RISK REDUCTION STRATEGIES
We know that some gay men don’t use condoms all the time but use other methods to reduce their risk of contracting or passing on HIV.
Knowledge of your HIV status and that of your partners is critical. These strategies have varying degrees of effectiveness and their effectiveness is based on specific conditions that must be met. Risk reduction strategies may include:
Serosorting is unprotected anal sex between gay men of the same HIV status. You have to know your own and your partner’s status for serosorting to be effective. Just assuming it is the same is not enough.
Undetectable viral load
This means HIV is present in a person’s blood but below the level where standard tests can pick it up. For HIV-positive men, an undetectable viral load sustained over six months or more, makes HIV transmission much less likely … though not impossible. To make an informed decision about unprotected anal sex based on undetectable viral load, you need to know how recently you/he got your/his viral load test results so you can decide whether they really are ‘current’. Even with an undetectable viral load, HIV transmission risk increases if either of you has an STI.
This is when the top pulls out before cumming. This strategy is relatively ineffective and doesn’t reduce the risk to the top very much at all.
Neg Top / Pos Bottom
This is when the HIV-negative guy tops an HIV positive-bottom. Topping is less risky than bottoming but still includes risk of HIV transmission. It also includes risk of STI transmission from top to bottom and vice versa.
This is a particular kind of relationship agreement where HIV-negative partners in a regular relationship disclose their HIV status to each other, discuss risks and agree to repeat HIV testing before having unprotected anal sex. Any sex with other partners outside the relationship must be with condoms. For more information see Let’s Talk About It!
To understand the level of risk involved in each of the strategies, use the Risk Calculator