Reducing the risks?

A proper use of condoms and plenty of lube will protect you against HIV. If you are HIV negative and you fuck without a condom (“bare”), you run a risk. Some men who do not use condoms apply strategies by which they try to reduce the risks in terms of HIV. Some of those strategies do not reduce the risk in any way; others may reduce the risk somewhat. The word “reduce” says enough, by the way. None of the strategies is watertight: you still run a risk of getting HIV. They also involve a major risk in terms of other STIs. If you choose for these strategies, make sure you get tested for HIV and STIs every three months. In the meantime, always be alert to the symptoms of an acute HIV infection.

A proper use of condoms and plenty of lube will protect you against HIV. If you are HIV negative and you fuck without a condom (“bare”), you run a risk. Some men who do not use condoms apply strategies by which they try to reduce the risks in terms of HIV. Some of those strategies do not reduce the risk in any way; others may reduce the risk somewhat. The word “reduce” says enough, by the way. None of the strategies is watertight: you still run a risk of getting HIV. They also involve a major risk in terms of other STIs. If you choose for these strategies, make sure you get tested for HIV and STIs every three months. In the meantime, always be alert to the symptoms of an acute HIV infection.

No reduction in the risk of getting HIV

None of the following strategies reduce the risk in terms of HIV in any way:

  • Serosorting: fucking without a condom with guys who, like you, assume they are HIV negative.
  • Fucking without a condom, but only with steady fuck buddies.

Possible reduction of the risk in terms of HIV

The following strategies might reduce the risk in terms of HIV somewhat:

  • Viral sorting: fucking without a condom with HIV-positive men whose viral load is undetectable.
  • Fucking without a condom, but only in the active role (as a “top”). 
  • Not coming in each other (Coitus interruptus, i.e. “pulling out just in time”).

By combining these three strategies, you could theoretically reduce the chances that HIV will be transmitted.  This has never been scientifically demonstrated, however. Even if you combination these strategies, you still run a risk of getting HIV and other STIs.

Serosorting

Serosorting means that you decide not to use a condom after you have checked with your partner that he, like you, is “seronegative” (does not have HIV).  

Pros

This strategy is only safe in terms of HIV if you and your sex partner both know for certain that neither of you has HIV.

Cons

Your partner could have HIV without even knowing it. It is possible, for example, that:

  • his infection had not yet become visible when he was last tested.
  • he only recently became infected with HIV.

If your sex partner only recently became infected with HIV (less than four weeks earlier), there will be huge amounts of the virus in his blood and sperm. That means the chance that he will transmit HIV to you is very great. You also run a greater risk of getting some other STI.

Conclusion

There is no risk reduction in terms of HIV. More importantly: with serosorting you may run an even greater risk of getting HIV if your sex partner only very recently got HIV but doesn't know that yet. You also have a greater chance of getting other STIs.

Fucking without a condom, but only with steady fuck buddies

This means that you limit the number of parters with whom you fuck without a condom. You only fuck without a condom with men you date on a regular basis.

Pros

  • The more sex partners you have, the higher the risk you run in terms of HIV and other STIs. It is indeed true that you run more risk of getting HIV and STIs if you have sex with many different casual sex partners without using a condom. 
  • This strategy is only safe if you are completely certain that both you and all your fuck buddies are HIV negative.

Cons

  • Having more sex partners really does mean more risk. But unfortunately you cannot flip that equation around. Having fewer partners with whom you have sex without condoms does not mean that you run less risk per sexual contact. To get HIV, you only need to have sex with person who has it. 
  • Also, one of your fuck buddies could have recently contracted HIV without even knowing it,

Conclusion

There is no reduction of the risk in terms of HIV and other STIs.

Viral sorting

This means that you have sex without condoms only with HIV-positive men whose viral load is undetectable.

Pros

A successful treatment of HIV leads to an undetectable viral load. That makes it almost impossible to transmit HIV to others.  
Cons

  • You can never know for certain whether or not your partner's viral load is really undetectable. Your partner can't “feel” whether it is undetectable or not. He must be checked on regular basis and he must take his HIV-medication faithfully every day. You don't always know him well enough to know for sure if that is the case.
  • The debate is still ongoing, but some scientists think that if your HIV-positive partner has a different STI, that infection will temporarily increase the amount of HIV virus that is present in his sperm and in his anus. In that case, HIV could be transmitted after all.
  • There is a great chance that your partner will pass on a different STI to you.

Conclusion

There is a possible reduction of the risk you run of getting HIV. There is also a great chance that your partner will pass on a different STI.

Fucking without a condom, but only in the active role (as a “top”) 

This means that you choose to use condoms any time someone fucks you, but not to use a condom if you fuck someone as the active partner or “top”.  

Pros

In theory you run less of a risk of getting HIV if you only fuck actively (as a “top”).

Cons

  • HIV is present in the intestinal mucous membranes. Even men who only fuck without a condom in the active role can still get HIV via their glans and their urethra.
  • If you have an STI as the top, you also run a greater risk of getting HIV.
  • You still run a great risk of becoming infected with other STIs.

Conclusion

There might be a reduction in the risk you run of getting HIV, but there is no reduction in the risk in terms of other STIs.

Not coming inside each other

This strategy is also known as “coitus interruptus”: you fuck each other, but you don't come inside each other.

Pros

If you don't use condoms, it is safer for you if he does not come inside you than if he does come inside you.

Cons

  • You need to pull out in time and come when you are outside of the other person. Many people don't manage to do that.
  • HIV can also be transmitted by fucking even when the top doesn't come inside the bottom. Your chances of becoming infected with HIV are greater if you have an STI.
  • You still run a great risk of becoming infected with other STIs.

Conclusion

There might be a reduced risk of getting HIV. But you also run a major risk in terms of other STIs.

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Preventing Hepatitis B

Laurens (25) did a PEP treatment

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