Gay sex uncovered Words by Stuart Haggas | @GetStuart What would life be without risk? If we didn’t push boundaries or challenge ourselves, it’d be a world of beige walls, sensible shoes, and bland food. Thankfully our natural curiosity encourages us to experiment and try new things, making this world a more colourful and fascinating place. It is however important that we recognise our limitations, because to jump in at the deep end regardless of risk can be a reckless thing to do. Like many things in life, the key is to get the right balance, to take steps to mitigate the risk. Take sex for example. Sex between men comes in many forms and flavours: oral sex, anal sex, NSA sex, group sex, outdoor sex, chemsex, hard sex, raw sex, kinky sex. But when does it veer towards risky sex? “We all measure risk differently,” acknowledges David Stuart, wellbeing programme curator for 56 Dean Street. “Some only associate risk with HIV; others consider all STIs to be a potential risk. For others, risk is measured by rejection for not being sexy enough, fit enough or interesting enough.” This month we asked readers of FS to tell us about their sex lives. Of the 500 gay and bi men surveyed, 27% consider themselves to have a risky sex life. So what do these men classify as risky sex? RISKY EXAMPLES “I slept with a couple of friends on the same night, both times without condoms,” says Tom, 19 from Essex. “They had previously slept together, and both of them have slept with lots of other people.” “Countless times I’ve met men on the internet, particularly apps like Grindr or Tinder,” says Michael, 21 from Doncaster, “and, without even asking about their sexual health, I had sex with them.” “Most of the time I bareback,” says Bernard, 37 from London. “I give and take loads orally and anally.” “I’ve been drunk and gone bareback,” says James, 41 from London. “I have anonymous bareback sex at cruising grounds,” says Lance, 45 from Surrey. “I used to do it all the time with cruising, chemsex and casual sex,” says Noah, 26 from London. “I rarely use condoms but I have the conversation,” says James, 45 from Edinburgh. “I’ve been addicted to sex for years so have had hundreds of partners and regularly got STIs. At 45 I’m slowing down and feel glad in that I’m not so often infected, but sad that I’m more lonely and isolated.” “Since I have started ‘playing away’ from my relationship, I feel I am increasing my risk,” admits Rudy, 35 from Oxford. “It’s usually with unplanned hook-ups, and we’re less likely to discuss our sexual health at a club or in a park.” COMPLICATED “‘Risky sex’ is a complicated term,” says David Stuart. “Many activists dislike the term, wishing gay sex to be free of the spectre of ‘risk’ that overshadows the pleasure for many gay men. But risks do exist in regard to sex, certainly – and more so for gay men, because we are disproportionately affected by HIV and STIs, and because the technological elements of hook-up culture do not lend themselves to the robust communication methods required to discuss and negotiate these complicated safer sex tools available to us.” “Sex is complicated and there is no one size fits all safer sex strategy,” adds Ian Howley, Chief Executive of GMFA. “First we need to define what is risky sex in this day and age.” CONDOMLESS SEX Of the 500 gay and bi men surveyed, 35% said they used condoms the last time they had anal sex – the other 65% didn’t. But this doesn’t mean the majority of us are having risky sex, because bareback sex doesn’t always equate to risky sex. Same sex couples who are married or in committed long-term relationships may choose not to use condoms when having sex with each other. Equally, HIV-negative men on PrEP, and HIV-positive men who have an undetectable viral load due to their HIV treatment, can have condomless sex without risk of HIV infection. “I think it’s true to say that in 2017 having bareback sex doesn’t necessarily mean you are having riskier sex,” says Ian Howley. “Safer sex in 2017 is more complicated that it was twenty years ago when your only options were condoms or abstinence as a way to protect yourself from HIV and STIs. The advancement of treatment, the fact that gay men who are on HIV treatment and have an undetectable viral load can’t pass on HIV, added to the increased number of gay men who are taking PrEP, means that gone are the days when sexual health education was just about telling people to use condoms. We now must do more to increase gay men’s knowledge about all the options open to them.” “I do want people to trust that you can’t catch HIV from an undetectable HIV-positive person,” explains David Stuart. “HIV-positive people on treatment are awesome, sexy, healthy people who represent no HIV risk to our communities at all, and do not deserve the rejection and stigma they often receive, particularly in hook-up culture and online. Undetectable equals uninfectious. “I also want people to trust in PrEP. You can’t catch HIV from someone who is on PrEP, and taking it as their doctor recommends (if you’re taking PrEP without a doctor’s supervision, join our Dean Street Prime free PrEP support service). These facts should give us great comfort, help us to relax into sex better. Condoms are always best for guys who hook up, because they provide protection from all STIs; PrEP, PEP and undetectable viral loads are great back-ups for when our condom commitment fails us, because they do protect us from HIV very effectively.” BARE AND UNDETECTABLE “I tend to only do bareback,” says Lachlan, 37 from London. He tests regularly, believes he’s currently HIV-negative, and will have unprotected sex with someone who is HIV-positive. “Undetectable guys cannot pass on HIV. I feel safer having sex with an undetectable guy than someone who claims to be negative.” “I am undetectable and on therapy, so I don’t really ask or care about other people’s HIV status,” says Bernard, 37 from London. The last time he had sex was “with someone who I met while cruising. We exchanged numbers, had sex 3 or 4 times already, and this time we had sex without a condom. I’m undetectable, and he came in me. I fucked him as well, but I don’t really care about his status.” “I met a guy on Grindr. I’m HIV-positive, undetectable, he was fine to take my bare cock,” says James, 45 from Edinburgh. BARE AND PrEP Jimmy is 36 from London and he describes his most recent sexual experience: “It was with a couple of guys I’d met before. One guy barebacked me, the other wanted to use condoms – both were fine as I’m on PrEP. A second time I met a hot kilted guy in a club last weekend. He barebacked me in the darkroom – it was hot as it was in front of everyone.” Jimmy would have sex with someone he knew was HIV-positive. “As long as they are undetectable there is no risk. I’m on PrEP now so the chances of catching it are significantly reduced.” Richard is 38 from London. He’s HIV-negative, and his most recent sexual encounter was with a HIV-positive undetectable guy. “It was a casual partner who I knew was positive but on treatment,” he explains. “We knew each other through Grindr but then met up following a party with a mutual friend. It was good sex. We both topped and bottomed and came in each other. I’m currently taking privately bought PrEP so I know I’m protected from HIV. Also if someone knows their status they are far more likely to be checked regularly for other STIs at their clinic appointments.” It’s essential to remember that the risk of HIV infection returns if you’ve not taken PrEP yet continue having condomless sex. “I take PrEP as an event based dosing as I can’t afford to buy it every month,” explains Bruce, 36 from Leeds. “I have some spontaneous encounters without PrEP and without condoms. I’m bottom and I know this is super high risk, so every time I do this I’m putting myself at risk.” Bruce’s most recent sexual encounter was in fact potentially risky. “It was with a guy from Grindr – bit of a spontaneous hook-up in the toilets of a gay bar during early evening. Not the most romantic, but it was pretty hot nonetheless.” RISK ASSESSMENT: We asked: When you last had anal sex, what type of sex was it? 35% of you said you used condoms. 32% said it was bareback sex but you knew the other guy was HIV-negative. 14% said it was bareback but one or both were HIV-undetectable. 11% said it was bareback but didn’t think about or worry about the risk. 8% said it was bareback but one or both were on PrEP. EX-RISK TAKERS Some men acknowledge that they used to have a riskier sex life, but they now take PrEP to mitigate the risk. “I used to take risks in terms of beginning to ‘dip the tip’ before getting condoms, or occasionally fucking or getting fucked bareback,” admits Jake, 35 from London. “I mostly used condoms, but knew that I could be liable to take the risk sometimes. Which is why I started on PrEP so I know I’m protected from HIV if I do have bareback sex at all.” Jake acknowledges that, now he’s on PrEP, his most recent sexual experiences have been bareback. “The latest was a new-ish guy. We’ve had sex a few times. We met originally in a club, and have since met for sex and sort of dates. The sex was great. Last weekend I went to Hard On. I sucked and got sucked by a number of guys, some of whom I also got fucked by or fucked.” Although he’s HIV-negative, Jake says he would have sex with someone who’s HIV-positive. “If they were undetectable they can’t pass the virus on, and also I am taking PrEP. The most recent guy, the kind of dates one, is HIV-positive and undetectable.” “Before I got on PrEP I barebacked a guy without having a convo about sexual health beforehand,” says Sam, 31 from Ireland. “The second time I met him, I noticed pill bottles on his nightstand so I made up an excuse, left and confronted him about them later. He apologised, admitted to being positive and just getting back on meds to keep it under control. I was so paranoid I did the recent exposure test and found a doctor to put me on PrEP as soon as the results came back.” Sam no longer worries about having unprotected sex, as his most recent sexual encounter testifies. “I met a man on hook-up app BBRTS. More of a one night stand. He and I have fucked twice in the last six months. He is HIV-positive and undetectable, I’m HIV-negative and take PrEP. He is great in bed. We have busy schedules but hopefully I’ll breed his ass again in the future. “I find guys who are positive are usually on meds and undetectable,” Sam adds. “Plus they are owning and being responsible about their sexual health by disclosing their status. Others have lied when they told me they were negative, but it’s never lies when guys tell me they’re positive.” LACK OF DIALOGUE It would appear that risky sex isn’t necessarily about condom use – it’s as much about whether a discussion has taken place beforehand. It’s also risky to assume you know someone else’s status, because facts are better than guess-timates, and knowing the facts allows you to make an informed choice. Danny is 27 from Glasgow. His most recent sexual experience was “with a friend who I regularly have sex with. It was great. We should probably use condoms, but it’s not been a discussion we’ve had yet – we’ve only been doing it for about two months.” Danny is HIV-negative, and believes his friend is also negative. “What we do know is that most people become HIV-positive through a partner or sex buddy for exactly this reason. I would never say don’t trust your friends or regular sex partners,” says GMFA’s Ian Howley, “but that’s kind of what I’m saying. Most people who pass on HIV don’t know they have it. So you think they are negative, they think they are negative, and both of you find this was not the case. This is why if you are having condomless sex you need to find the best strategy for the type of sex you are having. I would suggest PrEP and regular testing.” “Sometimes I fuck without condoms,” says Mushtaq, 31 from London. He’s HIV-negative, and his most recent sex was bareback, but he didn’t worry about risks. “It was a random stranger I met from Grindr. I don’t know him. It was a good fuck – I hadn’t fucked for ages so it felt really good.” “It was a Grindr meet which started off as just planning to be oral, but was going very well so it went further,” says Lee, 25 from Birmingham. “It was very good and very much in the moment – so little thought was given to getting him to wear a condom.” HEAT OF THE MOMENT “The vast majority of gay men will have risky sex at some point in their lives,” acknowledges Ian Howley. “Many times it’s not planned and in all honesty when you are in the throes of anonymous passion with a stranger in a sauna cubicle you are not going to stop and ask him about his status or his safer sex strategy.” “Thinking about ‘risk’ when in sexy situations can ruin the moment for some,” adds David Stuart, “but it shouldn’t. Only fear of the risks ruins the moment, and that can be remedied by being informed. Knowing the basics about how HIV and other STIs are transmitted, and having the confidence to discuss this with our partners, will help us to manage the risks confidently and enjoy the sexy time we deserve.” “Sex happens and people deal with the thoughts of ‘have I just put myself at risk?’ after. And that’s fine,” Ian continues. “However, there shouldn’t be any shame about having sex, even when putting yourself at risk. But what’s not fine is not knowing about what to do afterwards. Many gay men still don’t know about PEP and how it can be used to stop HIV if you’ve put yourself at risk. Many still don’t know about or trust PrEP either, so there is a massive need for basic safer sex education, safer sex strategies, and what to do if you put yourself at risk.” THRILLS For what reasons might we consciously choose to take risks? Sometimes it’s simply for the thrill of it. “Chemsex with app hook-ups always carries an inherent risk one way or another, but I guess that is part of the thrill,” says Robbie, 41 from London. “I am aware of the risks of barebacking and consciously choose to. Positive people often take more care over their sexual health than many who believe themselves to be negative.” OTHER STIS HIV is just one STI that puts our health and wellbeing at risk, and condoms remain the single best protection against all STIs. Of the 500 men surveyed, 200 say they have tested positive for an STI other than HIV. “The first time I had chlamydia, I had symptoms and caught it from an anonymous fuck in a sauna,” says Joe, 31 from London. “The second time I caught it from a friend who gave me a blow job.” “I had chlamydia and gonorrhoea at the same time following a trip to the sauna,” says Mat, 37 from London. “I got symptoms of gonorrhoea in the penis, which was transmitted from a Grindr partner’s throat,” says Tom, 22 from Essex. “He didn’t know he had it. I told him.” “I had symptoms of chlamydia in the penis,” says Lachlan, 37 from London. “I informed my partners. Treatment was quick and easy. I have been informed by others in the past when they have been diagnosed with an STI too, and have always gone to get checked straight away.” “I had symptoms of gonorrhoea, which was very painful. Was from a one-night stand on holiday and no way to contact him,” says Dave, 44 from Birmingham. “Treatment was quick and easy. I had syphilis and got this from a sauna visit. I was unable to trace the guy but I refrained from sex until I was clear. Treatment was also easy and effective.” “My first time was with syphilis. I had symptoms. The jabs were horrific,” says Jai, 40 from Birmingham. “The second time the treatment was a breeze. Telling partners to get checked was embarrassing, but I affirmed friendships with a couple of them.” “I’ve had chlamydia, LGV variant twice, both times anally. This is like chlamydia with spikes on – two weeks of awful symptoms before the antibiotics kicked in,” says Bruce, 36 from Leeds. “All other STIs I’ve had have been asymptomatic and only picked up during testing.” “Having bareback sex is still risky, because other STIs are increasing in gay men,” says Ian Howley. “PrEP has changed the game in how men are choosing to protect themselves and we need to respect that and meet them where they are, but also highlight other STIs that can be passed on through sex without condoms.” Testing positive for an STI encouraged 61% of these men to be safer and/or to get tested more frequently, although 39% consider STIs like chlamydia and gonorrhoea to be an unavoidable risk of sex. RISK ASSESSMENT: We asked: If you have ever tested positive for an STI, what was it? Chlamydia (in the penis) - 20% Gonorrhoea (oral) - 19% Gonorrhoea (in the penis) - 18% Chlamydia (rectal) - 15% Gonorrhoea (rectal) - 15% Syphilis - 12% Chlamydia (oral) - 11% Scabies - 9% HPV - 6% Herpes - 6% Hepatitis C - 3% Shigella - 3% Hepatitis B - 2% Hepatitis A - 2% LESS RISK “Sex and risk are joined at the hip, particularly in regard to the hook-up culture that gay men enjoy,” says David Stuart. “Risk is not a bad thing; just something we need to negotiate. Being confidently informed about how HIV and STIs are transmitted removes the fear that any risk might represent in the bedroom (or wherever sexy stuff happens). “Organisations like 56 Dean Street and GMFA can help our communities to enjoy sex better with less risk, by continuing to campaign for condom use, PrEP and PEP awareness, helping HIV-positive men to remain undetectable and uninfectious; but also by battling the ignorance and stigmas associated with these safer sex tools. Mostly though, by promoting dialogue about gay sex wellbeing within our communities.” “In regards to what is genuinely risk free, no sex act is 100% safe. The only strategy that is 100% risk free is abstinence. And let’s be honest, for the vast majority of gay men that is not going to happen,” adds Ian Howley. “But we do need to have a wider talk about de-shaming risky sex. We live in a world where we are told that you are a ‘bad gay’ for having risky sex, which usually involves a lot of slut shaming. This needs to change. Sex is natural. There is no shame in having sex, even without condoms. We just need to focus on getting gay men to test more often, and find a strategy that they are comfortable with. You are not a ‘bad gay’ because you have condomless sex and you are not a ‘good gay’ because you have sex with condoms. So let’s stop the sex shaming. It’s not helpful.” ADVICE Some final advice from Ian Howley: “We at GMFA recommend the following. If you are someone who is comfortable using condoms then keep on doing that. It’s the best strategy that helps prevent HIV and STIs. If you are someone who is HIV-negative and has condomless sex then we would recommend that you get yourself on PrEP. It won’t stop STIs but it’s been proven to stop people becoming HIV-positive. Also check out PEP. It can help if you’ve put yourself at risk. “If you are living with HIV and undetectable then keep on taking your medication. HIV-positive men who are undetectable cannot pass on the virus to anyone. If you are living with HIV and are not undetectable yet then we suggest you still use condoms with HIV-negative men, unless they are on PrEP. And all sexually active men, whether HIV-negative or HIV-positive should have regular check ups at a GUM clinic. We recommend once every six months or more often if you are having condomless sex. “And those are just some ways to protect yourself. As you can see, in this day and age, it’s not a one size fits all approach any more. We need to meet gay men where they are in their lives. We need to keep on pushing the message that there is more than one safer sex strategy. We need to increase people’s knowledge about PEP, PrEP and what HIV-undetectable actually means in the real world. “We need to remind people to test for HIV on a regular basis. And we need to keep on putting out the message about condom use, as it’s still the best way to stop HIV and STIs. But as medication improves so must we in our approach to promoting all the safer sex options open to gay and bi men.” SUPPORT: For more information about sex and sexual health, visit https://www.gmfa.org.uk/Pages/Category/how-risky-is To buy cheap condoms (that come in all sizes) and lube, visit www.freedoms-shop.com. To talk to someone about any issues, visit www.metrocentreonline.org