself. Our community has been flooded with lies, rumors, and misinformation. But here are the facts about having sex, even without a condom, with someone living with HIV.
Treatment as Prevention (TasP) is treating someone living with HIV with ART medications so that the virus is sufficiently suppressed in their body. This keeps him healthy and able to live a normal life span and sex life. But, it also means that he is uninfectious and unable to infect his partners with HIV, even if they choose not to use condoms. The PARTNER study is one of the latest studies of gay male couples who had condomless sex, with one partner living with HIV and the other HIV negative, without using PrEP. None of the HIV-negative partners contracted HIV from his ART-treated, undetectable partner!
The great news is that we no longer have to fear sex and intimacy with those who are living with HIV. And those infected don’t have to be concerned that they could even accidentally infect their sexual partners, with or without condom usage. This science not only helps reassure those in mixed-status relationships but should also reduce the stigma around being sexually active with a guy living with HIV. This is the news we have waited for, for a generation! This is to be celebrated, not fought.
UequalsU and other STI/STDs
Undetectable only applies to HIV infection. It has no relationship to other sexually transmitted infections or diseases.
PEP (post-exposure prophylaxis) means taking antiretroviral medicines (ART) after being potentially exposed to HIV to prevent becoming infected.
PEP should be used only in emergencies and must be started within 72 hours after a recent possible exposure to HIV. If you think you’ve recently been exposed to HIV during sex or through sharing needles and works to prepare drugs, or if you’ve been sexually assaulted, talk to your health care provider or an emergency room doctor about PEP right away.
It is not a substitute for regular use of other proven HIV prevention methods, such as pre-exposure prophylaxis (PrEP), which means taking HIV medicines daily to lower your chance of getting infected; using condoms the right way every time you have sex; and using only your own new, sterile needles and works every time you inject.
PEP is effective, but not 100%, so you should continue to use condoms with sex partners and safe injection practices while taking PEP. These strategies can protect you from being exposed to HIV again and reduce the chances of transmitting HIV to others if you become infected while on PEP.
Not having sex at all is the only 100% way to be sure never to contract a sexually transmitted illness. This is a very viable alternative for those who want a guarantee from any person or product.
None of the above activities have ever been shown to transmit HIV, but they are known to be avenues for other STD/STIs infections. Please click on the links to learn more.
Let’s talk about risk
Life, particularly gay male life, can be complicated and stressful sometimes. Our decisions about what we can and should do will sometimes vary significantly from those of our straight brothers. What we wear, where we go, and even who we tell that we are gay can be the literal difference between life and death. Even our sex lives are filled with hard choices that can have long-term and permanent negative consequences.
The AGE of AIDS did not make any of these issues easier. Fear and uncertainty were fueled by inconsistent and unreliable information from our doctors, government, and even the HIV/AIDS organizations set up to assist us. “Risk” became a buzzword for all of our sexual choices. “How risky is anal sex?” “Will condoms reduce my risk of contracting HIV?” “Does undetectable equal zero risk of infection?” We were trained and advised to seek an impossible standard of living.
But, we cannot have this conversation without taking some personal responsibility ourselves, with our actions and words. The desire to have a risk-free life is basic human self-preservation but an impossible standard for anyone to achieve. It is not wrong to want to limit the amount of risk in our lives, but it is unrealistic to attempt to forge a totally risk-free one.
Life involves risk, and this means with our sex lives as well. The only certainties in life are death and taxes; everything else consists of uncertain danger. But to make proper decisions about what levels of risk we find acceptable, we rely upon those in the medical field to give us clear and concise answers, which we never get. Hell, we’re still waiting for someone to tell us how much risk is involved in receiving oral sex!
The first question guys always ask about any sexual act is, “how risky is it”? The truth is that no one can give you an answer to this question because it is too vague. They would need much more information about you and the guy(s) you are having sex with. General guidelines have been created to help you make decisions, but they are not perfect and cannot factor in every scenario in your life.
Anal sex without a condom is HIGH RISK for HIV infection.
- If Joe and Todd are both HIV negative, there is ZERO RISK of HIV transmission.
- If Joe and Todd are both HIV positive, there is ZERO RISK of HIV transmission.
- If Joe is undetectable, there is ZERO RISK of Todd becoming HIV positive.
Having multiple partners is HIGH RISK for HIV infection.
- What if all of your partners are HIV-positive and undetectable?
- What if you are HIV positive and undetectable?
- What if all of your partners are HIV-negative?
Condoms protect against HIV/STD
- What if you don’t use condoms all the time?
- What if you don’t use them effectively?
- What if you use them, but your partner has herpes?
Safer sex is not about being 100% safe from contracting all STDs/STIs; that is impossible. But it is about reducing your risk levels and taking a proactive approach to making the best decisions for your sexual health. This also includes watching your drug and alcohol intake, which can impede your judgments about safer sex methods.
We hope this new guide to safer sex helps you but also reduces your anxiety and fears about having gay male sex and reduces the stigma within our community about those living with HIV.
Now, get out there and have some hot SEX!!!