How Risky Is Barebacking? Per incident risk quantified...

[rawTOP]

I've attached one of the only studies I know that has quantified how risky barebacking really is. When I say bareback tops are nearly as safe as safe sex bottoms - this is the study that backs up those numbers, but it says a lot more than that...

Read it over and see for yourself.

If you know of other more recent studies that have similar data, let me know.

varghese2002-29-1.pdf

[Belfast-Bottom]

I haven't had time to read the attached files, but I have no reason to doubt rawTOP's conclusion that bareback Tops are at only slightly more risk of HIV infection than "safe sex" bottoms. The implications of that conclusion are enormous. If Tops generally become aware that the risk from topping is quite low, then very many of them would start to regard barebacking as a risk worth taking. Look at how many guys smoke or drive motorbikes/fast cars.

There is a power imbalance in the gay scene. In my experience bottoms outnumber Tops by around 2 or 3 to 1. Most Tops can afford to pick and choose. In a market where bottoms compete for Tops attention, the Tops get to call the shots. Bottoms who want to get fucked regularly, learn to give the Tops what they want.

Given those dynamics, I think a marked increase in barebacking is likely to result. It might soon become the norm. There will always be some cautious "safe sex" guys, but bottoms who feel that taking it bare will increase their chances of getting fucked, might well decide to abandon condom use ( or at least restrict it ).

[Tom]

Consider this bottoms. Its more risky with versatile tops. If a top only tops, he's a bit less risky. A bit.

[rawTOP]

Consider this bottoms. Its more risky with versatile tops. If a top only tops, he's a bit less risky. A bit.

True, but even the ones who say they're 100% top may be taking loads...

[SethChase]

I say I'm a versatile top... The only loads I've taken in my ass are from my current partner of 10 years. And those are on very rare occasions. Maybe 3 times in 10 years.

I've taken dozens, possibly over 100 loads in my mouth and swallowed most. However, I've remained negative throughout my 17+ years of swallowing cum & topping guys, shooting my loads in their asses, almost always bareback.

So from my personal experience, I do think that bareback tops are at much lower risk. Is it zero risk? Of course not...

[PhoenixGeoff]

From what I understand, the risk to tops is about an order of magnitude lower than the risk to bottoms.

Swallowing cum (assuming healthy gums, etc.) is almost (but not quite) risk free.

For pretty much any sex act (including getting bred), the odds of contracting HIV in any one sex act are heavily stacked against infection. It's just the pigs like me who have sex with multiple partners routinely (plus a few unlucky ones) that are really at risk.

[CristianKnox]

Do you think the clinics / safe sex literature overstate the risk for the bb top? They claim its "high risk" but then reports suggest 0.6% chance of catching HIV from BB topping.

I haven't had as much experience as RawTop or Seth from BarebackPlace but I know I have fucked at least 10 poz guys bb and some of them were newly infected (tested v shortly after I fucked them and were poz) so therefore high VL and yet I remain neg. I think that as I only ever bb top if my cock is in good order (i.e not red or sore, not currently showing signs of infection, no spots/sores etc - which I rarely if ever have) and if the bottom's ass shows no signs of infection eiher, I have kept the risk low.

But having said this, I know a guy who got HIV from fucking a womans vagina. So he claims.

I wonder how many exclusive poz bb tops there are out there. That would be interesting to know

[rawTOP]

Do you think the clinics / safe sex literature overstate the risk for the bb top? They claim its "high risk" but then reports suggest 0.6% chance of catching HIV from BB topping.

But having said this, I know a guy who got HIV from fucking a womans vagina. So he claims.

I think the clinic literature (and even advice from "counselors") totally overstates the risk to the top. That said, the risk isn't zero and if you're unlucky (or just destined to get it) it can happen all sorts of "low risk" ways...

[PhoenixGeoff]

I think the clinic literature (and even advice from "counselors") totally overstates the risk to the top. That said, the risk isn't zero and if you're unlucky (or just destined to get it) it can happen all sorts of "low risk" ways...

I would point out that the odds increase the more times you repeat your exposure (since you only need to get "unlucky" once).

Let's suppose that the chance of getting HIV from fucking a poz bottom bareback are 0.6% for each time you do it. If you crunch through the math, you basically get a 50-50 chance of getting HIV from topping alone if you fuck a poz guy bare about 115 times, and a 90% chance of converting if you raw fuck a poz guy about 382 times.

Keep in mind, this is assuming that each and every one of the guys you fuck has HIV. Obviously, fucking guys who don't have HIV doesn't expose you to any risk, so if you're fucking both poz and neg guys indiscriminately, the probabilities drop based on the proportion of guys in your population who have been infected.

That will vary based on infection rates in your city and the kind of men you tend to have sex with, so it's kind of hard to estimate. But if you assume that one man in ten that you have sex with has HIV, then you need to top about 1,155 times to have a 50% chance of converting.

[rawTOP]

Let's suppose that the chance of getting HIV from fucking a poz bottom bareback are 0.6% for each time you do it. If you crunch through the math, you basically get a 50-50 chance of getting HIV from topping alone if you fuck a poz guy bare about 115 times, and a 90% chance of converting if you raw fuck a poz guy about 382 times.

That will vary based on infection rates in your city and the kind of men you tend to have sex with, so it's kind of hard to estimate. But if you assume that one man in ten that you have sex with has HIV, then you need to top about 1,155 times to have a 50% chance of converting.

It's important to note that your risk does not increase per incident. It's always the same, but the cumulative risk increases.

The other thing to look at in these studies is when the data are from. If I remember correctly this particular study used pre-ARV data, so now that most poz guys are undetectable the risks are much less.

[PhoenixGeoff]

It's important to note that your risk does not increase per incident. It's always the same, but the cumulative risk increases.

The other thing to look at in these studies is when the data are from. If I remember correctly this particular study used pre-ARV data, so now that most poz guys are undetectable the risks are much less.

I don't have access to the article itself, but Wikipedia cites a March 2010 study (Jin F et al. (March 2010). "Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART". AIDS 24 (6): 907–913.) that lists significantly higher risks of transmission than the Varghese study.

[rawTOP]

I don't have access to the article itself, but Wikipedia cites a March 2010 study (Jin F et al. (March 2010). "Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART". AIDS 24 (6): 907–913.) that lists significantly higher risks of transmission than the Varghese study.

I can't find the Sydney article in Medline, which is odd. The Varghese study was a study of studies, so it aggregated and averaged results found in many studies on the subject of per-incident risk. The Varghese study was also based on an enormous amount of testing that was done in the US. I don't think the Syndey study can have the same statistical certainty that the Varghese study can have. In addition the Varghese study was mostly drawing from pre-ARV research studies, so it should be a worst case scenario and things should be better now.

[PhoenixGeoff]

I can't find the Sydney article in Medline, which is odd. The Varghese study was a study of studies, so it aggregated and averaged results found in many studies on the subject of per-incident risk. The Varghese study was also based on an enormous amount of testing that was done in the US. I don't think the Syndey study can have the same statistical certainty that the Varghese study can have. In addition the Varghese study was mostly drawing from pre-ARV research studies, so it should be a worst case scenario and things should be better now.

It's interesting that the Sydney study came up with higher transmission rates then, particularly since it specifies that it's drawing on HIV+ guys on HAART. It's possible that the methodology has improved in the 15 years between the 1992 data that Varghese looked at and the Sydney study. It's also conceivable that something about HAART may make transmission more likely, not less (off the top of my head, I know that many of the protease inhibitors can wreak havoc on your digestive system...that may make transmission from poz bottom to neg top more likely).

Do we know for sure that undetectable viral load makes transmission less likely? Remember, viral load in the blood stream does not necessarily apply to other systems in the body. In fact we know that HIV sticks around in certain parts of the body even if the viral load in the blood drops to undetectable; that's why HAART is just a treatment, not a cure. It's possible that one of the places that HIV "hides" while you're being treated is in the reproductive system.

[rawTOP]

It's interesting that the Sydney study came up with higher transmission rates then, particularly since it specifies that it's drawing on HIV+ guys on HAART. It's possible that the methodology has improved in the 15 years between the 1992 data that Varghese looked at and the Sydney study. It's also conceivable that something about HAART may make transmission more likely, not less (off the top of my head, I know that many of the protease inhibitors can wreak havoc on your digestive system...that may make transmission from poz bottom to neg top more likely).

Do we know for sure that undetectable viral load makes transmission less likely? Remember, viral load in the blood stream does not necessarily apply to other systems in the body. In fact we know that HIV sticks around in certain parts of the body even if the viral load in the blood drops to undetectable; that's why HAART is just a treatment, not a cure. It's possible that one of the places that HIV "hides" while you're being treated is in the reproductive system.

There can be a lot of reasons. Since we can't get at the study it's hard to say what they might be, but the smaller the sample size the more likely there will be outliers - and one study in one city is likely to have a small sample size.

However, we can say conclusively that HAART is not the reason - there are a ton of studies showing lower viral levels throughout the body when the person is on ARVs - not zero, but still drastically lower than someone who isn't on meds.

And yes, we know lower viral loads = lower transmission. The Swiss Statement is something you should familiarize yourself with if you're wondering about that.

[hungry_hole]

I've been very lucky because after getting my hole creamed at least 1,500 times (avg. 12 per month for 10 years) and drinking thousands of creamy loads in gloryholes and darkrooms, I'm still HIV-neg. A top that had been breeding me for 10 years pozzed and according to him he infected by fucking cumfilled holes. I take all loads without asking, unles they tell me they are poz.

I'm sure that many "tops" do occasionally bottom bareback but don't really talk about much or pretend it hasn't happened.