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What’s up with withdrawal? Pulling out all the stops to prevent HIV

Withdrawal — This is not about symptoms associated with stopping drug or alcohol intake. This is about man on man sex. Emen8 investigates if pulling out before cumming is an effective way to avoid acquiring HIV.

It appears that all over Australia, some men who have sex with men pull out before ejaculating during anal sex without a condom. Clinicians and researchers call this ‘withdrawal’ — sexy term, huh? But how do we even know what guys are getting up to? Who’s spilling the beans on the intricacies of our intimacy?

Every year, the Gay Community Periodic Survey investigates sexual practices correlated with transmission of HIV and other STIs. It’s a survey of homosexually active men recruited from a range of community sites around the country. And it doesn’t hold back on its questions.

The survey asks guys about a variety of nitty-gritty topics, including the lowdown on any anal sex they’ve had in the last six months. With tick box options for ‘Never’, ‘Occasionally’ and ‘Often’, guys are asked to provide honest responses to statements like these about their casual sex encounters:

  • I fucked him without a condom but pulled out before I came.
  • He fucked me without a condom but pulled out before he came.
  • I fucked him without a condom and came inside.
  • He fucked me without a condom and came inside.

The results give researchers, medical professionals and community healthcare organisations detailed insights into trends and changes in behaviours over time, which are of vital importance in understanding where to focus collective efforts in Australia’s response to the HIV epidemic.

Which brings us to the juicy topic of pulling out.

Is pulling out before cumming an effective way to prevent HIV transmission?

Simply put: No. Pulling out before cumming is not an effective way to prevent HIV transmission.

This blunt answer has held currency for many years based on our knowledge of how HIV can be transmitted, but is it always true in every situation — especially in a new world where HIV prevention strategies include more options than just using a condom?

“Pulling out before cumming is not an effective way to prevent HIV transmission.”

Although we’re discussing HIV specifically, it’s worth knowing that pulling out isn’t an effective way of preventing STI transmission either. But that’s the same for common practices such as oral sex without a condom. Using condoms for oral and anal sex can reduce the possibility of acquiring or transmitting some STIs, but doesn’t eliminate the risk completely. That’s why going for regular sexual health testing is important to help identify and treat STIs on an ongoing basis.

Before getting deeper into this, let’s look at how it’s possible for HIV to be transmitted.

How is HIV transmitted?

HIV is only infectious in blood, cum (semen), pre-cum, anal mucus, vaginal fluids and breast milk. A person can only acquire HIV if one of these fluids containing the virus gets into their body and passes into their bloodstream.

It’s conceivable that some guys might think HIV can only be transmitted if someone cums inside. While pulling out before squirting might feel like it’s somehow less risky, the fact is it’s not guaranteed to prevent either the top or the bottom from acquiring HIV.

“…although there is increased risk associated with bottoming, it’s still possible to acquire HIV while topping.”

Even though pulling out before shooting a load means someone won’t get cum in their bum, fucking raw can still involve transfer of pre-cum and anal mucus during skin to skin contact. And sometimes it might be tricky to get the timing right to disengage before climaxing.

Friction when fucking can result in tiny cuts or abrasions on someone’s dick, or inside their butt. These can be so tiny they wouldn’t even know by feel or by sight, but these still enable a means for HIV to enter the body. And that’s the case regardless of sexual positioning too — although there is increased risk associated with bottoming, it’s still possible to acquire HIV while topping.

What if someone’s using PrEP or managing an undetectable viral load?

When it comes to fucking without a condom while using biomedical HIV prevention options, the topic of withdrawal becomes a little more involved.

Firstly, there’s the matter of managing an undetectable viral load. This is a big deal because people living with HIV who manage this continuously for at least six months have effectively no risk of sexually transmitting the virus. So whether you’re topping or getting fucked bareback, if he’s undetectable, there’s no real risk of transmitting or acquiring HIV in this situation, whether pulling out in time or otherwise.

Secondly, there’s PrEP. Using PrEP is a highly effective way to protect yourself against HIV. Thanks to the way it helps protect the body from HIV at a cellular level, PrEP offers high levels of protection against HIV for both tops and bottoms.

“PrEP offers high levels of protection against HIV for both tops and bottoms.”

However, neither of these strategies offers any protection against STIs. The most reliable way to avoid STIs is to not have any sex at all. Using a condom every time offers protection too, although some STIs can still be acquired through other means of transmission. For example, herpes simplex virus (HSV) can be acquired through kissing.

Regardless of your chosen strategy, it’s important to support other people’s choices, even if different to yours. When it comes to your preferred HIV or STI prevention strategy, there’s always an opportunity to discuss, negotiate or even use a combination.

Calculating risk

Sexual desire is often uncomplicated, even if understanding sexual safety practices and HIV prevention options might seem more so. But help is at hand — you can use this online risk calculator to get a clear position on how you can pull out all the stops to help prevent HIV.

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