HIV has been a concern for the health of the queer community since the early 1980's…and of particular importance to gay and bisexual men.  Many beliefs about HIV are widely shared within our community…but as science learns more about the virus sometimes these beliefs must change.  For example, traditional wisdom in our community has held that men who are “tops” (the insertive partner during anal sex) are at very low risk.  Research data from the past several years is telling us, however, that their risk might not be as low as they (or WE) have always thought.

The belief that tops can’t get HIV has always stemmed from the knowledge that the anus and rectum don’t really secrete any natural fluid that his high in HIV content AND that any fluid that is present has no way to really get into the tops bloodstream and infect him. Both of these facts might not actually be true, however. 

First, there actually is a fluid produced within the rectum commonly referred to as rectal secretions. The gastrointestinal (GI) tract, from mouth to anus, essentially has its own immune system lying just outside its membranes and consisting of a network of lymphatic (immune) cells that release cells into the GI tract.  Additionally at the lower end of the colon and in the rectum these cells are released with a mucus-like lymph fluid designed to not only protect the body but to also lubricate the rectum to pass waste during bowel movements.  The lymphatic cells that are released into the GI tract, and in the mucus that makes up rectal secretions, are often CD4 cells---the exact cells that are targeted by HIV and that can carry HIV in an infected person…meaning that these secretions can indeed carry HIV.

Additionally, it actually is possible for these fluids to get into a top’s bloodstream.  A process called “reuptake” occurs when a man ejaculates.  The contractions along the urethra that force semen out of the penis actually cause a small suction effect that allows the penis, right after ejaculation, to pull some fluid back into the urethra where it could infect the bloodstream.  Additionally you may recall from one of my previous articles that men who are uncircumcised, or uncut, have a different kind of skin cell on the outside of their penis that is also susceptible to HIV and the foreskin can trap fluid increasing risk. 

The implications of this information are very important for men who top---especially when considering  scientific data that has been released in the past several years.  A study published in The Journal of Infectious Diseases reported that rectal secretions have high concentrations of HIV.  In fact, the study found that in some cases the amount of virus in these secretions were 5 times higher than in the patients’ blood and 25 times higher than in their semen!  Additionally the same study found that in HIV+ men who are taking medications to treat their HIV that virus levels in their rectal secretions (and sometimes semen) can remain high even when those levels are low or undetectable in their blood.

For tops, bottoms and versatile alike---knowing about your body and the health risks that exist helps to keep you queer, proud & healthy!!!