Uncovered in the U District
Dear Dr. Dick,
I'm a bi guy who has a couple of intimate partners (both men and women). At this time of year when it's freezing out, it's basically a 24/7 orgy. We all tested negative two months ago, and we're good about getting tested regularly. I feel like I don't have to worry too much about getting HIV. The only thing is, I really don't like condoms. They don't feel good and I have a hard time getting off when I use them. My partners are OK with me not using them. Two of us use crystal, but we smoke only (we don't inject or booty-bump).
How worried should I be about getting HIV? Dr. Dick, I'm not about to start covering myself up. Is there anything I can do to play it safer?
Sincerely,
Uncovered in the U District
Dear Uncovered,
I'm glad you brought this up! While condoms can make sex a whole lot safer--it's important to acknowledge that some people just don't like them or use them. For many guys, sex without condoms just feels better---but it can come with a price (pardon the pun). If you're NOT in a monogamous relationship (where you and your partner only sleep with each other, and are sure you are both HIV/STI free) --- barebacking is risky.
Here's Why:
1) The lining of the anus and vagina are delicate. Micro tears can happen easily (especially with rougher, prolonged crystal sex), which leaves you and your partners vulnerable to HIV and other sexual bugs.
2) It's always a possibility that your partners have other partners. Even though you trust them, you should never assume you're 100% safe when it comes to sex. Whether its oral, anal, or vaginal sex, all sex carries some risk.
3) Even though you and your partners test often, people are most infectious in the weeks right after they get infected with HIV. If one of your partners gets infected and doesn't yet know it, they could infect you.
With that said, if you're sure that you're never going to use a condom---consider the following tips for safer sex:
1) SKIP DOUCHING:
Douching (using an enema) damages the skin in and around your hole--making it easier to spread or get an STI. If you absolutely MUST douche before sex, use warm water only. Check out my recent article on enemas for more info.
2) SMOKE SAFER:
Talk about sex before you smoke. Do you have the supplies you need? (water-based or silicone-based lube etc.).
Try to use your own pipe only. Passing the pipe around can expose you to diseases and infections that can weaken your immune system.
3) TEST:
Test every 2-3 months
? If you test positive for an STI--connect with a medical provider ASAP. You and your partners must all get treated. Otherwise, the bacteria/bug will continue to be spread back and forth. Your immune system will also be more compromised---which will make barebacking riskier.
4) EXPLORE YOUR OPTIONS:
Have you thought about trying an insertive condom? Insertive condoms are used in the anus or vagina, and offer protection against HIV, pregnancy, and STIs. You can put one in yourself, or ask your partner to do it. This is a great option for guys who have a difficult time staying hard with condoms on. Have fun with them by making them a part of foreplay.
For more info, see my recent article Too Big to Fit in Here.
5) REDUCE:
Have fewer partners. Fewer partners = less chance of getting or spreading a sexual bug.
.
6) PrEP & PEP:
PrEP
HIV-negative guys who are at high risk for getting HIV can take PrEP (Pre-Exposure Prophylaxis). PrEP involves taking a pill once a day, every day, to help prevent getting HIV. Guys who take PrEP should also use condoms, & get tested often for HIV and other STDs.
Talk to your medical provider if you are interested in PrEP.
PEP
(Post-Exposure Prophylaxis) can also lower your risk of getting HIV. PEP is the use of an HIV drug after a possible exposure to HIV. If you feel you might have been exposed to HIV, visit your medical provider ASAP. PEP needs to be started within a couple days of being exposed to HIV.
7) COMMUNICATE:
It sounds like you're doing a superb job of talking with your partners. Keep it up. Talk about your HIV and STI status with your current partners--and if/when you get a new partner. You might say "I tested negative for HIV 2 months ago." If you don't talk with your partners, you don't have the chance to find out their status or sexual history.
8) LUBE:
Some guys use lube because they feel like it decreases friction and trauma to the skin. Friction can tear the lining of the anus or vagina, which makes you or a partner more likely to get a sexual bug.
We really have no idea whether lube increases the risk of HIV and other STIs, decreases the risk, or has no effect. More research is needed in this area. Your risk of spreading or getting HIV and other STIs may depend more on the kind of lube you use.
Not all lubes are safe! Some lubes hurt the lining of the rectum and may increase HIV replication (the virus making copies of itself). Here's a bit more info:
· If you are using condoms, don't use oil-based lube--which breaks down condoms. Crisco, Vaseline, and chapstick (lip balms) are oil-based and are NOT good options--even if you're desperate!!
· Stay away from lubricants that contain nonoxynol-9. Nonoxynol-9 is a spermicide that can irritate the delicate lining of the rectum and vagina, increasing the risk of HIV and other STIs.
· Some evidence suggests that lubricants containing an ingredient called polyquaternium-15 may boost HIV replication. Some of the lubricants that contain polyquaternium-15 are: Astroglide Liquid, Astroglide Warming Liquid, Astroglide Glycerin and Paraben-Free Liquid, and Astroglide Silken Secret.
· Some evidence suggests that certain lubricants can damage the cells in the lining of the rectum. These lubricants include: Astroglide, Elbow Grease, Gynol II, KY Jelly, Relpens, and Boy Butter.
· Some evidence points to the following lubricants as safer choices: Good Clean Love, PRE, FC 2 lubricant, and Wet Platinum.
9) CONSIDER THIS:
Have you thought about how important it is to you to stay HIV-negative? What would you do if you tested positive? It's worth thinking about....
Here's to safer humping.
Dr. Dick
*For more info on PrEP and PEP visit
PrEP
Go to: http://www.kingcounty.gov/healthservices/health/communicable/hiv.aspx
& click on PrEP Q&A: Using HIV Drugs to Prevent HIV Infection.
PEP
Go to: http://www.kingcounty.gov/healthservices/health/communicable/hiv/links/pep.aspx
& http://www.cdc.gov/hiv/topics/treatment/post-exposure-prophylaxis.htm