Sex and the Gay Man: FAQ’s
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HIV RISK REDUCTION STRATEGIES

Question: I want to enjoy sex with other men and not worry about getting HIV. What do I need to know to help protect myself from HIV?

There are simple things you can do as an HIV- gay man to insure you do not get HIV accidentally. In addition, the strategies listed below can also help protect you against other STD’s as well. The following can help reduce your risk of becoming infected with HIV:

• KEEP CUM AND BLOOD OUT OF THE MOUTH AND ASS, including the eyes or nose and away from any cuts/breaks in the skin.
• USE CONDOMS FOR ANAL SEX. Doesn’t matter the type (latex, plastic, polyurethane) condoms are the best way to avoid getting HIV, for tops and bottoms.
• USE WATER/SILICONE-BASED LUBRICANTS WITH LATEX CONDOMS. Oil-based lubes like Crisco, Vaseline, baby oil, hand creams, etc., can cause latex to break. If you must use oil-based lubricants, use polyurethane condoms since these are safe to use with oil.
• DON’T DOUCH BEFORE GETTING FUCKED. This actually puts you at a higher risk for becoming infected with HIV. Douching may wash away helpful or "good" bacteria in the mucous membrane lining your ass as well as reducing your natural lubrication. This increases the friction of being fucked, which can cause tears in the rectum and anus. It's also not good to douche after being fucked since this could spread the virus around even more. Taking a crap afterwards is a safer bet.
• USE LOTS OF LUBE. Make sure that your ass and rectum are as thoroughly lubricated as possible, which helps to lessen cuts and tears that can it easier for HIV to get into your body's blood stream.
• USE LATEX GLOVES FOR FISTING, especially if you have any cuts or sores on your hands.
• DON’T BRUSH OR FLOSS YOUR TEETH RIGHT BEFORE ORAL SEX. Wait at least 15 minutes before heavy kissing or performing oral sex.
• BE AWARE OF ANY CUTS OR SORES IN YOUR MOUTH. In general, good oral hygiene prevents the possibility of having any easy tears/cuts in your mouth.
• DON’T GET CUM IN YOUR MOUTH. If you do, as the saying goes: “Swallow or spit, just don’t let it sit.” The longer cum stays in your mouth, the more potential for HIV to find an entry point into your body.
• AVOID DEEP THROATING. This can cause abrasions in your throat, which can be effective entry point for HIV infection.
• DON’T SHARE SEX TOYS. Use condoms on dildos or vibrators, and/or clean them with soap and water or in hydrogen peroxide after use.
• DRUGS AND ALCOHOL DON’T HELP. Drugs, including alcohol, can impair your judgment on who you have sex with and what you are willing to do with that person or persons. Many people have trouble keeping to their commitments to safe/healthy sexual behaviors after getting high or drunk.
• IT IS NOT ALL ABOUT ORAL AND ANAL. Massage, hugging, masturbation (solo or with others), and other activities doesn’t involve the exchange of bodily fluids.
• IF YOU BAREBACK, PULL OUT BEFORE YOU CUM. This may not prevent HIV transmission but then it also might.

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ORAL SEX

Question: Can I get HIV from kissing opened-mouth or French kissing ("swapping saliva")?

Open-mouth and French kissing is considered a very low-risk activity for the transmission of HIV because the amount of HIV in saliva is very small and relatively inactive. However, prolonged open-mouth kissing for about 24 hours straight may get enough HIV into your system to become infected.

Question: Can I get HIV from performing oral sex?

Yes, it is possible for you to become infected with HIV through performing oral sex, although highly unlikely. There have been a few cases of HIV transmission from performing oral sex on a person infected with HIV, but not statistically significant. The risk for HIV transmission increases:

• If you have cuts or sores in your mouth or throat, including cold sores, abscesses, herpes sore or bad dental hygiene
• If your partner cums in your mouth, or
• If your partner has another sexually transmitted disease (STD)

The safest way to have oral sex and not have HIV transmission is to wear a condom during oral sex. Since most guys who suck dick do not use condoms, there are ways to reduce the chance of HIV transmission during oral sex:

• DON’T BRUSH OR FLOSS YOUR TEETH RIGHT BEFORE ORAL SEX. Wait at least 15 minutes before heavy kissing or performing oral sex.
• BE AWARE OF ANY CUTS OR SORES IN YOUR MOUTH. In general, good oral hygiene prevents the possibility of having any easy tears/cuts in your mouth.
• DON’T GET CUM IN YOUR MOUTH. If you do, as the saying goes: “Swallow or spit, just don’t let it sit.” The longer cum stays in your mouth, the more potential for HIV to find an entry point into your body.
• AVOID DEEP THROATING. This can cause abrasions in your throat, which can be effective entry point for HIV infection.

Question: Can I get HIV from someone giving me head?

Yes, it is possible for you to become infected with HIV through receiving oral sex, but highly unlikely. The main way it could happen is if blood you’re your partner’s mouth comes into contact to your urethra (the piss-slit), the asshole, or directly into the body through small cuts or open sores on the head or shaft of the penis.

Since most top guys don’t use condoms or want to use condoms for oral sex, there things you can do to reduce HIV transmission. Avoid deep throating (also known as “face fucking” or “throat fucking”). Deep throating makes it easier for the piss-slit of your cock to come into contact with the mucous membranes at the back of your partner’s throat, providing a good entry point for HIV to get into the body's blood stream.

Question: If someone is HIV+, but has an undetectable viral load, is it still "safe" to suck their cock without a condom?

Yes, as long as you do not have any cuts or sores in your mouth and he does not cum in your mouth. That being said, an undetectable viral load is only a measure of the HIV levels in a blood sample and there is still no sure way to know or average how much HIV virus there is in cum or pre-cum.

Question: How much HIV is there in pre-cum?

Pre-cum is generally considered to have low levels of HIV. There is no sure way to know how much HIV virus there is in pre-cum since it varies from man to man, and is dependent on a bunch of factors, including the potential presence of some cum in pre-cum.

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Ass Play

Question: What's the risk of getting HIV from rimming?

There's a very, very low risk of getting HIV from eating ass or rimming. On the other hand, there are a whole bunch of other STDs that are much easier to get from rimming — like parasites, hepatitis A/B, Shigella, and herpes.

Question: How safe is fingering?

Fingering is generally considered a low-risk activity for the transmission of HIV, particularly if there are no open cuts or abrasions on the fingers/hand or the body orifice (asshole) being fingered. To be sure, it's a good idea to use latex gloves or finger cots for fingering.

Question: Is it safe to share dildos with my sex partner?

HIV and other STD’s can still be active on sex toys after use and can be transmitted to another partner if it has not been cleaned after use. Use condoms on dildos or vibrators, and/or clean them with soap and water or in hydrogen peroxide after use.

Question: What are the pros and cons of fisting and how best to go about it?

Fisting or receiving a hand or fist up the anus and into the rectum is a sexual activity that can provide stimulation and gratification for both players. It is wise to use lots of lubrication and many people also use latex gloves. Going slowly will minimize any trauma to the rectum. Washing up before and after with soap and warm water is a good idea to prevent the transmission of enteric infections like hepatitis A, shigella, giardia and amoebiasis.

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Watersports

Question: How safe is piss for HIV?

The risk of getting HIV is relatively low since there's normally not a lot of HIV in piss. But there is a chance that there may be some cum or blood in the piss, which could contain active HIV, but not enough of it to cause infection. Even though piss is safe for HIV, it is not for the risk of getting hepatitis A/B, or other STDs.

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ANAL SEX

Question: I want to try being a bottom for the first time. What happens to my ass after this? Will it affect my bowel movements? Will there be bleeding?

Receptive anal sex can be very enjoyable. The key is to start slow and use plenty of lubrication. Men and women can have receptive anal sex for years and not have problems with excess relaxation of the anal sphincter. For first-timers, use a lubricated finger at first and then slowing inserting additional fingers. An erect penis can be fairly large, but once it slips past the anal sphincter, it's home free. Of course condoms make it easier, safer and more fun.

Question: How do I get HIV from anal sex?

It is possible for either the top or the bottom to become infected with HIV during anal sex. HIV can be found in the blood, semen, pre-seminal fluid, or vaginal fluid of a person infected with the virus. In general, the bottom is at greater risk of getting HIV because the lining of the rectum is thin and may allow the virus to enter the body during anal sex. However, a top who has ex with an HIV+ partner also is at risk because HIV can enter through the urethra (the opening at the tip of the dick) or through small cuts, abrasions, or open sores on the penis.

Having unprotected anal sex is considered to be very risky behavior. If you are going to have anal sex, use a condom (latex or polyurethane). 98% of the time condoms work as they should. However, condoms are more likely to break during anal sex than during vaginal sex. So, even with a condom, anal sex can be risky. You should also be sure to use a water-based lubricant (rather than an oil-based lube) in addition to the condom to reduce the chances of the condom breaking because of friction.

Even though there is a greater chance for HIV transmission as well as other STD’s if you bareback, pulling out before you come if you are the top is also a strategy to reduce HIV transmission.

Question: Why do tops think they cannot get HIV?

Unprotected anal sex is an incredibly risky activity for a bottom, much more so than for a top. The risk of HIV transmission to a bottom during unprotected anal sex is 15 in 1,000 versus 3 in 10,000 from a bottom to a top. Still, even though the chance is smaller, tops still can get infected with HIV.

Question: Should I douche before getting fucked?

No. Douching actually puts you at a higher risk for becoming infected with HIV. Douching may wash away helpful or "good" bacteria in the mucous membrane lining your ass as well as reducing your natural lubrication. This increases the friction of being fucked, which could cause tears in the rectum and asshole. It's also not good to douche after being fucked since this could spread the virus around even more. Taking a crap afterwards may be the safer bet.

Question: How safe is barebacking if the partner withdraws before ejaculating?

Barebacking carries various risks of STD transmission even without ejaculation -- herpes, gonorrhea, chlamydia and syphilis infections can all be transmitted without any cum present. HIV has been isolated from pre-cum and could theoretically be transmitted even without full ejaculation. Of course, the risk of transmitting HIV without ejaculation is definitely lower than with ejaculation, but there is still some risk involved.

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CONDOMS

Question: Do condoms work?

Yes. Although controversy persists regarding whether condoms are an effective means of preventing human immunodeficiency virus (HIV) transmission, condoms that are readily available, effectively promoted, and used correctly and consistently, play an important public health role in HIV prevention.

Studies have shown that latex condoms are highly effective in preventing HIV transmission when used consistently and correctly. These studies looked at uninfected people considered to be at very high risk of infection because they were involved in sexual relationships with HIV-infected people. The studies found that even with repeated sexual contact, 98-100 percent of those people who used latex condoms correctly and consistently did not become infected with HIV. Condoms have been shown to be effective barriers not only to HIV but also to herpes simplex, CMV, hepatitis B, chlamydia, and gonorrhea.

Question: I'm allergic to latex. What kind of condom should I use as an alternative?

If you are allergic to latex, and some gay guys are, then you should use polyurethane condoms. The most popular brand is Avanti Duron which the STOP AIDS Project provides to participants free of charge.

Question: I like the natural feel of lambskin. Are they as good at protecting me from HIV as latex?

No, lambskin condoms do not prevent transmission of HIV.

Question: Is it safe/safer to use two condoms (instead of one) at the same time?

While controversy continues over this question, it is generally believed that it is better to use a single condom at a time. When a single condom is used properly, the resulting safety factor for prevention of HIV transmission increases dramatically. When two condoms are used, there is a much bigger chance of friction between the two latex barriers. Friction (heat) is a condom's worst/biggest enemy. Heat contact with latex will increase the chance of breakage. (Hot temperatures, humidity, and even ultraviolet light can contribute to the deterioration of latex condoms.) Although if you were to use a small bit of latex-safe (water- or silicone-based) lubricant between the two condoms, the chances of the condoms breaking is reduced significantly.

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Question: What types of condoms are out there to use?

Follow this link to our web page about the types of condoms gay men can use for sex.

LUBRICANTS

Question: What kinds of lubricants should I use?

It is always safe to use water-based lubricants and silicone-based lubricants with latex condoms. The lubrication heightens the sexual experience and, if you put a few drops of lube inside the tip of the condom, you'll have better stimulation along with added safety.

It is NEVER safe to use oil-based lubricants (skin lotions, baby oil, Vaseline, Crisco, cold cream, or even whipped cream) with latex condoms because oil dramatically weakens latex and definitely increases the chances of condom failure/breakage. For example, mineral oil is a common ingredient in many lotions. With as little as 60 seconds of exposure, a 90% decrease in latex strength will occur in a condom when using an oil-based lubricant.
Only polyurethane condoms can safely be used with oil-based lubricants, so if you must use an oil-based lubricant, please use only polyurethane condoms. Polyurethane condoms also work well with water- and silicone-based lubricants.
Question: What is the story about the spermicide nonoxyl-9 (N-9)? Does it help with preventing HIV transmission?
No. Recent scientific studies have conclusively/significantly proven nonoxyl-9 ineffective in preventing HIV transmission. In fact, it actually appears to increase your chances of becoming infected with HIV. Given the risks and the lack of any preventive benefits, the use of nonoxyl-9 is no longer recommended as a preventive measure against HIV transmission/infection.

The STOP AIDS Project does not buy or distribute any condoms with nonoxyl-9.

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HIV & OTHER STDs

Question: Is there a connection between HIV and other STDs?

Yes. Having a sexually transmitted disease (STD) can increase a person's risk of becoming infected with HIV, whether the STD causes open sores or breaks in the skin (e.g., syphilis, herpes, chancroid), or does not cause breaks in the skin (e.g., chlamydia, gonorrhea). If the STD infection causes irritation of the skin, breaks or sores may make it easier for HIV to enter the body during sexual contact. Even when the STD causes no breaks or open sores, the infection can stimulate an immune response in the genital area that can make HIV transmission more likely. In addition, if an HIV-infected person is also infected with another STD, that person is three to five times more likely than other HIV-infected persons (who don't have an STD) to transmit HIV through sexual contact.

Question: What are routine questions regarding gay men's health that I should be asking my physician during a regular examination?

Some questions gay sexually active men should ask their doctor about are your risk for hepatitis A and B and the value of immunization; what your syphilis infection status is; whether you have gonorrhea or chlamydia in your butt, throat or penis; and ways to reduce the risk for getting STDs and HIV.

You should also ask about anal cancer and your risks; what warts look like and how they are treated and different than the virus that causes anal cancer.

Question: What other STD’s can I get besides HIV from sex?

There are many different types of STD’s a gay man can get from having sex. The following is a listing of the major STD’s and how they can be transmitted:

• Chlamydia - Chlamydia is a sexually transmitted disease (STD) caused by a bacteria called Chlamydia trachomatis. It can spread from person to person during sexual intercourse (vaginal and anal) when a person's mucous membranes come into contact with the vaginal secretions or semen of an infected person. It can be transmitted without complete insertion of a penis into the vagina or anus. It is less likely, although possible, to be transmitted to the throat during oral sex. It can also be passed from mother to newborn during childbirth. Chlamydia infections are treatable and curable with antibiotics.
• Gonorrhea - Gonorrhea is a sexually transmitted disease (STD) caused by a type of bacteria called Neisseria gonorrhoea. Gonorrhea can be transmitted to both male and female partners during vaginal, anal and oral sex from a partner infected in his or her throat, vagina, urethra or anus. Gonorrheal infections are completely curable with antibiotics.
• Hepatitis - Hepatitis is the name for inflammation of the liver caused by several different viruses. The viruses are classified by letters of the alphabet -- with types A, B, and C being the most common. Each of these viruses can be transmitted in a number of ways, some sexually. Hepatitis B and C viruses can cause inflammation of the liver, liver failure, liver cancer, and death. Hepatitis B is the most common cause of liver cancer in the world. Chronic Hepatitis C (HCV) is the leading cause for liver transplants.
• Herpes - Herpes is a sexually transmitted disease caused by the herpes simplex virus (HSV) and transmitted via direct skin-to-skin contact during oral, anal and vaginal sex. HSV I usually causes fever blisters and cold sores on the mouth, but can also cause sores on the genitals. HSV II usually causes sores on the genitals (vagina, penis, anus) and the skin around those areas. The majority of oral herpes cases are caused by HSV I and the majority of genital herpes cases are caused by HSV II; however, since so many people are now having oral sex, type-I is often appearing in the genitals. HSV is different from other common viral infections because once it is introduced into your system, it lives there forever, often with periodic symptoms or without symptoms at all.
• HPV - HPV is the virus that causes genital and anal warts, also sometimes called condyloma. The virus may cause wart-like bumps to form on the penis, in and around the vagina, on the cervix (opening to the uterus), and/or around the rectum. The virus is passed via skin-to-skin contact from one person to another during anal or vaginal sex. Warts caused by HPV are not the same warts commonly found on hands and feet, and one type of wart can not be passed from one body part (hands and feet) to another (genital area).
• Syphilis - Syphilis is a sexually transmitted disease (STD) caused by a type of bacteria called T. Pallidum. It can spread from person to person by physical contact during vaginal, anal, or oral sex. Syphilis infections are treatable and curable with antibiotics.
• Crabs and Scabies - Crabs are very small bugs that attach themselves to pubic hair and bite the surrounding skin. Scabies are mites (bugs) that dig under the skin where they lay their eggs, often in the genital area. Both cause extreme itching in men and women. Both are usually passed from one person to another during sex, but can also be transmitted by having contact with clothes, bedding, and towels that have been used by an infected person. There are both over-the-counter and prescription creams available to get rid of crabs and scabies. Use as directed by your medical provider. You must also wash your clothing, bedding, and towels in hot water to avoid re-infection.
  Molluscum Contagiosum - Molluscum or m. contagiosum is a skin affliction caused by a virus that can be passed from one person to another during sex or, more commonly, other close skin-to-skin contact. It is also possible for molluscum to be passed by sharing towels. It's commonly found in people that exercise in gyms and people who ride bicycles frequently. Symptoms include several smooth, firm, rounded bumps with a dip in the center that appear on the thighs, sex organs, buttocks, below the waist, and/or in the pubic hair. The bumps may be tan, yellow, grey or pink. Molluscum will go away on its own without any treatment or complications, but if you choose, the bumps can be frozen off by a medical provider with liquid nitrogen.
• Shigella - This is a bacterial infection that causes serious stomach cramps and diarrhea. Shigella can easily be spread from one person to another through rimming (oral-anal contact) and from oral contact with contaminated skin including skin in the groin area, the testicles and the penis. Shigella can also be spread via fecally contaminated food and water. People with HIV are more likely to have serious complications from Shigella infections.. Shigella can be treated with antibiotics. Very thorough washing of your genitals and hands before and after sex can help prevent shigella and other infections, as well as using a barrier (cut-up condoms, dental dams, or household plastic wrap) for oral-anal sexual activities.
  Non-Gonoccochal Urethritis (NGU) - Also called non-specific urethritis, this is an infection in the male urethra caused by bacteria such as chlamydia, mycoplasma, ureaplasma or trichomoniasis. NGU is passed from one person to another during anal, vaginal and possibly oral sex. Symptoms may include a mild discharge from the head of the penis that goes away after a few days and pain or burning upon urination. Antibiotics are used to cure NGU.
  Trichomoniasis - Also known as trich, this is an infection caused by a protozoa that is passed from person to person during vaginal sex. Women have more symptoms than men, in fact most men have no symptoms. A prescription drug called metronidazole will cure trichomoniasis.

Question: What would I be doing to contract an STD? [an error occurred while processing this directive]

Question: How can I reduce my risk for contracting an STD after sex?

Washing hands and the genital area thoroughly before and after oral-anal sex reduces the risk of transmission of most of the listed STDs and conditions.

Question: How can I tell if I have a STD?

First of all, remember that some STDs cause no symptoms, and when symptoms do occur, they often go unrecognized. Most people with STDs have no symptoms—none! So you can be infected and even infect someone else without knowing it. However, there are some common signs to watch for. The symptoms listed below are tricky, as they can show up anywhere from two days to a couple of months after initial exposure to the disease. Sometimes symptoms can show up as much as several years after the initial STD infection. Take note of any:

• Sores, bumps, or blisters near the mouth or genitals
• Burning or pain during urination or a bowel movement
• Flu-like symptoms including fever, chills, and aches
• Swelling in the groin area
• Discharge from the penis
• Pain in the testicles

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SEX AND DRUGS

Question: What types of drugs do gay men use with sex?

While not all gay men use drugs before or during sex, some do. From alcohol to heroin, some gay men use drugs or alcohol to enhance sexual performance and to prolong sexual activity. The drugs that can be used are:

• Alcohol
• Marijuana
• Acid - LSD
• Crystal Meth
• Ecstasy
• Mushrooms
• GHB
• 2CB
• Special K
• Nitrous Oxide
• Cocaine - Crack
• Poppers
• Heroin

In addition, many of these drugs can be used in combination with other drugs to increase sexual activity or to mitigate the effects of another drug (help you with coming down).

Question: What does party and play (pnp) mean?

PNP is a code word used by gay men to indicate that they will be on a drug or be willing to take a drug when they engage in sex. The drug of choice for these people is usually crystal-meth, but can also include cocaine or heroin. People who party-and-play also can experience a loss of erection or trouble with cumming.

Question: Who or what is Crissy?

Crissy is a nickname for speed a.k.a. crystal or crystal methamphetamine. Crystal is a popular club and sex drug, which can impair judgement and decision-making and so potentially increase the risk of getting HIV.

Question: Why do young gay men take Viagra?

Young gay men take Viagra to compensate for the loss of an erection when they are taking other drugs, namely crystal-meth or cocaine.

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TATTOOS/BODY PIERCING

Question: I just got an oral or genital piercing. How long should I wait before having sex?

A fresh piercing should be treated just like an open wound to the body, so it's best not to expose it to potentially infectious body fluids until it has fully healed (@ 8-10 weeks depending on the piercing). Condoms and dental dams should provide you with proper protection from infection when used correctly. Your piercer should be knowledgeable enough to let you know when it's safe to play with a pierced area again.

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