How HIV is transmitted.
How is HIV transmitted?
While HIV seems to be “old news” in the media, it’s still very much alive and well – especially in the Phoenix gay community. Gay men continue to be much more affected by HIV than other populations in the US. But before we learn to prevent HIV, let’s get a better understanding of how it’s most commonly transmitted. First, let’s look at the physical ways HIV can be transmitted among men who have sex with men before we dive into social issues that affect HIV transmission.
Anal sex is the highest-risk sexual behavior for HIV transmission – especially if you’re a bottom and someone infected with HIV cums inside you. The lining of your rectum is thin, susceptible to microscopic tearing during anal sex, and may allow HIV to enter the body more easily. Tops aren’t free and clear though. While being a top is lower risk than being a bottom, a number of factors can increase that risk. Uncut tops, microscopic tears in the penis from not enough lube, sores or breaks in the skin on the penis, or STDs with either partner can increase the top’s risk for contracting HIV.
Vaginal sex is the second highest-risk sexual behavior for HIV transmission. While being the top is lower risk than the receptive female partner, a number of factors can increase that risk for the man. Uncut men, microscopic tears in the penis, sores or breaks in the skin on the penis, or STDs with either partner can increase the man’s risk for contracting HIV. Often, women become infected by a bisexual partner/spouse who has sex with men, but doesn’t use protection when having sex with women. If you’re having risk sex with men, wrap it up and stay on top of testing when getting with your female partners.
Sharing injection drug equipment is also a risk for contracting HIV. Infected blood can get into drug solutions by using blood-contaminated syringes to prepare drugs, reusing water, reusing bottle caps, spoons, or other cookers, and/or reusing cottons to filter out particles that could block the needle. This includes sharing equipment to inject steroids. There’s also a strong link between meth use (even snorting or smoking) and HIV transmission for men who have sex with men. Guys who use meth may increase their sexual risk factors, putting you at higher risk for contracting HIV.
Social items play a big role in HIV transmission
Now that we’ve explored the science behind how HIV is transmitted, let’s dive into some of our social issues and beliefs that bring us face-to-face with HIV:
He didn’t know he was HIV positive.
One in five men in Arizona have HIV and don’t know they have it. Each day in the US, over 100 people are infected with HIV. And when he doesn’t know that he’s HIV positive, and isn’t taking antiretroviral therapy (ART), then his chance of transmitting the virus can be extremely likely. According to the CDC, the majority of HIV infections occur from someone who is unaware of their status. If just hooking-up or if you’re not in a place to get tested together, play it safe until you both can get tested. The decision to remove a condom as a relationship progresses can be a very good thing, but not if you define relationship progress as a ‘second date’ or before you and your partner get an HIV test together.
We’re falling in love.
You shouldn’t feel like you need to condoms on your wedding night, but when you start feeling that warm place in your heart, get tested with your new man before you start to shed the condoms. If it really is love, you’ll stick by each other if one of you tests positive for HIV. If you don’t love him enough to be by his side if he tests positive, then you may have answered your own question about barebacking before you both get tested.
I thought we were monogamous.
Unfortunately, many of us have been there for our friends when the man they love was caught with another man. A cheating partner is one of the most common ways people report becoming HIV positive. You shouldn’t have to stay focused on your guy’s faithfulness, but there’s always a possibility he may end up sleeping with another person. Even if you’re in a relationship, keep up your testing routine for HIV by getting tested at least once a year. Make it part of the ground-rules of your relationship early on to keep each other accountable. National HIV Testing Day is June 27th and World AIDS Day is December 1st each year. Mark one on the calendar, get tested together to strengthen your relationship in the name of global awareness! If you’re the cheating partner and are worried that you may have had an exposure to HIV with the guy you had sex with – consider seeking a prescription for PEP if the exposure was within 72 hours, or get yourself tested before you expose the man you love with whatever you may have picked up.
We’ve been in an open relationship for years, but we don’t wear condoms when we’re together.
One of the biggest reasons people claim for not wearing condoms when hooking-up is that they got caught-up in the heat of the moment. Even if you’re in an open relationship, and have laid out some ground rules that you can both only play safe with others, consider the possibility that your partner may get caught-up in the heat of the moment from time-to-time too. You may become infected because of a slip in judgement that he’s too embarrassed to talk with you about. Depending on your sexual activity outside of the relationship, bump up your HIV testing routine to every 3-6 months. Make a regular testing routine be part of your conversation around your open relationship and get tested for both of you.
I was under the influence...
We know alcohol and drugs can impair our ability to drive or operate heavy machinery. But it can also impair your ability to make good on your promise to always wear protection when you hook-up. If you know you have lapses in judgement when you drink or party, have a plan in place when you are thinking clearly to make sure you’re ready. For example, put your condoms and lube on top of your pillow before your leave the house so they’ll be a trigger even when you stumble in the door feeling foggy and frisky with the hot guy in the bar. If cutting back on the cosmos isn’t in the cards, having little plans or triggers ahead of time can make a huge difference.
I didn’t ask, and he didn’t tell.
We close our eyes sometimes and see a magical world full of rainbows and unicorns, but unfortunately, when we open them up, we remember that sometimes guys just lie. Surely he’d let you know, right? Unfortunately, people fail to disclose all kinds of things – all the way down to the ‘what the hell is that smell’ morning breath you didn’t see coming. Just because he didn’t bring it up, doesn’t mean you’re safe. And even if he does tell you he’s neg…it doesn’t mean it’s true. We put a lot of trust in strangers we get let into our beds and get naked with, but HIV status shouldn’t be something you blindly put faith in – especially when you may not even know his last name.
I’m a top so I’m safe.
Slightly lower risk maybe, but not low enough to high-five all the members of the safer sex committee. In fact, if your bottom boy doesn’t know he has HIV or if he has an STD with HIV (even if he’s ‘undetectable’), the risk may not be as low as you think. When he doesn’t know that he’s HIV positive, isn’t taking antiretroviral therapy (ART), or has an STD, then his chance of transmitting the virus can be much higher than you think.
He’s the hottest guy I’ve been with and he’s not a fan of condoms.
This one happens a lot…and it sucks. You finally scored a hot one, but he’s not willing to play by your rules. You know how you’ll handle this situation on your own better than anyone.
- If your rules are firm, and you have no problem speaking up, then he’ll either glove-up or get out.
- If you know you historically give-in when he starts looking at you with those puppy-dog-eyes, then it may be time to take a look at PrEP as an option to decide if it’s right for you. PrEP will have your back even when your better judgement doesn’t.
I don’t have a condom that fits well.
Take a test drive from IGNITE’s Condom Bar where you’ll find a large variety of standards, snug fit, large fit, textures, colors and more! Pick up some different condom types / sizes and give them a try on your own. If you’re a top, see how different ones fit and feel with some self-stimulation so you’ll be ready with the perfect fit. If you’re a bottom, slide different ones on a toy or your fingers and see if there’s a texture or type that gets you going. If you’re going to bottom, stock-up and have a variety of sizes ready to go!