Are Condoms the Only Answer to Keeping Him Safe?

By: Todd Heywood

Editor's Note: Our sister publication, HIV Plus magazine, recently ran Todd Heywood's feature about the escalating HIV rate among gay men and why the push towards condoms-only prevention might be impacting those rates. The feature, called "State of Affairs: Crisis of Prevention in the Gay Community," is worth a gander. Go read it, but before you do, take a look at Heywood's explanation of various risk reduction technologies and their effectiveness in reducing HIV risk.

Condoms are amazingly successful in keeping you or your guy safe from transmitting HIV — if they're used 100% of the time correctly. But some other techniques and technologies are either used or on the horizon. Here's the rundown.

Drug Interventions

  • Treatment as Prevention

Following a large scale study of heterosexual couples in Africa where one partner was HIV-positive and the other was not, it was determined that a person on a medication regime that had successfully suppressed the viral load – the measure of virus in the blood – there was a 96 percent reduction in transmission of HIV. As a result the federal government has been scaling up treatment for people living with HIV who are aware of their status as a prevention tool.

  • PrEP

This is the use of Truvada, a combination pill of two powerful anti-HIV drugs, taken daily to prevent infection in HIV-negative persons. It has been approved for use in men who have sex with men, as well as intravenous drug users and women at high risk. It has been proven to be as much as 72.9 percent effective in preventing infection when taken more than 90 percent of the time.

  • n-PEP

This intervention is the use of three or more anti-HIV drugs taken for 28 days following an exposure to HIV to prevent infection. The regime must be initiated within 72 hours of the exposure to be successful. No studies provide solid answers on the effectiveness of this intervention, but it is estimated to be 81 percent effective in preventing an infection.

Tools and Technology

  • Rectal mircobicides

Scientists are working feverishly to develop drug related interventions that can be applied in the anus or the vagina and prevent an infection. Some trials have proven of interest, but nothing has been approved.

  • Female Condoms

This is a condom that is inserted in either the anus or the vagina. It is large, and loose fitting and looks like a pocket. Ironically, this was originally designed for anal sex, however, the FDA declined to approve it for that use. Instead makers repurposed the product as a vaginal insert and it was approved. This is currently an off-label use, although several pocket or pouch condoms specifically for anal sex are working their way through the FDA approval process.

  • Rapid HIV Testing

Those who are infected, but unaware of the infection are significantly more likely to transmit their infection to another. As a result, testing for HIV antibodies is a key tool in preventing HIV. The Centers for Disease Control recommends men who have sex with men be tested every three months for HIV. Knowing one’s status, whether positive or negative, is key in preventing transmission and creating prevention options for people.

Risk Reduction

  • Sero-sorting

This is where a person says he or she will only engage in sexual activity, whether condomless or not, with a person of the same HIV status. In theory this should be effective in preventing new transmissions, however, with the low testing rates and knowledge of actual HIV status in the MSM community, it is not very effective. A study released in 2012 at the 19th Annual Conference on Retroviruses and Opportunistic Infections found this option had only a 51 percent reduction in HIV infections.

  • Condoms-only/no anal sex

This category is pretty self-explanatory and was found to be 74 percent effective in reducing HIV infections in the 2012 study. However, a 2013 study from CROI found that condoms are only 70 percent effective in preventing HIV infections, and only if used every time. Inconsistent condom use had no prevention effect.

  • Sero-positioning

In this risk reduction option, a man who has sex with men determines whether to be top or bottom based on the HIV-status of his partner. The person using sero-positioning, will opt to top for those who are HIV-positive or whose HIV status is unknown or a test is out of date. It was found in the 2012 study to be 75 percent effective in reducing infections.

  • Top-only

Those who are tops-only during anal sex have 86 percent reduction in transmission, according to the 2012 CROI study. This may have something to do with the already low probability risk of insertative anal sex – estimated at .065 percent for a one time sexual episode for a top by the CDC.

This article originally appeared in the print and online editions of Between the Lines, Michigan's LGBT newsweekly, and is available at