What is Viral Load?
"Viral load" is the amount of HIV present in a milliliter of blood.  Viral load is stated as a number that can range from "undetectable" (in Ontario this is below 40 copies per milliliter) to over one million copies per milliliter.  Viral load is usually measured in blood (by your doctor) but the virus is also present in other tissues and bodily fluids like semen and rectal secretions.

In the first few weeks to months after HIV enters the body, the viral load is often extremely high – this is called "acute HIV infection". A high viral load increases the chance of transmitting HIV to a sexual partner.  Almost half of the new diagnoses in Ontario are due to acute HIV infection.  This means guys may be fucking without condoms thinking they are HIV-negative.

Poz (HIV-positive) guys usually get a viral load (blood) test to measure the amount of HIV in their system. In addition to viral loads, "CD4" or "T-cells" are a subset of white blood cells that play an important role in the body's immune system and are also monitored during routine checkups to determine whether or not it is best to begin HIV treatment. When on treatment, an undetectable viral load means we are better able to maintain a strong immune system.

HIV treatment is the best way for us to attain an undetectable viral load.  For some of us it can take longer to achieve than others.  An "undetectable" viral load means that the amount of HIV in the blood has been reduced to such a low level that the particular test used to measure viral load cannot find the HIV, but it does not mean HIV is gone.

Sexually transmitted infections (STIs) can also negatively impact our viral loads so it is very important to continue to get tested and treated for STIs before using undetectable viral loads as a single risk reduction strategy. 

The Good News

We now know that (in general) an undetectable viral load lowers the risk of HIV transmission to sexual partners. 
This is exciting news!  For poz guys, it is proof that if we take our HIV treatment as prescribed by our doctors it can decrease the chance of passing HIV on to our sexual partners.  Fear and anxiety about HIV transmission can be further reduced if we get tested and treated for STIs and use condoms properly. 
Consider these points when talking strategy with your sex partner(s): by using a condom we prevent an exposure to HIV.  An undetectable viral load lowers the risk of transmission, but does not prevent exposure – these are two separate but complimentary points of consideration.
In essence, an undetectable viral load is good for the health of poz guys, and, condoms remain the most effective tool for HIV prevention.  The most effective risk reduction strategy is combining condoms with our undetectable viral loads. 

Going a little Deeper.
Today, experts throughout the world still recommend we use condoms when we fuck our casual and anonymous sex partners.

Here's why:

• Most research only deals with heterosexual couples having vaginal sex - not gay, bi or trans guys, and, not people who enjoy casual and anonymous sex.  These two things can make a big difference.
• It is up to 20 times easier to get HIV through the ass than the vagina or front hole – simply because of the way the ass is made.  It means there may still be a higher risk of HIV when we have anal sex, even if a partner's viral load is 'undetectable'.
• CATIE: Putting a number on it: The risk from an exposure to HIV
• We lack any evidence about the effects and risks of hormones/HRT on trans guys having sex with front hole.
• We know that the amount of HIV in our blood is not necessarily the same as it is in our semen or our ass - some studies suggest that difference may be more common than we realize.
• STIs (herpes, syphilis, or warts) make it easier to pass on or get HIV, even if our viral load is 'undetectable'.  It is not unusual for a guy to have an STI and not know it.
• Approximately 26% of guys in Ontario who have HIV do not know it.  We may think we don't have HIV and pass it along without realizing.
• Even though there has been successful HIV treatment available since 1996, the number of HIV infections for gay men in Ontario has not declined.

Good sexual health does not start and stop with HIV.  There are good reasons why all of us should use condoms when we fuck casual or anonymous sex partners.  In Ontario there has been:

• An increase in the transmission of HIV that is resistant to some HIV treatments.  This may make it more difficult to treat HIV.
• An increase in gonorrhea that is harder to treat.
• A big increase in syphilis.  Syphilis can harm your health, especially if you have HIV.

Take Care of Yourself and Each Other.

• If you think you have a hard time negotiating condoms with your sex partner(s) – relax, it's normal - chat about this with your friends, professional supports or others in the community.  Many of us can find it hard to use condoms or ask for what we want before/during/after sex.
• HIV isn't the only thing to impact on our health; so does HIV-related stigma. Poz and neg (HIV-negative) guys can and do have hot, safe sex together.  Building spaces to have a conversation about our HIV status' (negative and/or positive) is key to good, risk reducing sex strategies.
• When testing regularly for STIs - ask for a throat swab if you suck cock and a rectal/digital exam if you get fucked. 
• If you are HIV-negative and have condomless sex - get a regular HIV test.  You should test three weeks after each time you fuck without a condom – especially if your partner is poz or you aren't sure of your partner's HIV status. It could be possible that you recently got HIV and may be in the "window period".  If you are newly infected, you will likely have a very high viral load and can easily transmit HIV. Speak to an HIV test counsellor about when you should get another HIV test.
• For more info on HIV testing and where to get tested visit: www.come-on-in.ca
• Put the condom on before you fuck and keep it on until you stop fucking.  Some guys 'dip' or 'withdraw' as a way to prevent HIV - this is not as effective because an exposure to HIV can still occur (HIV is present in pre-cum and in rectal secretions).
• If you like rough sex, are concerned about the condom breaking, or, are allergic to latex - try non-latex condoms.  They are stronger and allow for oil-based lubes.
• Take good care of your mental health.  If you feel depressed or anxious or are concerned about your use of drugs or alcohol, seek out support from a friend or a professional.  Check out www.thesexyouwant.ca for more tips on addressing mental and emotional wellbeing before, during and after sex.

Having a Hard Time using Condoms?

For some guys it's not easy using condoms.  But, talking about this with our sex partners may make it better. 
There is a lot you can do to make safer play easier:

• Try using your imagination and fantasy during sex play.  You can talk dirty and fantasize about condomless sex while continuing to use protection.
• Find a condom with that perfect fit/feel.  There are ultra-thin products that give you the sensation of going bare.

If you lose your erection when using a condom, remember that it happens – and has to most of us!  There are many reasons why this can happen, but we shouldn't be made to feel bad about ourselves when losing that hard-on...

• Try foreplay, dirty talk and porn.
• Take your time and don't hurry.
• Try different positions to see what gets you off and avoids discomfort.
• Use a cock ring. Choose ones that doesn't fit too tight when you are hard, and are easy to remove. They will enhance your orgasm, as well as your erection.
• Try sex in the morning, or at another time when you might be more relaxed - or horny.
• Too much alcohol or drugs before sex can make it difficult to get hard and stay hard.
• Look into the side effects of medications you're taking, but don't stop taking medications without consulting your health care provider.
• If you find poppers impact your erection during safer sex – try using poppers when you masturbate.
• Speak to your doctor if you're having problems keeping a hard-on – there are drugs to help.
• Try insertive ('female') condoms if you are getting fucked.  Some guys mention this eliminates the interruption because the top doesn't have to stop and put something on his dick before he sticks it in.

To reduce HIV risk, we should only consider condomless sex with a regular sex partner with the same HIV status as our own.  In this case:

• Both get tested for HIV before you stop using condoms.
• Be honest if you are having sex with another guy other than your regular partner and something happens -- like you don't use a condom or it breaks.  Use protection with your regular partner until you test for HIV and/or complete STI testing/treatment.

Check out: "Condoms Unwrapped" at www.actoronto.org/home.nsf/pages/safersex

To understand more about HIV non-disclosure and the law contact:
HIV/AIDS Legal Clinic of Ontario via end_of_the_skype_highlightingwww.halco.org or call 1-888-705-8889

Canadian HIV/AIDS Legal Network via www.aidslaw.ca
For more tips click here

Do you Fuck without Condoms during Casual Sex?
Some guys fuck casual and anonymous sex partners without condoms.  If that's you, take action to reduce HIV risk for you and the guys you love to play with.

While these strategies do not protect you from STIs they may offer you more protection from HIV transmission than if you did nothing at all.  If you combine some of these suggestions you may reduce your risk further (e.g. a poz guy is "undetectable" and chooses to bottom).

• Fuck guys who have the same HIV status you do (called "sero-sorting").  Make sure both of you talk about HIV status (poz or neg) before you fuck.  Don't assume you know the other guy's HIV status – considerer the "window period" as a neg guy.
• Avoid poppers if you get fucked without a condom.  Poppers can increase the risk of HIV infection for the guy getting fucked – because it can make inner lining of the ass more vulnerable to infection/absorption.  Some guys also report a loss of erection when using poppers, which may deter condom use.
• Get tested and treated for STIs on a regular basis. 


• For HIV-negative guys:
  • Get tested for HIV each time you fuck without a condom – after three weeks.
  • If you have signs of HIV infection (fever, sore throat, headache, muscle pain, rash) get tested for HIV right away.
  • Choose to top when you fuck.
• For HIV-positive guys:
  • Choose to bottom.
  • Find another poz sex partner to fuck.
  • Fuck without a condom only when you have an undetectable viral load.  Take your HIV treatment as prescribed by a doctor.  Combine this strategy with other strategies. 
  • If you pick up an STI along the way go back to condoms until your STI has been treated. 

Check out info on: "barebacking" at http://www.actoronto.org/bareback for a good discussion on condomless sex visit: www.aidsmap.com.
To understand more about HIV non-disclosure and the law contact:
HIV/AIDS Legal Clinic of Ontario via end_of_the_skype_highlightingwww.halco.org or call 1-888-705-8889
Canadian HIV/AIDS Legal Network via www.aidslaw.ca

The Bottom Line:

• HIV treatment works to reduce the effects of HIV and reduce the chance of HIV transmission from poz to neg guys.
• Condomless sex happens for a variety of reasons – but that's not the end of the conversation.  What does this mean for you and how will you minimize HIV risk for you and your sex partners?
• There is not enough research to tell us (gay, bi, trans men) that HIV treatments will be as effective as a condom when we have anal sex with casual and anonymous sex partners.  
• The evidence that exists has mostly looked at straight couples having vaginal sex.  It is easier to get HIV through the ass than the vagina.  But, we don't have research to tell us whether this is true for trans guys if they fuck with their front hole.
• There is a higher risk of STIs when we have casual or anonymous sex.  STIs increase the risk of HIV transmission.
• There has been an increase in syphilis.  There has also been a rise of gonorrhea that is resistant to treatment.  We've also been seeing an increase in the transmission of HIV that is resistant to some HIV treatments.  These infections can produce harmful impacts on poz guys – this is why testing is key!
• The number of gay or bi guys who get HIV every year in Ontario has not gone down in over 15 years.
• Condoms are nearly 100% effective if we use them properly.  This is because they can prevent us from coming into contact with HIV and STIs.  Condoms can fail when they aren't used properly.
• If we use both condoms and HIV treatments we can imagine a world where it is very rare for gay, bi and trans guys to get or pass on HIV.
• Think about how you can protect yourself and the guys you play with while still getting the kind of sex you want.
• Plan ahead; what's your risk reduction strategy and how will you bring it up?
• Take care of yourself and each other, regardless of your HIV status.
• Have fun, be creative, and enjoy great, hot sex with other guys – we deserve it!

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