| Frequently Asked Questions —
and Some Answers — about Gay Sex
This information is meant for educational purposes only. Furthermore,
due to explicit sexual content, it is meant for people over 18.
Disclaimer
Anal Sex and Pleasure
Talking HIV
Oral Sex?
Rimming
"Undetectable"...
But Still Infectious?
Harm Reduction
Anal Sex and Pleasure
Q: Dear GMHC,
I like getting penetrated. You may think I'm a huge freak, but
recently I have been kind of getting into this relationship with
my asshole. I am sending this e-mail from work, where yesterday
I was talking to my supervisor and thinking, "Wow, I can't believe
I'm standing in front of my boss and a few hours ago I had a guy's
dick all the way up my butt." Anyway, my question is: why is it
that guys who get penetrated seem to be the ones who get infected
and have all the health problems?
Wide Open in Chelsea
A: Dear "Wide Open,"
If loving to get penetrated makes you a freak, there are a lot
of freaky queens out there. In fact, it's nice to hear that you
and your ass are getting to know each other. At GMHC, we have couples
counseling so that you and your ass can "dialogue" — Just kidding!
More seriously, the anus — thanks to half the nerve endings
in the pelvic region and men's answer to the "G-spot," our prostate
gland — is capable of giving us great pleasure. Knowing your
way around can help you treat yourself, and your anus and rectum,
with love and care. For example, one reason why you might go "Ouch!"
when you're getting penetrated is because about six inches in, the
anal passage curves toward your navel. Rather than ramming away
when he hits a wall, your partner should pull back and reposition,
letting you tilt your pelvis a bit more to allow him to slide on
in more easily. Similarly, the path to prostate pleasure for many
men is through stroking, not poking- be gentle as you search for
what fans describe as their walnut-sized way to sure-fire orgasm
(inside your anus about two inches, then up toward the navel. When
you feel like you're touching the edge of a plum, you're there.)
It's not being a bottom that puts you at risk for HIV and other
diseases — it's the decisions you make about what goes up your
ass, and how. You expose yourself to HIV only if you allow infected
semen or blood to get inside you. This, by the way, can also expose
you to other serious viruses, including hepatitis B and, perhaps,
hepatitis C. (If you don't know the ABC's of hepatitis, see the
hepatitis
fact sheets, and get vaccinated for hepatitis A and B as soon
as possible. Unfortunately, there's no vaccine for hepatitis C).
As for HIV, you probably know that using a condom is strong protection.
Some men ask their partners to pull out before ejaculation just
to be extra safe. Talking to your partner about HIV may not be sexy,
but it can go a long way to helping you feel good about the sex
you're having.
The reason why unprotected anal sex carries a far greater risk
of HIV infection than, say, unprotected oral sex, is because the
walls of the rectum are made up of highly porous mucous membranes
that can allow blood and semen to pass easily into your blood stream.
The walls of your mouth or throat, on the other hand, aren't especially
good avenues for blood or semen to get into your blood stream, unless
you have cuts or open sores in there. Also, saliva provides a lot
of natural lubrication and is full of digestive enzymes, which some
experts believe may help reduce the risk of HIV infection.
A few final points: If you're a hungry bottom, protect yourself
against HIV not only with condoms, but with lots of water- or silicon-based
lubricant to avoid tears from rough sex. Keep in mind that douching
may make you feel cleaner, but it can also cause small abrasions
in the walls of your anus — if you do it, make sure you use
a condom afterward. Nonoxynol-9, the spermicidal lubricant, has
also been shown in some studies to irritate the inside of your ass,
so use with caution and always with a condom. Of course, how comfortable,
or "loose," you feel while being penetrated affects how much damage
your anus suffers, so it's a good idea that you feel at ease with
your partner, and explore deep breathing or other forms of relaxation.
Try some anal exploration when you're home alone. Practice makes
perfect.
Anal Sex Without Condoms?
Dear GMHC,
I've been with my boyfriend four months now, and he's ready to
penetrate me — without condoms. I'm negative, he's negative
and it seems like every gay magazine I see has something about people
barebacking or doing it raw. But there's still some tiny uptight
part of me that isn't sure.
Questioning in Queens
Dear "Questioning,"
It makes sense that you and your boyfriend are taking time to think
about this important step rather than just, er, plunging right in.
As is so often the case with the media and sex, soundbites about
"barebacking" tend to reduce something complicated and personal
into something different than most men's reality. There are a few
men who explore the fantasy (or reality) of anal sex without condoms
or any worry about the danger of HIV infection. But a lot of men
who say they're "barebacking" are positive already. The term doesn't
mean the same thing to all people, and anal sex without condoms
usually involves a lot more complicated feelings than the desire
to join a "movement" or a devil-may-care orgy.
In fact, most of the men who aren't using condoms say they "know
their partner's HIV status is the same as their own." The important
question, of course, is what does it mean to say you "know you're
both negative"? Are you assuming he'd say something if he were positive?
Are you going on a two-year-old test result? And how do you know
you'll both stay negative? Do you have a shared understanding of
how you'd proceed if one of you did something risky outside the
relationship? Australian researchers call the process of finding
all this out "negotiated safety." Basically, the Australian formula
for successful negotiated safety goes like this: "Talk, Test, Test,
Trust, Together." Here's how it works:
1. Talk. This is the first step, though it remains crucial
throughout. Why do you (or he) want to put away the condoms? What's
behind the fantasy? Can you talk openly about the fears, or only
about the fantasy? Try to have this conversation with some detail,
rather than just saying, "it'd be hot." Do you both feel comfortable
taking another HIV test to make sure you're negative? What would
happen if one of you tested HIV-positive? What if you both test
positive?
2. Both get tested. Be completely honest about your test
results or get tested and collect the results together. (For more
information about GMHC's one-week testing process with pre- and
post-test counseling and support, call: 212/367-1100.) Be prepared
for all of the possible outcomes. Even if both tests are negative,
continue having protected sex. Then...
3. Get tested again three months later. The vast majority
of people who get HIV will develop antibodies detectable by standard
tests within a month of infection, but to be absolutely sure of
your HIV status, retest three months after your last test.
4. Trust each other to tell. Reach some clear working rules
about sex inside and outside the relationship. To reduce risk of
one of you getting infected outside, these might include a) no anal
sex outside the relationship, b) all anal sex outside the relationship
is with a condom. Talk also about whatever oral sex arrangement
feels comfortable (see Oral Sex).
Some men keep it simple, and just agree on no sex outside the relationship.
Whatever the agreement, it's crucial to give each other the OK to
talk about it if you step outside of the "rules." If one of you
"slips up", it shouldn't automatically mean the end of the relationship,
but it may mean going back to using condoms again and starting the
negotiated safety process over again.
5. Together. This is the principle underlying all negotiated
safety — that getting rid of condoms is not something either
of you can do alone. Your partner may be clamoring for condom-free
sex... but is that what you really want too? It's important to put
all your feelings into words if you're going to make the process
work. If you do get into fights, don't simply decide to trust each
other with condom-free sex just to patch over the dispute.
If all this sounds talky and complicated, it should. In the end,
you might find that your relationship is stronger for having learned
how to talk honestly with each other. Or you may find that negotiated
safety is not right for you, or not possible given your HIV status.
Negotiated safety is for couples who both identify themselves as
negative or status-unknown. If one of you turns out to be positive,
there's nothing safe about dispensing with condoms while having
sex. The "top" may be less at risk, but he is at risk nonetheless.
And remember, it's definitely better to explore any hesitation you're
feeling now, rather than waiting until after you've done something
you regret.
Finally, one important point about anal sex without condoms: it
can transmit things other than HIV, some of them serious. Risk of
syphilis, gonorrhea, herpes, and warts are all reduced if you use
a rubber during anal sex, though the last two aren't always totally
contained by a condom. For more on any of them, see the ABC's
of STD's for gay men.
Talking HIV
Q. I go home from the gym the other day with this guy who's
totally hot for me. We're playing around, and in the course of things,
a drop of my cum gets in his eye. Which is fine until later —
when we're talking about our lives — and he gets freaked out
when I tell him I'm positive. All of a sudden, all he can think
about is his eye: not about how he's acting, or how unlikely it
is that he'd get infected that way, just about how somehow he might
have gotten HIV. He's really upset — like, 'how can you not
have told me,' — and rushes out the door. I was upset too.
But this was not a virgin new to New York City. Why was it just
my problem to tell him?
A. Men discuss versions of this scenario all the time at
GMHC. Negative men say they'll do certain things if they don't know
someone's status, but won't do the same if they know he's positive.
Positive men describe their decision to stay quiet about HIV as
a response to feeling like they have all the burden, and talk about
how many negative men seem to be walking around in "la la land,"
or about how people who were all over them find out they're positive
and then drop them like a hot potato.
The truth is, if there's a kind of comfort in not knowing, it often
isn't very deep. Particularly if the relationship is at all serious,
not talking about it will soon create its own problems. And though
it may be small consolation, if he freaks out upon finding out your
HIV status early on, it's not you he really has problems with. That
gets cloudier as time goes by.
The other truth, much as we'd like to fantasize that it doesn't
matter so long as you use a condom, is that HIV-negative men and
positive men have different stakes in HIV prevention, and different
kinds of anxieties about it. Neither of you should assume that silence
means you're both on the same page.
Some suggestions
If your know you're HIV positive:
You definitely need to be more cautious when you're having sex,
to make sure you don't infect someone. Even when things are "clearly"
safe — masturbation or kissing, for example — you may
want to talk about your HIV status and his. In gray areas, such
as ejaculating in someone's mouth or with a condom in someone's
ass, staying silent may amount to making decisions for both of you,
whether or not it was your responsibility to bring it up. You may
be okay with a gray area, and he may seem okay, but what he actually
knows about your HIV status might make him act differently. If you
don't feel ready for that fact, or a discussion about HIV, then
definitely don't come in his mouth or up his ass, even with a condom.
Even putting your dick in his mouth may cause him to get worried
later.
If you know you're HIV negative:
Don't assume that silence means he's taking care of you. With oral
sex, you need to ask yourself what an acceptable level of risk is
for you. If you want him to put his penis inside you, ask yourself
if you would let him do the same thing if you knew he was infected.
What are your limits? What risks seem acceptable in the situation?
What would you have to know about your partner to let him come in
your mouth or ass, even with a condom? If you aren't ready to ask,
what limits do you set up for yourself with anal or oral sex? And
if you do ask, what limits do you set for yourself about how rude
you'll be in your response. Failing to make seemingly unimportant
decisions — or to have important conversations — may lead
to things "just happening," and you freaking out afterward.
If you don't know your HIV status, get information about the HIV
test and then, get tested.
Oral sex?
Q: I am 22 years old and have never even tasted another
guy's cum, but I still feel anxious every time I put a dick in my
mouth. Can't you just tell me once and for all if I can get HIV
from oral sex?
A. Here is what is currently known:
The risk of getting HIV from oral sex without a condom is very
low. It is much lower than the risk of getting HIV through receptive
anal sex. One eight-year study of nearly 1,000 men found HIV transmission
through oral sex too rare to be measured. The risk of getting HIV
from oral sex, though, is not zero. A small number of cases of HIV
infection through oral sex have been anecdotally reported in professional
journals, by doctors and by patients.
Most people find it difficult to decide what to do based on this
information alone. Does this mean you should consider oral sex essentially
safe and stop worrying about oral transmission? Or does it mean
it is risky and you need to stop oral sex without a condom altogether?
If you think about driving, each time you go for a ride you have
a small but real risk of being killed in an accident. Most adults
know this and still continue to drive. Thinking about the strategies
we might and do use to protect ourselves while taking other risks
may help you decide how to manage the risk of oral sex.
For example, if someone were to ask you to tell them "once and
for all" if driving is safe, you might answer this way: Driving
with a seat belt is safer than driving without one. Driving on dry
roads is safer than driving on icy ones. Driving sober is safer
than driving drunk. And so on. In real life you wouldn't think,
"Is driving safe in general?" when you get into your car. Instead,
you might think, "Is it safe to drive tonight during light snow
if I drive slowly on the back roads?"
The way you think about the risk of each instance of oral sex can
be as specific and as nuanced. Oral sex in which there is a small
amount of precum in your mouth is likely to be safer than sex in
which there is a lot. Oral sex with a lot of precum is likely to
be safer than sex in which your partner cums in your mouth. Oral
sex is safe with someone you know to be HIV negative, and obviously
entails more risk with someone who's status is unknown or with someone
you know is HIV positive. Oral sex entails more risk if your mouth
is cut or has sores.
As with driving, ask yourself: "Is it safe enough for me to have
oral sex, given the way I'm feeling tonight? With this guy whose
HIV status I don't know? Should I let him come in my mouth?"
Remember: oral sex takes two people, and so does safer oral sex.
Your ability to communicate with your sex partner plays a crucial
role in how safe any sexual encounter will be.
In addition to trying to make each instance of oral sex safer by
monitoring variables like the amount of semen in your mouth, you
can limit your overall risk of getting HIV from oral sex by limiting
the amount of oral sex you have with people who may be HIV positive.
Some evidence suggests that sucking a lot of partners in a short
period of time may raise the risk of transmission, particularly
if you are using drugs that reduce sensation. The less often you
do something with a risk, the safer you are.
How you use each of these methods — lowering the risk of a
given encounter and limiting the total number of possibly risky
encounters — will depend on you. Those who don't strongly value
oral sex may rely more on limiting the number of encounters they
have. Those who value oral sex more may decide to continue to have
it but not allow partners to cum in their mouths. Those who enjoy
oral sex but who feel extremely anxious after even a very low risk
encounter (such as oral sex without exposure to cum or pre-cum)
may try to look at their anxious feelings and see if they are about
HIV or something else. Maybe a workshop? (see Calendar.)
Rimming
Q. I love to eat ass. Give me a good butt and I go to town.
I do worry, though, about whether my eating habits are "safe."
A. A good ass is a thing of beauty, but eating ass —
rimming — does carry some risks.
First off, rimming can put you at high risk for hepatitis A, and
may pose a risk for hepatitis B and C (see below and hepatitis fact
sheets).
Note on Hepatitis
If you haven't had hepatitis A or B, or the vaccines to protect
yourself against them, get vaccinated. Even the milder of the two
— hepatitis A — can make you seriously sick, and outbreaks
have been reported recently among gay men in New York, Atlanta,
San Francisco and other cities. Hepatitis A is transmitted by getting
a particle of feces in your mouth from someone who's infected, which
can happen through rimming, general sex play (a finger that's been
up an ass goes to a nipple, which is kissed), or even a waiter who
didn't wash his hands before he made your salad. Bad water or seafood
can also give you hepatitis A. Symptoms, if you have them, include
yellow eyeballs, vomiting, or feeling weak and like you have the
flu. Once you get over hepatitis A, you won't get it again, but
you really don't want it in the first place.
Hepatitis B — like HIV — is transmitted through blood
or semen, but is a lot easier to get. Sharing razors or piercing
instruments, or even toothbrushes may put you at risk. For 5% to
10% of people infected with HBV, that initial infection will lead
to chronic illness. If you're HIV positive, HBV may speed up the
weakening of your immune system, and will certainly stress your
liver just when you need it most to process all those anti-HIV drugs.
Symptoms are the same as for hepatitis A, though many men don't
even know they've been infected. There's also hepatitis C, which
is even more serious, is also carried by blood, and for which there
is not yet any vaccine.
Vaccines are available for hepatitis A and B. They're safe for
people with HIV and without. Hepatitis A vaccine is a two-shot process,
and protection against HBV takes three shots. That may sound like
a pain, but it's a lot less painful than lying sick in bed.
For more information on hepatitis, see the
fact sheets on this site. For more information on sexually transmitted
diseases, see the ABC's of STD's.
Eating ass also carries a risk of infection with amoebas and other
nasty parasites. These can make you very sick and, like hepatitis,
the illness may be more serious and harder to treat in people with
HIV. And because there may be blood in the rectum or around the
hole, there may be a risk of contracting HIV. This is a theoretical
risk, since few studies have looked at rimming as a "sexual behavior."
The few that have didn't find rimming to be a factor in HIV transmission,
but most researchers agree it is a possibility.
Finally, a word about cleaning out. Douching or showering really
well may reduce risks, but it's probably not enough to eliminate
them. Doctors say it takes such a tiny amount of fecal matter to
transmit amoebas, for example, that even Mr. Clean can't be sure
he's not transmitting anything. Douching may also irritate the inside
of your rectum, so make extra sure to use a condom for anal intercourse
afterward.
Some guys, given the risks, choose to get into other kinds of ass
play as an alternative to eating ass. It's also possible to reduce
the risk by using plastic wrap or a condom (cut open the condom
so that it lies flat, and place it between your mouth and the guy's
hole). Of course, using a condom in this way means that the whole
nature of rimming changes. If what you're into is the taste, smell,
and feel of his ass, a condom might not feel like much of an option.
"Undetectable"... But
Still Infectious?
Q. I've been HIV-positive for a while, but now with the
protease inhibitors the viral load in my bloodstream is down to
undetectable levels. Even with the new, sensitive tests, I'm undetectable.
I feel like I'm practically HIV negative again. Do I still need
to worry about giving HIV to my partners?
A. It's great that you're responding well to the new anti-viral
drugs — you're one of many who are finding that a combination
of anti-viral drugs has their spirits and their T-cells up, and
their viral load to below detectable levels. Unfortunately, "undetectable"
viral load does not mean that the virus is no longer in your body;
it means that the level of virus in the blood is below the level
that the test can detect. There still may be HIV in your testicles,
however, or in your lymph nodes, or other places in the body, that's
actively reproducing.
What this means for sex is that you cannot yet throw away the condoms
for fucking. Some HIV positive men — and this is part of what
lies behind all the attention to "barebacking" — have decided
that fucking other HIV positive men without condoms is a risk worth
taking. Researchers have yet to agree fully about the effect on
your health of getting someone else's HIV into your bloodstream
after you have HIV already. They have documented that different
strains of the virus, including strains resistant to certain HIV
drugs, can be passed from one man to another.
As for fucking with someone who is HIV negative, the research is
clearer. There are HIV-infected cells in semen, even when there's
no HIV detectable in your blood. You're still infected, and the
safest thing you can do is to continue to use condoms when you fuck.
Harm Reduction
Q. I keep hearing about harm reduction, harm reduction.
Whatever happened to "no means no?" As in, don't have anal sex.
Or don't do drugs. I don't do those things anymore because they're
too dangerous for me. Hello, gay men? Clue phone: it's for you.
A. Every pleasure, or even things that are useful without
always being pleasurable, come with risk. That's why so many people
drive in cars despite thousands of annual deaths in auto accidents.
Gay men have a lot of practice in balancing risk and pleasure, gauging
the safety of going home with a stranger, or coming out at work,
or other things that seem both important and potentially dangerous.
How quick you are to give up a particular activity usually depends
on how important it is to you. If it's not important — as anal
sex may not be to you — it's easy to give it up. Those decisions
vary from person to person.
Harm reduction is based on the idea that change is not all or nothing.
It may be harm reduction when you decide to suck someone but not
let him cum in your mouth. It may be harm reduction when someone
decides not to do that fourth line of coke, but to go home instead.
There may still be risks involved, but steps toward change still
count as change. More people are able to make that kind of gradual
change than to give up an activity altogether.
If you're interested in harm reduction, try this at home.
Compare two different sexual interactions, one where you felt good
about the sex and one where it felt risky or worried you. In each
instance, try to go back to the experience, and lead yourself -
or better yet, someone else - through the details. It sounds contrived,
but telling it to a friend can help you hear it in a different way.
Find someone to listen who isn't going to reassure you, or judge
you, or try to ëfix' the situation. You want them just to help you
get through the story, the way someone would spot you while lifting
weights at the gym.
1. Be honest about the pleasure
In both instances, start with the positive. Focus on what you wanted
that day or night. What were you hoping to feel? Bring yourself
back, not just to the moment, but to the lead-up. What was attractive
about the situation? Who was it with? What drew you to him or them?
Play with yourself — not literally, but in the telling. It
can be vivid, not just dreary. And it's not vivid enough to say,
"I loved sucking him." What exactly did you like so much about it?
The feeling of making him come? Feeling like you "had him"? Feeling
romantically merged? Taken over?
2. Spell out the risks
What risks did you accept or manage well in the situation you felt
good about? How did those compare to the situation that made you
worried? Were your worries related to the sex itself or about something
else: the time and energy or money it took to get it? Were you worried
from the start, only worried afterward, or was there some point
in between where things got uncomfortable? Would it have changed
if you had known the other person's HIV status? Or was the issue
that you did know?
3. How might you hold on to the pleasure and cut down on the
risk?
Return once more to the course of events. If you had stayed on
the phone-sex line for half an hour instead of four hours, would
that have worked better? If you had felt less used, more like he
knew you better, would that have helped? If it was a risky encounter
for HIV, how might you have held on to the pleasure and reduced
the risks? If, for example, you loved sucking him but freaked out
when he came in your mouth, could you have said, "Tell me when you're
close, OK?" as you started? If you were afraid that stopping for
a condom would make you lose your hard-on, might you have asked
him to put one on you? If you like to be with "straight" guys but
worry that they'll pull off the condom, could you limit it to oral
sex until you know them better?
This may not sound as easy as "just don't do it." But talking about
the sex you have in front of someone else can be a much more effective
way to reduce risks than just telling yourself to "shape up!" or
swearing you'll never do something again (until you do).
Disclaimer
This information is meant for educational purposes only.
Nothing contained here should be regarded in any way as a substitute
for medical advice from a qualified physician who is familiar with
all the details of your situation. For more information, please
contact GMHC's HIV Prevention department for gay men, at 212/367-1353,
or the GMHC Hotline (see below). (TTY: 212/645-7470, for the hearing
impaired.)
This material is sexually explicit and intended for adults 18
years and older.
If you want to talk about anything you read here, or anything else
that has to do with gay sex, what you like to do, what you don't,
and how to make sense of it for yourself, you can also call GMHC's
Hotline. We have
workshops and counseling for HIV-positive and -negative men, and
they're all free and confidential (see Calendar).
We're interested in talking about sex, and we'd love to hear from
you. You can also email questions to us at hotline@gmhc.org.
© 2003 Gay Men's Health Crisis |
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