Anal & Oral

Anal sex, men and HIV

Effective HIV prevention also needs to take into account an issue that causes some young gay men to be at particular risk of HIV. This is unprotected anal sex, which can be especially risky in terms of the transmission of HIV. Anal sex involves a man putting his penis into the anus or rectum of another man or woman. It is unprotected when he does not wear a condom.

Not all gay men have anal sex. Some don’t like it or want to do it and others only do it rarely, even if they are in a relationship. Research in the UK has suggested that about two thirds of men who have had any sexual experience with another man in their lives have never had anal sex at all. However, for those who do have anal sex condoms are essential for HIV prevention. Unprotected anal sex carries a high risk of HIV transmission because during anal sex it is easy to make small tears or cuts in and around the rectum through which HIV can pass.

Why do some young gay men have unprotected anal sex even if they know the risks?

When two men do decide to have anal sex there are a variety of reasons and circumstances when they might not use condoms, even though they know the facts about the risks of HIV infection. These reasons are not exclusive to gay men and can affect the choices heterosexual men and women make about using condoms too.

If two men both think that neither of them have HIV or another sexually transmitted disease they might choose not to use condoms for anal sex. For many young gay men making a decision not to use condoms based on their knowledge about their own and their partner’s HIV status is not really a realistic option. Research has shown that this is because when people are young they are very likely to have more than one sexual partner in a fairly short period of time and may well have sexual relationships with two people at the same time.

For some gay men not using condoms is bound up with trust or love. Some of them say that using a condom in the context of a monogamous relationship suggests that they have been unfaithful. Problems can arise here if either of them does have sex with someone else. Then they have to deal with potential difficulties of telling their partner about it because they will have to use condoms until they can be sure they haven’t contracted any infections including HIV. Using condoms with every partner means this situation doesn’t have to arise.

…there is also a rumor out there that it’s an urban myth. That is cross infection doesn’t really happenHIV positive man

Some gay men may choose to have unprotected anal sex because they are both infected with HIV. In fact, this is still risky because they might pass on other diseases which can make them particularly ill because their body’s immune system is already weakened by HIV. They can also be repeatedly re-infected with HIV which can counteract the benefits of any treatment. A UK study of HIV positive gay men found that only a minority were concerned about the possibility of becoming infected with a new strain of HIV, or ‘superinfection’ despite the long term effects on treatment options.

Men can find themselves in circumstances where they feel less cautious about protecting themselves and their partners than they usually do. This can be in social situations like in clubs and bars or when they are on holiday. Drugs and alcohol in these settings can make men less likely to protect themselves . Some research with gay men visiting gay clubs and bars in London has shown that there are small number of gay men who socialise at these venues who have had significantly more sexual partners than most other gay men or heterosexual men and women. The research in London had some parallels with that in North America, showing that about a third of men have had unprotected anal sex in the year before being questioned. These men tended to be under 25 or over 40 years old.Research with gay men on their sexual experiences on holiday showed a similar trend with a small number taking risks they wouldn’t usually take at home because they thought there was less risk of meeting someone with HIV, there were more opportunities to have sex with new partners and because they felt under less pressure to have safe sex.

I guess I’m putting the blame on the drugs but it’s true that if I was totally sober then I would probably have thought of using condomsYoung gay man

Research has shown that some young people, including young gay men, can see taking risks as valuable. For some it feels like an important part of learning to make decisions for themselves. It is also the case that being too worried about risks associated with sex can also make them feel fatalistic about the outcomes of their behaviour.

Some young gay men may find it difficult and embarrassing to raise the issue of using condoms in some circumstances and to negotiate using them. For some men asking a partner to wear a condom can feel like they are suggesting that they might have HIV or another sexually transmitted disease. The best strategy is probably for a man to point out to a sexual partner that they want to use a condom because it protects them both. Talking about using condoms can be very difficult nonetheless.

In some situations men may not have access to condoms – either because they aren’t carrying any with them or can’t find anywhere to obtain them. It is recommended that special stronger condoms are used for anal sex and for some young men asking for these may be difficult because it means they have to effectively disclose their sexuality when they might not want anyone to know or feel confident about their sexual identity.

HIV and oral sex

Unprotected oral sex is low risk for spreading HIV but using a condom or dam or avoiding ejaculation into the mouth is recommended when either partner has ulcers or bleeding gums, or has recently brushed or flossed their teeth. Condom and dam use may also prevent the spread of other STIs such as herpes, chlamydia, syphilis and gonorrhoea. These STIs may be spread more easily by unprotected oral sex.

HIV and deep kissing

Only very small amounts of HIV are found in the saliva of people who have HIV. For you to get HIV, a lot of saliva would need to get into your blood via ulcers or bleeding gums. Deep kissing is a low risk behaviour for spreading HIV.