We’ve all heard that ‘tops’ are less likely to get HIV than ‘bottoms’. Sometimes guys will be on top during anal sex (or frontal sex with trans guys) in order to reduce their risk of getting HIV. When guys with different HIV statuses have unprotected anal or frontal sex, sometimes the negative guy will top the poz guy to reduce the risk of transmission.
This is called ‘strategic positioning’, and is based on the fact that it’s easier for HIV to get into the body through the ass than through the cock.
However, some factors could make strategic positioning not so strategic for reducing HIV transmission risk.
- If a poz guy is ‘strategically positioning’ himself on the bottom, but he isn’t used to it, he could be more likely to injure himself and increase the risk of HIV transmission.
- If a negative guy is ‘strategically positioning’ himself on top, but he isn’t used to it, he could be more likely to injure his partner and increase the risk of HIV transmission. If he is uncircumcised, he may injure his foreskin, which can also increase the risk of transmission.
It’s technically less likely to be infected as the top than the bottom, although the risk isn’t eliminated. According to a study in Australia, around 1 in 5 men who recently contracted HIV were tops. In a research study published in 2007, among a sample size of 102 gay and bi men who were recently diagnosed HIV-positive, 10 of them were infected despite ‘strategic positioning’.
Giving and receiving unprotected anal sex are both considered high-risk for HIV. That means a lot of guys have become HIV-positive this way. When a condom is used, it’s low-risk for both partners.
Don’t assume another guy will bottom or top just because he is trans, masculine/feminine, or because of his ethnicity, race, age or cock size. Also, don’t make assumptions about your partner’s HIV status.
From the Sexual Health survey 2014 conducted at AFA Anonymous Testing Site and online, a total of 91 MSM responded. 27% of the participants have an inconsistent condom use with casual partner(s).
Figure 1. In the past 6 months, with your casual male partner(s), would you say that condoms during anal sex (whether insertive or receptive, top/bottom) were used?
|Never used condoms||5||5%|
|Most of the time||12||13%|
|All the time||43||45%|
|No casual male partner(s)||22||23%|
With practice most guys can have pleasurable anal sex without any pain whatsoever. Here are some tips for trying out a new position:
- Try it on your own first. Use your finger or a sex toy.
- Go slow. Foreplay can help. Spend some time getting turned on, lubing up your or his ass, and getting mentally prepared. If it hurts, stop.
- If you’re on top, pay attention to his body language: tensing up, breathing, etc. This will give you cues as to whether you’re going too hard or too fast.
- Alcohol and other drugs (like cocaine) can numb pain, so you should avoid using them when trying a new position for the first time. You might hurt yourself or your partner and not know it.
- If you’re bottoming for the first time, try a position that’s comfortable for you. Some guys prefer to bottom from on top, lowering themselves onto him while he lies on his back, so they can have more control. Some guys prefer to lie back with their legs in the air, so they can relax more. It varies from guy to guy, and can depend on factors such as his or your body size, weight, cock size, flexibility, and sheer will.
- When he’s entering you, try relaxing your ass just after a short tight clench. Clench, relax, repeat. It will get easier with practice!
- If you have questions about improving your anal sex experience, you can talk to a local AIDS service organization, some sex shops, and research online.
- Remember: not all gay men have anal sex. If it isn’t doing it for you, there are plenty of other ways to get off.
Your risk reduction strategy is up to you. But it’s important that you know the facts before you decide what kind of sex you want to have. No risk reduction strategy is as effective as consistently using condoms with lots of lube.
Remember that unprotected sex puts you at greater risk for HIV and other sexually transmitted infections. An STI can harm your health, and also put you at greater risk of getting or passing on HIV. They often don’t show symptoms, so you should get tested regularly.