Anal sex or sex on the bum is not just between men, but also women and men and women and women (with the help of ‘devices’). Years ago I read an article from Brazil where young girls—school girls—to maintain their chastity, virginity, would have anal sex.
Having anal sex without a condom is one of the highest-risk activities in terms of transmission of HIV (and other sexually transmitted infections). Researchers have reported that HIV transmission risk during anal sex could be 18 times higher than during vaginal sex.
Being the receptive partner—the “bottom”—during unprotected anal intercourse puts you at a much high risk of HIV infection but it’s possible for either partner to get HIV. The reason for this is that HIV-infected semen can come into contact with mucosal tissues in the anus that can be damaged easily during anal intercourse. And the risk of HIV transmission isn’t necessarily reduced if the “top” pulls out before ejaculation—studies have demonstrated that pre-ejaculate (pre-cum) can contain high amounts of HIV and can result in transmission during anal intercourse.
The insertive (“top”) partner is at lower risk but it is possible for HIV to enter through a cut or abrasion on the penis or through the lining of the urethra inside the tip of the penis.
The chances of a man passing on HIV during anal sex is greatest when he is the active, or insertive, partner during sex. The risk is particularly high if he has a high viral load, or if he has an untreated sexually transmitted infection (as these can cause inflammation or damage to tissue in the genital area), if he ejaculates insides his partner, or if he has sex that causes tissue damage.
Using poppers (a recreational drug) during sex significantly increases the chance of the receptive partner acquiring HIV (these seem to increase blood flow to tissue in the rectum).
Similarly, if an HIV-negative person has an untreated sexually transmitted infection, their chances of contracting HIV during sex without a condom are increased.
If you are the receptive, or passive, partner during sex, man or woman, the risk that you will pass on HIV is reduced, but there is still a risk – especially if you have a high viral load or an untreated sexually transmitted infection.
Being on HIV treatment with an undetectable viral load or correctly using condoms each time you have sex can prevent HIV transmission. n