10 Ways To Have Safer Sex Even if You Don't Use Condoms

OK, guys, the truth is out.  We’re not using condoms.  A recent report indicates that gay and bisexual men have been having more and more condomless sex since 2008. By 2014, over 40 percent of both HIV-negative and HIV-positive gay and bi men reported having sex without condoms. Clearly, it’s time to admit that the condom-only focus isn’t working.

Sure condoms are still an excellent way to practice safer sex. When worn correctly, a condom is extremely effective in preventing the transmission of HIV. For gay men, the consistent use of condoms is 76 percent effective in preventing new HIV infections during anal sex. But that cavet says it all, “consistent use” is essential for condoms to prevent HIV (unless combined with other prevention methods like PrEP). 

How long are we going to deny that we’re having sex without condoms? How long are we going to pretend that the only guys who go bareback are sluts, party boys, or young men who don’t care about their sexual health?

Researchers found that the condom decline wasn’t reflective of increases in other, non-condom-based prevention strategies like PrEP or serosorting. For the most part, we aren’t replacing condoms with other HIV-preventative alternatives.

So let's look at the options that are available for condomless safer sex.

What does being healthy have to do with safer sex? A lot. We're not talking about whether you or your partner have HIV, we're talking about your overall physical and mental health. Numerous studies have shown that those dealing with mental health issues like anxiety or depression have greater risk of becoming HIV-positive. Using substances — from alcohol to injection drugs — or having an active sexually transmitted infection can also raise your risks. If you want to have safer sex without a condom, it starts with you and your partner being healthy. 

Getting tested and knowing your status is another element that's critical to having safer sex without a condom.  Face it, without knowing your status you don't know how to protect yourself or your partner. You can't start HIV treatment without knowing your status, you can't get on PrEP without an HIV test, and even avoiding sexual partners of another status requires you know your own. The Centers for Disease Control and Prevention recommends that people at high risk for HIV infection (including gay and bi men and transgender women) be screened for HIV at least annually. But the virus can be present for up to three months before it's detectable in a blood test; so to really be certain of your HIV status, you need to test more frequently. 

Getting a prescription for pre-exposure prophylaxis, or PrEP, isn't as easy as buying condoms. But if you weren't going to use one anyway, the one-a-day HIV prevention pill is a great way to play safe, regardless of what your partner's status is. PrEP requires you (or your partner if you're a magnetic couple) to take responsibility for your sexual health, a step with its own advantages. Plus, taken correctly, PrEP has been proven more effective than committed condom use. In studies of couples where one is HIV-positive and one is not, PrEP has reduced the risk of HIV transmission by 99 percent, when taken daily by the HIV-negative partner. Even if someone misses a dose, PrEP’s efficacy remains high. The key difference between PrEP and condoms is timing: PrEP is taken daily, with your morning breakfast or right before bedtime. Although it directly impacts sexual health, taking PrEP is separate from the sexual experience (unlike condoms) because you aren’t fumbling for a pill at the height of passion. 

Treatment as prevention, or TasP, is the BEST safer sex method for people living with HIV. It takes advantage of the fact that reducing your viral load decreases a poz person’s chances of transmitting HIV. When the virus has been controlled and is no longer detectable in a blood test, you have so little chance of transmitting HIV that, researchers are now saying "undetecable equals uninfectious" (in a study there were zero transmissions from over 58,000 individual times that people had sex without a condom while one was undetectable). There are numerous reasons for you to get on treatment early and stay compliant with your medication; like that little benefit of keeping you alive and healthy.  Being healthy enough for sex is a great side effect, but adherence to your antiretroviral meds also has an HIV-prevention bonus for your dating life: you know you won't transmit the virus to anyone else. To date, there has never been a confirmed case of someone with an undetectable viral load transmitting HIV.

Some sex acts are safer than others. According to the CDC, anal sex is the highest-risk sexual activity for HIV transmission. Although even tops can get HIV, being a receptive partner (or bottom) for anal sex is the highest risk sexual activity for HIV transmision. Activities like oral sex or digital stimulation (hand jobs or finger banging) have much lower risks attached. After giving oral sex, always spit or swallow the fluids to lower the risk even more—stomach acid and enzymes in the esophagus will kill the virus, so swallow away. (More on the lowered risk of getting HIV via oral sex here.)

Out of all of the tools in the safer-sex toolbox, communicating honesty is the most effective when it comes to preventing HIV. Whether it is being honest with yourself or with your sexual partners, telling the truth about your HIV status, the date of your last HIV test, or your desire to stay HIV-negative or keep your partner from contracting the virus; honesty can have up to a 100 percent efficacy ratio when used correctly. Honesty is also an essential component to intimacy. So share how you really feel, say no when you want to, and share what turns you on.  It doesn’t matter whether you are a top or a bottom, HIV-positive or HIV-negative, using honesty will allow you to combine other methods of prevention to ensure your safety without taking away from your ability to have a good time in the sack. 

[Editor's note: In the name of honesty, we should add that most of these safer sex options won't prevent other STIs like condoms would.)

We all know people who like to combine sex and drugs.  But there are good reasons do avoid doing so (click here for reasons not to mix meth and sex). For example, the use of drugs during or around sex can increase your risks. Being drunk or high has been shown to encourage people to engage in riskier sexual behaviors than when they are sober. You want to be in your right mind, and not under the influence when making decisions around sex and your sexual health. Plus, there's also evidence that intoxicants can cause erectile dysfunction. If you are going to use, you can still reduce your risks by not sharing the same needle, straw, or spoon. Needles are especially risky as they can introduce HIV and other infectious diseases directly into your bloodstream, dramatically raising the risk of infection.  

You can reduce your risk of getting HIV by limiting the number of people you have sex with. Each person you have sex with brings their sexual history with them. To limit your risk you have to known and be able to trust your partners. All that initimacy requires—well, intimacy. So embrace it: have great sex with a dozen partners you know well instead of OK sex with 50 acquaintances. You can't fit everyone in your bed anyway, so you might as well be picky. 

Serosorting is the act of choosing your sexual partners based on their HIV-status, and many experts say it’s an outdated, antiquated, and ineffective way to prevent HIV. A study presented at the 2012 Conference of Retroviruses and Opportunistic Infections found that restricting sex to partners who think they are HIV-negative isn’t an effective prevention strategy, because many people just assume that they are HIV-negative even if they aren't.  The rates of those currently living with HIV who are unaware of their status is going down, but at least 13 percent of poz people don't know it still. Dating only other people with the same HIV status may be a safer sex option, but it's one that adds quite a limitation on your own sex — and dating — life. 

Post-Exposure Prophylaxis (PEP) is a multidose pill that's given after potential exposure to HIV through sex or occupational means. PEP should absolutely not be used as your first line of defense in preventing HIV — it's the female equivalent of taking Plan B after every sexual encounter instead of just getting on regular birth control — but it is a good secondary option if you or your partner may have been exposed to HIV unexpectedly (for example, if the condom you were using broke, one of you is poz and the other isn't on PrEP, you're an injection drug user, or someone with HIV isn't virally suppressed). You have up to 72 hours after possible exposure to get on PEP (which requires a prescription), but it’s ideal to start the regimen within 24 hours of possible exposure.

The treatment consists of a 28-day course of antiretroviral medication, administered by a doctor or medical facility (most emergency rooms are outfitted with it as well). PEP has a reported efficacy rate of reducing HIV transmission by 83 percent. PEP can come with some unpleasant, but temporary, side effects such as vomiting, nausea, and fatigue. Still, PEP is an excellent option if sex or injection drug use has potentially exposed you to HIV. ​

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