HEALTH CENTRE: Tops and the Threat Of Sex-Related Infections

HEALTH CENTRE: Tops and the Threat Of Sex-Related Infections

Question: “I am a guy who plays top. During sex, I use protection, but not often. Honestly, more often than not, I do not use protection. Life gets in the way sometimes. I know of the prevalence of STIs but I want to understand how someone who tops could be vulnerable to these. I understand that a Top could get infected, but while a Bottom’s case is clear because of the lesions and tears he is susceptible to, what about a Top? Do they also have to have tears on the dick for a contraction to happen?”

Answer: “Some of us have heard the whole ‘Tops can’t catch HIV’ opinions even in 2018, and it baffles me how one can make that statement and cling on to it like it’s some gospel. It’s a line of thought that should be shattered with just common sense. If Tops aren’t affected by HIV or STIs, who is then infecting the women and Bottoms? Why do straight men have HIV?”

The truth of the matter remains that just like women, Bottoms are a lot more vulnerable to HIV due to the design of the vagina/anus. The risk of a HIV-negative Bottom getting infected with HIV by having bareback (no condom) sex with a HIV-positive Top is higher than the risk of a HIV-negative Top getting infected by a HIV-positive Bottom during bareback sex. This risk increases further if the HIV-positive Top discharges his semen in the anus of the HIV-negative Bottom, or of the Top isn’t on antiretroviral drugs and has a high viral load count.

The “intense” friction that comes with masturbation and penetration can create micro tears on the penis through which a Top can get infected. These micro tears might be more in uncircumcised males, which is part of the reason why circumcision is said to help reduce the risk of HIV transmission.

The pain and peppery sensation some Tops complain of after anal sex come from these micro tears. If one doubts the existence of such tears, he should try touching his penis after the sex, with hands that have been used to wash pepper. O.Y.O would be your case.

Aside from the micro tears on the penis, you also have the urethra through which semen and urine exits the body. Infections can easily occur there. Sometime ago, a friend mentioned that he doesn’t entertain the thought of barebacking when he tops because the urinary tract infection that follows right afterwards is hell.

In conclusion if you’re going to have sex with random folks, ALWAYS use a condom. And in relationships, maintain the condom unless you trust your partner that well and both of you have sense enough to understand the health-related consequences of away games.

 PS: Allow me to use this opportunity to touch on another issue which I have been seeing a lot in HIV patients. There is this belief that as long as one is taking his/her HIV medication regularly and so far as he/she has an undetectable viral load, he/she can engage in bareback sex anytime, anywhere, anyhow – like anything goes fa.

Please STOP this if you are not on a slow suicide mission.

That you have HIV and it’s under control doesn’t mean you can’t be reinfected. God forbid you get reinfected with a strain of HIV that cannot be managed with the few drugs we have in Nigeria, then a slow painful death most probably awaits you.

I’ve lost a patient to this, and her husband is unfortunately next in line as none of the medications on ground worked for her or is working for him. The Nigerian Government has decided to officially start a third line of HIV treatment but the drugs are nowhere to be found yet, despite the promise of an October 2018 rollout. Every time I see that man, my heart breaks for him, as he keeps deteriorating as the days go by.

If your HIV drugs are working for you at the moment i.e. your CD4 is going up, your viral load is undetectable and you are doing fine in general, DO NOT relax oh! Make staying healthy like this your permanent goal. It’s one thing to have HOT AMAZING bareback sex for some minutes/hours and another thing to be constantly in and out of the hospital without relief. Choose wisely.

Here’s to wishing everyone a happy prosperous 2019. May the Good Lord/Thanos/Amadioha/Sango etc. be with us all.

Written by Francis

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  1. Sim
    January 08, 07:22 Reply

    Dr. Francis I agree with everything you said. It is unfortunate that Nigeria is still battling with sourcing ARVs for her population.
    To piggyback Dr. Francis, we should also note there is something called transmitted resistance. It means HIV naive patients resistant to 1st line ARVs, therefore folks stay woke with safer sex.

    • Francis
      January 08, 09:53 Reply

      Thanks for the contribution. ? ? That’s very true as we’ve had patients who adhere very well to their meds but unfortunately six months after commencing therapy , their viral load is still high. Who knows maybe someday we will start doing drug resistance testing like abroad people before initiating therapy.

  2. Peace
    January 08, 11:19 Reply

    Thanos kwa?? Issorite! Thanks Dr Francis. I sure have learnt a lot from reading this

    • Francis
      January 08, 14:20 Reply

      Yes oh. All man with him almighty creator ???. You’re welcome

      • Higwe
        January 09, 00:56 Reply

        Any improvement amongst the gay community?
        Has the rate of infections decreased ?

        • Cocent
          January 09, 04:20 Reply

          It’s difficult to say. Our official 2016 National Guidelines says prevalence is very high (35%). While another 2017 study says it’s 23% and this same study says the prevalence continues to rise. Regardless, the prevalence remains high. Good news though is that HIV preventive measures is rising amongst MSM e.g condom use (82%). Nevertheless, health seeking behaviour remains poor in Nigeria and is even worse amongst homosexuals.

            • Cocent
              January 09, 20:44 Reply

              Please doc, May I have your email address. Let’s anastomose on (MSM) health related issues…

  3. Higwe
    January 09, 00:54 Reply

    Posts about HIV always almost get the least amount of comments on this blog.

    I don’t even think people are taking this seriously yet.

    • Delle
      January 09, 08:55 Reply

      Educative posts like this usually do not require any input especially when you have no complaints or questions. The most natural comment to make on such a post is one of appreciation (and that’s not all that necessary). Most just read, digest the info and move on.

      Controversial updates garner the most response (it’s only natural). This type of post is far from controversial.

    January 10, 08:11 Reply

    Lovely post. Thanks alot for this. I’d also like to expantiate on something that is already stated on the write up that some of us may not understand because I got a message from a reader who had questions and fears concerning his status and if he is at risk of ARV resistance.
    Resistant strains can result from the re-infection that happens to HIV positive people who have bareback sex with other positive people. So the thought of “I am already infected anyway, I’d probably not get infected again.” Chances are, you could and thus create some kind of “hybrid forms” of the virus which can be resistant to the regular ARVs we have around.
    Re-infection worsens the disease and could predispose one to ARV resistance.
    And it’s the transmission of this resistant form to a negative (HIV naive) person that would cause the person to show resistance to ARVs ab initio.
    Safe sex is still the best. Let us endeavour to use condoms as a norm, positive or negative and also, get tested and know your status.
    And in the event that one is positive, early detection is very important because with that and the absence of transferred resistance, HIV positive people who are compliant with their ARVs can live long and apparently normal lives and even outlive HIV negative individuals.
    Stay safe.

    • Francis
      January 10, 16:12 Reply

      Thanks for breaking it down.?? I didn’t think it necessary to go deeper into the resistance thing while writing it.

  5. Omari
    July 02, 07:34 Reply

    Please Can I have some legit HIV testing and treatment centers in Lagos.
    Thank you.

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