Safer Barebacking / Considerations by Michael Scarce

This is not a set of HIV prevention guidelines. Intended only for gay men who have already decided not to use condoms for anal sex, these strategies may help reduce the harm associated with barebacking, some advocates believe. Here, harm should be interpreted more broadly than HIV infection; these tips may also help reduce the risk of other STDs. Bear in mind that much of this information is anecdotal and debated by researchers. 0. POPPERS AND VIAGRA Dilated blood vessels in the rectum caused by sniffing poppers make it easier for viruses to enter your bloodstream, so if your partner ejaculates inside you, you're wide open for infection. Viagra works similarly -- increasing blood flow to the pelvic region (facilitates erection) and to the rectum -- and poses similar risks. 1. LUBRICANT Use it generously to help prevent tears that allow infection. Don't rely on saliva. Nonoxynol-9 may afford limited protection against some STDs; however, by irritating them, it may increase the urethral or rectal tissues' susceptibility. One study of N-9 use in gay men's rectums found it didn't create irritation that would significantly increase risk of infection, but the medical literature yields conflicting data. An over-the-counter contraceptive gel, like Advantage 24, is unlikely to fully coat the rectum and provide complete protection. 2. EARLY WITHDRAWAL Pulling out before ejaculation may reduce risk. But since HIV and other infectious agents are in pre-come, this method still poses a risk. 3. RATIONING Limiting your barebacking over time can reduce exposures and sex partners -- which may decrease the risk of harm -- and allows time for healing of tears or trauma in the rectum, urethra and outer skin of the penis. 4. NEGOTIATION Try to talk with partners about STD status, including HIV, herpes, hepatitis and human papilloma virus (causes anal and genital warts). If talk isn't part of your sex, you may be able to see or feel warts, lesions, discharge or other physical signs of STDs. But one may be asymptomatic yet still infectious. Decide ahead of time if you're willing to come in your partner or allow him to come in you, then assess your ability to trust your mutual adherence to that agreement. 5. BEFORE- AND AFTER-CARE Douching or using enemas with harsh detergents can strip away protective cells in the rectum. If you use an enema before sex, try warm water. Be careful not to create tears inside or around the anus. Some believe lubes, especially oil- and silicon-based, can trap germs against the skin, increasing likelihood of infection. Douching with a spermicidal foam or homemade vinegar-and-water solution after sex may render some infectious agents inactive, but little research has been conducted. If having sex with multiple partners over a short time, don't douche until after the last one. Try to urinate right after sex: Urine's acidity can help clean out the urethra. 6. IMMUNITY The more stressed, under the influence of alcohol or drugs, tired or ill you are, the higher the chance that an exposure will result in infection. If you have HIV and another STD, you're more likely to transmit HIV. If you're HIV negative with an STD, you're more likely to become infected. 7. VACCINATIONS Get vaccinated for hepatitis A and B. Barebacking exposes you to fecal matter and other hepatitis-carrying fluids.