HIV in Canada: A primer for service providers

 

Strategic positioning

Key Points

  • Strategic positioning refers to the choice of position that gay, bisexual and other men who have sex with men (gbMSM) take when having anal sex (either insertive/top or receptive/bottom) to reduce the risk of getting or passing HIV.
  • There is limited evidence that strategic positioning may reduce the chance of HIV transmission; in the absence of other prevention strategies there is still a high risk of HIV transmission regardless of what sexual position is taken.

Strategic positioning refers to the choice of position that gay, bisexual and other men who have sex with men (gbMSM) take when having anal sex (either insertive/top or receptive/bottom) to reduce the risk of getting or passing HIV.

Receptive anal sex carries a much greater risk for getting HIV compared to insertive anal sex. This is because it is easier for HIV to pass through the thin lining of the rectum, compared to the penis of the insertive partner. Therefore, an-HIV negative person may choose the insertive role when having anal sex in an attempt to reduce their risk of getting HIV, and an HIV-positive person (who does not have an undetectable viral load) may chose the receptive role to lower the risk of passing HIV to an HIV-negative partner.

This is not a reliable strategy on it’s own to prevent HIV. While there is limited evidence that insertive anal sex may reduce the risk of HIV transmission, it remains a high risk activity for the transmission of HIV.

Sources

  1. Jin F, Crawford J, Prestage GP, et al. Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS. 2009 Jan 14;23(2):243–252.
  2. Vallabhaneni S, Li X, Vittinghoff E, et al. Seroadaptive practices: Association with HIV acquisition among HIV-negative men who have sex with men. Plos One. 2012 Oct 3;7(10):e45718. Available from: https://doi.org/10.1371/journal.pone.0045718