Other prevention strategies
The following strategies have low or uncertain effectiveness. In other words, they’re not effective on their own for preventing HIV infection. Combine them with other strategies discussed in the prevention strategies section.
Agreement between partners (negotiated safety)
Negotiated safety consists of deciding, with your regular partner, to stop using condoms after getting tested for HIV and other STBBIs. Negotiated safety also involves determining rules for your behaviour and for having protected sex outside the relationship.
- Fooling around with other people, but without having anal sex;
- Having anal sex, but always using a condom;
- Not having sex with others, meaning that you’re monogamous or exclusive.
If you decide to move forward with this idea, here are a few elements that can provide a good foundation for your agreement:
- The two of you have a steady relationship (stable over time).
- You both agree to get tested for HIV and STBBIs before and during the time of your agreement.
- You both agree to stop using condoms together.
- You both clearly agree on what you can and can’t do outside the relationship.
Getting tested is the first step before you stop using condoms together. This gives you a chance to get treatment if you have an infection.
Do you feel comfortable telling your boyfriend about your desires and limits? Consider telling him what kinds of experiences you’d like to have outside your relationship: having a fuckbuddy, having one-night stands, going to the bathhouse. He can also tell you about his preferences and needs, and you can come to an agreement. You and he then agree to stop using condoms together and agree on the conditions under which you’ll have sex outside your relationship.
In the context of your agreement, communication is essential—and it needs to be frank, open and respectful.
Effectiveness of negotiated safety
To be “safe,” meaning to reduce everyone’s risk of infection while increasing your pleasure and well-being, the agreement must be respected. And it only works when both partners respect their agreement. Studies show that many couples negotiate about sex, but that one out of every three agreements gets broken. For this reason, it’s important to talk about what to do if that happens. Would you be comfortable telling him if you were to break your agreement? How would you react if he were to tell you that he had broken your agreement? Regardless of the scenario, it remains important for you to continue to get regularly tested for STBBIS.
Maybe you’re part of a limited group of people you like to play with? If so, you can also negotiate about safety with a group. The same principles apply. The difference is that instead of being an agreement between two people, it’s an agreement among several. This means that everyone who’s part of the group needs to take part in the discussion and decisions. Remember that the more people you’re dealing with, the more likely that situations will arise that make it hard to respect the conditions of the agreement. The agreement may include the following conditions:
- Getting tested for HIV and other STBBIs and repeating the test to confirm everyone’s status.
- Establishing a clear agreement about what’s allowed and not allowed within and outside the group.
- Getting clear consent from each person to stop using condoms within the group.
- Respecting the agreement and identifying what to do if the agreement is not respected.
To be “safe,” the agreement must be respected by everyone, and the group must be closed. If the group opens, the agreement needs to be renegotiated.
Serosorting means choosing sex partners based on their HIV status.
For example, an HIV-negative guy might have sex only with other HIV-negative guys, thinking this will protect him from HIV infection. This strategy isn’t effective, because a lot of people think they’re HIV-negative but are actually living with HIV. In our communities, one out of every five HIV-positive men doesn’t know he has HIV. He may have gotten infected since his last test, for instance. And if he has just recently been infected, the risk of transmitting HIV is higher, because the viral load is higher at the start of the infection.
Serosorting can also happen between HIV-positive guys who only have sex with other HIV-positive guys. This can help prevent you from being rejected due to your HIV status. Or maybe you’re afraid of transmitting HIV.
Have you heard about U = U? When you’re taking effective HIV medication, there is no risk of sexual transmission. Learn about it by reading the section on viral load.
If you use serosorting, a number of elements are important, and some of them are hard to control. You need:
- To get regularly tested for HIV and other STBBIs.
- A very good knowledge of the ways HIV transmission works and how to prevent it. For example, you need to know exactly when each person was last tested and whether they have had any potential virus exposure risk since then.
- Clear, honest and precise communication between partners—meaning you need to be comfortable telling them things and asking them things.
- Established trust between partners, since you can’t verify their information, or an acceptance of the risk.
Whether you’re HIV-positive or HIV-negative, if you don’t use a condom, you won’t be protected against other STBBIs.
Top or bottom (seropositioning, strategic positioning)
A sub-category of serosorting, sometimes called seropositioning, involves adopting a sexual position based on your HIV status to reduce the risk. For example, an HIV-negative guy may always choose to top, regardless of his partner’s status. The risk of contracting HIV is lower for the top than for the bottom.
However, the risk still exists even for tops, because HIV can be present in the bottom’s anal mucus membranes or rectal fluid. In this context, HIV can be transmitted when the top’s penis enters into contact. For the bottom, even if the top doesn’t ejaculate in his ass, he may be exposed to HIV, because the virus can also be present in pre-ejaculatory fluid (precum). To date, scientific research has not shown the seropositioning strategy to be effective on its own in preventing HIV transmission. In short, whether you top or bottom, the best way to reduce transmission risk is to use a number of strategies, such as PrEP.
Top: the guy penetrating another guy’s ass
Bottom: the guy getting penetrated or fucked
Versatile: a guy who likes both positions
Maybe you’ve heard that being circumcised—meaning the foreskin, which covers the head of the penis, has been removed—protects against HIV. In Canada, circumcision is not a recommended prevention method. Studies in some countries where HIV is widespread show a reduced risk of infection for circumcised heterosexual men. But science has not proven the effectiveness of circumcision as a method of preventing the transmission of HIV or other STBBIs for men who have sex with men.