Risk reduction without condoms?

In attempts to have unprotected sex while still lowering their risk of infection, many men are using methods such as 'strategic positioning' and 'delayed condom use'. While methods such as these may not be reliable or fully effective, they may be at least partially effective in lowering risk.

A study of gay men in Australia¹ found that men were using practices that would not likely be countenanced by 'standard' safer sex education programmes, including only taking the insertive role (strategic positioning), withdrawal (having the insertive partner withdraw before ejaculation), serosorting (choosing partners they believed to be HIV-negative), and negotiated safety (agreeing to ongoing unprotected sex with a regular HIV-negative partner, while agreeing to disclose test results and sex outside the partnership).

Taken alone, the individual strategies did not result in significant risk reductions. Withdrawal was one of the least successful strategies: men who used it were five times as likely to become infected than men who had no unprotected sex – a finding consistent with another study.²

Taken together, men using any of these practices were still three times more likely to acquire HIV than men who had no unprotected anal intercourse (UAI). (In other words, consistent condom use was three times more effective than any of the 'attempted safety' strategies.) However, men who practised UAI without any of these safeguards were almost eleven times more likely than men having no UAI to acquire HIV. In other words, use of these strategies did result in a reduction in risk compared to using no safeguards at all.