Last night, I was hanging out with my old friend Insomnia, and I gave a shout out to Facebook and found that I was in abundant good company. A friend of mine popped up on my chat and asked me if he could ask a question. This young man is a HIV negative but an HIV scholar and knows his stuff. But as have almost all of us, positive and negative, he made a choice recently to have unprotected sex with a twink that said he was HIV negative. My friend topped him bareback, and decided that he was going to go in and get an HIV test. But he had a question about risk if, in fact, the individual turned out to have been HIV positive.
It's not an uncommon question though it is one that folks rarely ask. In fact, I know many men that always top without a condom whether or not their sex partner is negative or positive. Their is a misconception that tops can't get HIV by topping. And, unfortunately, the model for prevention in this country would have you believe that topping without a condom will not only instantly give you AIDS but your right nut will fall off. The answer to that particular question is that yes there is a risk. Period---but you won't get the dropsies just because you stuck it in without a rubber. But the level of risk involved depends on numerous factors. The internal health of the bottom, lube usage, the health of the penis of the top, the size of the top's urethra, the viral load of the bottom, and I am sure there are other variables that a doctor would be able to add into the mix.
I shared with my friend that in my adult relationships, I have mostly dated men that are negative and for those that were tops they rarely used a condom. This was an informed decision based on medical facts, and if, for example, one of the variables mentioned above happened to be off for a time, then we wrapped it up. The point was that based on the available scientific/medical data, personal preference and risk tolerance, the particular men I am talking about made a choice around the risk they wanted to take. And I kept them informed of any issue that would impact that risk choice. I have also, with one negative boyfriend in particular, topped without a condom with his consent, considering all the risk factors, eliminating internal ejaculation (and I am not a pre-cummer but if it happened to be one of those rare times when I was...then it was condom time), and again that was a mutual decision based on medical information.
And remember this number: 96%. A person with an undetectable viral load has less than a 4% chance of transmitting HIV. There have been NO DOCUMENTED CASES of a person with an undetectable viral load transmitting HIV. The fact is that there is a risk to a negative bottom, but again the science and medical data is way ahead of a prevention messaging that still puts the onus on poz folks and shames consensual sexual choices regarding condom usage between consenting adults.
But the part of the conversation that was most important was that my friend was taking responsibility for his own sexual health. Yes the twink said he was negative. Yes he could have lied. Yes that would have been wrong (and any poz person that has been living with HIV for any significant amount of time and says that they have a 100% disclosure rating is either a leprechaun or lying). But in the end, my friend realized that he made the ultimate choice for himself to top this kid without a condom.
The analogy that I used was that he could tell me that Jesus himself was slinging beers down at the local Irish Pub, but if I hauled my ass down to the pub and it turned out that Jesus wasn't there, my friend may have told me a story that got me to jump in my car....but I am in fact that one that climbed in, turned the key, and headed down to get some water-to-wine action. That does not absolve anyone from knowing their status and disclosing it when necessary, but HIV positive people are not responsible for anyone else's sex choices.
I commended my friend on doing what was best for him and taking care of his health. Based on actual facts and data, I was able to suggest that his risk factor in this situation was low. The more we can all engage with our sex choices, understand we are going to make mistakes, and try and remove the HIV related stigma from sex, we will move a long way forward into the fight to eliminate HIV.
It's not an uncommon question though it is one that folks rarely ask. In fact, I know many men that always top without a condom whether or not their sex partner is negative or positive. Their is a misconception that tops can't get HIV by topping. And, unfortunately, the model for prevention in this country would have you believe that topping without a condom will not only instantly give you AIDS but your right nut will fall off. The answer to that particular question is that yes there is a risk. Period---but you won't get the dropsies just because you stuck it in without a rubber. But the level of risk involved depends on numerous factors. The internal health of the bottom, lube usage, the health of the penis of the top, the size of the top's urethra, the viral load of the bottom, and I am sure there are other variables that a doctor would be able to add into the mix.
I shared with my friend that in my adult relationships, I have mostly dated men that are negative and for those that were tops they rarely used a condom. This was an informed decision based on medical facts, and if, for example, one of the variables mentioned above happened to be off for a time, then we wrapped it up. The point was that based on the available scientific/medical data, personal preference and risk tolerance, the particular men I am talking about made a choice around the risk they wanted to take. And I kept them informed of any issue that would impact that risk choice. I have also, with one negative boyfriend in particular, topped without a condom with his consent, considering all the risk factors, eliminating internal ejaculation (and I am not a pre-cummer but if it happened to be one of those rare times when I was...then it was condom time), and again that was a mutual decision based on medical information.
And remember this number: 96%. A person with an undetectable viral load has less than a 4% chance of transmitting HIV. There have been NO DOCUMENTED CASES of a person with an undetectable viral load transmitting HIV. The fact is that there is a risk to a negative bottom, but again the science and medical data is way ahead of a prevention messaging that still puts the onus on poz folks and shames consensual sexual choices regarding condom usage between consenting adults.
But the part of the conversation that was most important was that my friend was taking responsibility for his own sexual health. Yes the twink said he was negative. Yes he could have lied. Yes that would have been wrong (and any poz person that has been living with HIV for any significant amount of time and says that they have a 100% disclosure rating is either a leprechaun or lying). But in the end, my friend realized that he made the ultimate choice for himself to top this kid without a condom.
The analogy that I used was that he could tell me that Jesus himself was slinging beers down at the local Irish Pub, but if I hauled my ass down to the pub and it turned out that Jesus wasn't there, my friend may have told me a story that got me to jump in my car....but I am in fact that one that climbed in, turned the key, and headed down to get some water-to-wine action. That does not absolve anyone from knowing their status and disclosing it when necessary, but HIV positive people are not responsible for anyone else's sex choices.
I commended my friend on doing what was best for him and taking care of his health. Based on actual facts and data, I was able to suggest that his risk factor in this situation was low. The more we can all engage with our sex choices, understand we are going to make mistakes, and try and remove the HIV related stigma from sex, we will move a long way forward into the fight to eliminate HIV.
