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: