HIV Risk: Top vs Bottom


According to the US Centers for Disease Control and Prevention, receptive (bottom) partners are 13 times more likely to become infected with HIV than insertive (top) partners during anal sex. Here’s why!

The Bottom

The anatomy of the anus makes transmission riskier for the bottom partner. The bottom is at risk of HIV in the semen and pre-seminal fluids of an infected top partner.

The lining of the anus is thin and does not lubricate like the vagina does, which can give the virus direct access to the bloodstream. As a result, it can tear, making it easier for viruses and bacteria to enter.

However, such tissue damage is not necessary for infection to occur: the rectal tissue itself is rich in cells that are directly susceptible to infection.

The Top

Being the top is safer than being the bottom during condomless anal sex, but viruses and bacteria can still enter the top partner’s body through cuts and sores on the penis. Sometimes, these cuts are so small, you don’t even know they are there.

There are high levels of HIV in rectal secretions, as well as blood from the rectal tissues. This creates a risk of transmission to the insertive partner through the tissue in the urethra and on the head of the penis, particularly underneath the foreskin.

Though being the top partner carries lower than the bottom, condomless anal sex remains a high-risk activity for both partners. The risk for the insertive partner in anal sex is comparable to the risk for the male partner in vaginal sex.

Whether you are a top or bottom, If you do choose to have condomless anal sex, there are very effective ways that have been scientifically proven to keep you and your partner safe. If you are:

  • HIV Negative
    Pre-exposure prophylaxis (or PrEP) is pill taken daily to prevent getting HIV. PrEP is highly effective for preventing HIV when taken as prescribed and it reduces the risk of getting HIV from sex by about 99%.
  • HIV Positive
    If you are positive, it is crucial to go onto ARVs and stay on them. Taking ARVs as you should suppresses HIV levels in your body. It doesn’t cure HIV, but it can lower HIV to such low levels that you can become undetectable. At this point the risk of passing HIV onto a partner is 0%. Also see U=U.

Article courtesy of Engage Men’s Health.

Get the Mamba Newsletter

Leave a Reply

Your email address will not be published. Required fields are marked *

Send this to a friend