HIV and gay men - safe sex

In Australia, the human immunodeficiency virus (HIV) is most commonly spread through unprotected anal or vaginal intercourse with an infected person. Gay HIV positive men with HIV negative partners can still enjoy physically intimate relationships if they follow safe sex practices.

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
Unsafe sexual activities include:

• Unprotected anal sex, since the virus can enter the bloodstream via mucus membranes or small cuts or abrasions.
• Withdrawing before ejaculation, since pre-ejaculate fluid can contain the virus.
• Using pre-ejaculate as a lubricant prior to anal intercourse.
• Sucking ejaculate from the anus (felching).
• Activities involving razors or shaving, as blood can be drawn from small nicks and cuts.
• Any sexual activity that draws blood.

• Kissing
• Cuddling
• Stroking and massage
• Masturbation
• Mutual masturbation
• Ejaculating on unbroken skin
• Urinating on unbroken skin
• Protected anal intercourse (using condoms).

• Anal sex – use condoms and use plenty of water based lubricant.
• 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 via 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.
• 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.
• Licking and kissing the anus (oral–anal contact, or 'rimming') – HIV can't be transmitted via oral–anal contact, but other diseases can, such as 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).
• 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.
• 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.
• 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.

• 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.
• 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. If you think you have been exposed to HIV, or think you need help, call 1800 889 887. This is a 24-hour telephone service.
• Talk about the factors that led to the unprotected sex, and work out ways to avoid the same mistake in future.

• Fear – both partners could be fearful of the HIV positive partner developing AIDS, or of the HIV negative partner contracting the virus.
• Sexual problems – some people may feel bored and frustrated by the constraints of always practising safe sex, which can cause tension within the relationship. Sometimes, treatments may also affect the HIV positive partner's libido.
• Insecurity – the person with HIV may feel insecure, and worry that their partner may leave them because of their HIV status.

• Your doctor
• Victorian AIDS Council/Gay Men's Health Centre Tel. (03) 9865 6700 or 1800 134 840
• Blood Borne Viruses/Sexually Transmissible Infections Program, Department of Human Services Tel. (03) 9616 7777
• AIDSLINE Tel. (1800 133 392
• Positive Living Centre Tel. (03) 9863 0444 or 1800 622 795
• People Living with HIV/AIDS Vic Inc Tel. (03) 9865 6772
• Melbourne Sexual Health Centre (03) 9347 0244 or 1800 032 017 or TTY 9347 8619
• The Centre Clinic, Northcote Tel. (03) 9481 7155
• The Centre Clinic, St Kilda Tel. (03) 9525 5866
• Education & Resource Centre at The Alfred Tel. (03) 9276 6993

• 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.