Safe Tips for Gay Men

It is important to remember that the virus is transmitted by bodily fluids – for men this includes, blood, ejaculate and pre-ejaculate – entering the bloodstream. Remember that the risk goes both ways – for example, it is commonly believed that only the partner who is penetrated (the ‘bottom’) is at risk, but the HIV virus can be transmitted to the partner who penetrates (the ‘top’) via small cuts and abrasions on his penis.

Unsafe sexual activities

(i) Unprotected anal sex, since the virus can enter the bloodstream through mucus membranes or small cuts or abrasions

(ii) Withdrawing before ejaculation, since pre-ejaculate fluid can contain the virus

(iii) Using pre-ejaculate as a lubricant prior to anal intercourse

(iv) Sucking ejaculate from the anus (felching)

(v) Activities involving razors or shaving, as blood can be drawn from small nicks and cuts

(vi) Any sexual activity that draws blood.

Safe sexual activities

(i) Kissing

(ii) Cuddling

(iii) Stroking and massage

(iv) Masturbation

(v) Mutual masturbation

(vi) Ejaculating on unbroken skin

(vii) Urinating on unbroken skin

(viii) Oral sex (with a condom or no ejaculate in the mouth)

(ix) Protected anal intercourse (using condoms).

Safer sex suggestions

(i) Anal sex – use condoms and plenty of water-based lubricant.

(ii) Oral sex – there are a small number of recorded cases of people getting HIV from performing oral sex and taking ejaculate into their mouth. In almost all of these cases, the person had herpes sores, wounds, cuts or infections in their mouth. It isn’t easy for HIV to enter the bloodstream through the mouth or throat when sucking. However, to be sure of being safe, the HIV positive partner shouldn’t ejaculate into their partner’s mouth. To further reduce the risk, a condom can be worn. The HIV negative partner should avoid performing oral sex if they have cuts or sores in their mouth, a throat infection, have recently undergone dental work or have just brushed or flossed their teeth.

(iii) Penetration of the anus with finger or fist – avoid if there are cuts or abrasions on the fingers, hand or arm. To be absolutely sure, wear a latex glove.

(iv) Licking and kissing the anus (oral–anal contact or ‘rimming’) – HIV can’t be transmitted via oral–anal contact, but other diseases can. These include hepatitis A and intestinal parasites and bacteria (for example, shigella). Use a barrier such as a dental dam or clear plastic wrap (but not the ‘microwave safe’ variety – it has tiny holes in it).

(v) Urinating on skin – avoid this practice if there are cuts or abrasions on the skin. Don’t allow urine to come in contact with the eyes or mouth, in case there is blood in the urine.

(vi) Faeces – HIV can be transmitted if there is blood in the faeces. Don’t allow faeces to come in contact with the eyes, mouth or cuts on the skin. Other illnesses, such as hepatitis and intestinal parasites, can also be transmitted by faeces.

(vii) Sex toys – always put a condom on any sex toy (such as a dildo) before use. Wash all sex toys after use with warm water and soap. Consider having a separate collection of sex toys for each partner.

What you can do after unprotected sex?

Sometimes, a couple may slip and have some form of unprotected sex. Suggestions include:

(i) If the broken skin of the HIV negative partner comes in contact with the ejaculate, blood, urine or faeces of their HIV positive partner, wash well with warm water and soap.

(ii) Seek advice from your doctor. Post-exposure prophylaxis (PEP) is a month-long course of medications for people who have been exposed to the HIV virus. To be most effective, they should be commenced within 72 hours of exposure. It is best to take them as early as possible after exposure. These drugs can be toxic on the body with unpleasant side effects such as vomiting, nausea and lethargy. PEP is not an alternative to safe sex.

(iii) Talk about the factors that led to the unprotected sex and work out ways to avoid the same mistake in future.

Things to remember

• HIV positive men with HIV negative partners can still enjoy physically intimate relationships.
• Sexual activities that are considered safe include kissing, cuddling, stroking, massage, masturbation, mutual masturbation, oral sex (with no ejaculate in the mouth) and anal sex with a condom using water-based lubricant.