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Top or bottom?

Dr. David: This is a question that is common with a lot of gay men. Are there different levels of risk for top and bottom. And the answer is yes. I’m a doctor.
Dr. Demetre: I’m Dr. Demetre.
Dr. David: And I’m Dr. David.
Dr. Demetre: We’re HIV doctors.
Dr. David: And we’re here to answer your questions on HIV and sexual health. If you are a sexually active gay man or a man who has sex with other men, just by the fact that HIV is more prevalent in the gay community as compared to heterosexual communities, you’re more likely to come in contact with it. So what’s important to think about with HIV is that HIV has to get into the blood stream to actually set-up infection. So when you think about it anatomically, with someone who is a top, the skin of the penis is going to be a little bit tougher, you’re not going to be able to get into the blood stream as quickly. When you look at the rectum and the inside of the rectal tissue called the rectum mucosa, it actually is a little bit more easily breakable. And so sometimes when you’re having anal sex and you’re the bottom in a relationship that can cause mild tears in the rectum tat maybe you won’t even see and you may not even bleed. And in those kind of cases it’s a more efficient risk of HIV. So yes, to answer your question, there is a different level of risk between tops and bottoms.

Not all sexual positions are protected equally. Dr. David breaks down the different risk levels, whether you’re on top vs. bottom.


#AskTheHIVDoc is a video series from Greater Than HIV featuring top HIV doctors providing answers to commonly-asked questions about HIV prevention, testing and treatment.

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