Strategic Positioning

Topping versus bottoming

Many HIV-negative men think it's safe for them to fuck without condoms, even with a partner who is, or might be, HIV-positive, as long as they are the top (i.e. the guy doing the fucking). Similarly, many HIV-positive men think they can fuck without condoms without putting an HIV-negative partner at risk, so long as the HIV-positive guy is the one being fucked.

Many men believe this because they have heard that it is easier for HIV to travel from the guy who is fucking to the guy being fucked than the other way round. Although it is easier for HIV to pass from the top to the bottom, many men become HIV-positive as the top (i.e. insertive partner) when fucking without a condom.

Why is the guy being fucked more at risk when fucking without condoms?

The guy being fucked is more at risk during condomless sex for two reasons:
  • HIV is carried in body fluids including semen. When someone comes inside you, if they are HIV-positive then the HIV in their semen is also inside you and can enter your bloodstream through the sensitive lining of the anus. This can be influenced by viral load levels, so it might be worth having a look at the viral load section to get more informed.
  • The sensitive lining of the anus is more susceptible than the skin of your cock to cuts and abrasions caused by friction during anal sex. These cuts and abrasions in the anus offer any HIV present in cum or pre-cum an entry point into the receptive partner's bloodstream.

Does that mean condomless anal sex is safe for the top?

No. Choosing to be the insertive partner is NOT a reliable technique for avoiding getting HIV during condomless anal sex. Many men have become HIV-positive as a result of being the top during unprotected sex.

How can HIV enter the insertive partner's penis?

HIV in body fluids in the bottom's anus can enter the top's cock through the urethra (i.e. the opening at the tip of the penis through which urine and cum passes). It can also enter the cock through any cuts or abrasions caused by friction during sex, or through sores or other irritations caused by the presence of another STI.