Unsheathed sex
PN’s new guide togood
sex for HIV positive people thismonth takes us into the taboo world of condom-less
coitus
Illustration C(Aitch)
Words Jack Summerside
If
you have no problems using condoms during sex, this month’s edition
of The Sex Pages will be a bit of mystery to you. If you use condoms consistently,
and aren’t having difficulties sticking with them, then good for you.
If it’s working for you I wouldn’t change that for the world.
For some of us, however, condom use can be difficult or impossible for a variety
of reasons. If you struggle to use condoms consistently, find the damn things
won’t co-operate, or you and your partner feel that exchanging fluids
is a vital part of sex, then you might want to think about how to minimise
the possible downsides for your and your partners’ health.
Rule breakers?
We’ve been told penis-inserting sex without a condom is mad, bad and
dangerous for nigh on 25 years. We’re only talking about non-oral sex
this month; we’ll save oral for another time. There’s no doubt
that condoms greatly reduce the likelihood of HIV being transmitted. Statistics
on this can be misleading so I’ve not dug any out. Condoms also make
a physical barrier for sexually transmitted infections (STIs) like syphilis,
gonorrhoea and hepatitis C. We all know using them is better for your health,
so why don’t we?
Unmentionable reality
The reasons some of us have it away without a condom aren’t really shrouded
in mystery. Being honest, our fondness for condom-less sex is the reason many
of us (those infected sexually, and with some degree of consent) became HIV
positive in the first place.
Talking to prospective partners about using a condom can be tricky. Just mentioning
the word can be a passion-killer for many. If the partner doesn’t know
your HIV status, insisting on condoms can arouse suspicion. The fear of disclosure
and rejection can be enough to make some of us close our eyes and cross our
fingers.
Compare it to crossing the road without waiting for the green man. The reality
is, we do it because we’re in a hurry, don’t really expect to
get hit by a car, or reckon that motorists will pull up sharp to save their
no-claims bonus. Maybe we simply have other priorities at the time.
The truth is, it’s human nature to take risks, for some more than others.
The bedroom is no place for risk-assesment, and in the throes of passion rational
thought is often discarded quicker than your socks. But that seems to be an
unmentionable reality.
‘I’ve got the same HIV as him’
Beatrice and her husband never used condoms and were always faithful. But
her husband George was infected long before they met.
“It was only when I got pregnant and was tested positive for HIV at
the ante-natal clinic that either of us knew about it. We talked long and
hard about whether to start using condoms.
“But for us it just wasn’t ever going to be something we felt
there was much need for. After all, I’ve got the same HIV as him. Maybe
if one of us found our HIV had become drug-resistant we might think again,
but for now it’s not something we worry about.”
Sex without a condom is called barebacking by some and just normal by others.
Giving unprotected sex a fancy name helps increase the sense of it being taboo.
Some ‘experts’ claim this gives it an extra appeal. I don’t
buy this theory, but reckon it makes it all the harder to talk about the importance
that rubber-free shagging has for many of us.
Damage
limitation
The condom thing simply isn’t that straightforward for many of us. Accepting
this, it is probably best to know the facts. Aside from the possible legal
implication, which we covered in last month’s Positive Nation (PN126,
p38), there’s a couple of things worth considering (see pink boxes)
about how to reduce any potential harm to yourself or your partner if you’re
putting it in, or having it put in, without a hat on.
High days and holidays
Brian and his partner, Jon, had always had sex without condoms since both
being diagnosed with HIV in 1998. They hadn’t thought about potential
problems, even though they both enjoyed sex with other people.
“It was a shock when Jon got hep C. At first we tried using condoms
but the intimacy and fun kept just going down the pan. We’ve sort of
reached a compromise: we don’t use them when I’m fucking him and
sometimes do when it’s the other way round. It is rare if we go as far
as him cumming in me. I guess we save that for high days and holidays. We
know it’s an imperfect solution, but it’s a balance we know we
can achieve. It’s better than setting ourselves up to fail, because
then you just give up altogether”
A viral snapshot
Studies have shown that having a low HIV viral load has some relationship
with how infectious you might be to someone else, especially for men who cum
inside their partners arse or vagina. But unfortunately it isn’t so
straightforward:
• An undetectable viral load does NOT mean you can’t pass on HIV
• Viral load only measures the amount of HIV in your blood
• Even with an undetectable blood viral you load may still have high
levels of HIV in your cum or vaginal fluid
• You might even have a different type of HIV in your blood than in
other bits
• Your viral load is only a snapshot of how the virus is behaving on
the day the blood was taken, not how it is today
• At best, your knowledge of your infectiousness is already a fortnight
out of date by the time you get the numbers
You could use your last viral load test result as some sort of guide, but
not one you can have complete confidence in. It’s more useful if you
are stable on treatment or are lucky enough to have a consistently low viral
load without meds. But you can never be certain if might have changed since
your last test.
Would like to meet similar
Many of us choose to only have relationships or sex with other HIV positive
people so that means there’s absolutely no risk of someone getting HIV
from us. But positive-on-positive sex can have other complications that mean
it is not that simple:
• Although opinion is divided, it appears possible though rare for someone
already HIV positive to catch a stronger or drug-resistant strain of the virus
through condom-less sex.
• Unfortunately there are few hard facts about this. All of us will
have to reach our own conclusions about how to balance these facts against
what kinds of sex you enjoy.
• There’s a far greater chance of some STIs being passed if you’re
not using a condom
• HIV can make us more susceptible to some STIs and they can be harder
to diagnose and treat.
• Prevalence rates of some STIs are much higher among HIV positive gay
men who have many different partners. That isn’t some kind of political
correctness - it’s a simple statistical fact.
• Hep C is being diagnosed among HIV positive people at an increasing
rate (more on this in future Sex Pages)
l Hep C is especially prevalent among gay men into fisting and more ‘challenging’
sex toys
• And of course, you’ll be wanting regular check-ups for yourself
and your partner(s) and treatment for any STI. If
it’s good enough for Scarlett Johansson, it’s good enough for
us.
It’s pointless pretending that using condoms when you’ve not been
in the habit of them is easy. There’s little support or guidance on
how to make that transition, and I’d be happy to hear suggestions.
Not
all Mr Spocks
For most of human history, unprotected sex has been the only option. Until
about a decade ago, the only condoms available were great slimy rubbery things.
Nowadays there’s the luxury of choice, with a range of different types
on the market. It might be worth road-testing a few see if they’re more
palatable than they used to be. The choice, if you have one, between protected
and unprotected sex seems like an no brainer on paper. It’s a trade-off
between pleasure or greater safety. Logic suggests you’d go for the
latter, but we’re not all Mr Spock.
I’ll leave you with a question: is any fuck, no matter how pleasureable,
worth potentially doing serious damage to your health or the person you’re
doing it with? Only you can decide which matters most.
