Bareback Sex: What you Need to Know.

Some guys have ‘bareback sex’ (anal sex without a condom). At ACT, we encourage men to practice safer sex by using latex or polyethylene condoms and water or silicone-based lubricant for anal sex. This is the best way of avoiding HIV infection, HIV transmission, or infection with other sexually transmitted infections (STIs).

However, we also understand that there are other ways guys can reduce their risks. While these ways are not as effective as condom use, we respect the decisions men make for themselves. Our hope is that guys can make fully informed and conscientious decisions based on accurate information, if they choose to bareback.

All adults have the right to choose the type of sex they want to have. People have the right to decide what level of risk they are willing to accept for themselves.

In partnership with the Ontario Gay Men’s Sexual Health Alliance, ACT created a comprehensive resource on gay men’s sexual health. To learn more about other ways to reduce risk when barebacking visit: www.thesexyouwant.ca

Things to Consider if you are Thinking about Bareback Sex:

■Make sure your partner is actually agreeing to bareback sex: he shouldn’t be drunk or high, or in any other type of altered state that may prevent him from making a decision he wouldn’t normally make for himself. Just because a partner didn't ask to use a condom, doesn't necessarily mean he wants to have bareback sex: perhaps he's making an assumption about your HIV status, or he doesn't feel he can ask to use a condom. Think about this.

■If you are HIV positive it’s good to be aware of the legal obligations surrounding HIV disclosure (i.e. telling your HIV status). For more information about this check out this page.

■Use lots of water and silicone based lube when fucking. Apply more lube as you fuck. Water and silicone based lube will minimize the risk of irritation to the mucosal lining of your anus which allows a route of entry for HIV and other STIs. Lube also makes the initial penetration feel good! Avoid using saliva for lube. Try silicone lube. It has a different thickness and texture than water based, is safe with condoms, and may be hotter for you.

■Spread your barebacking adventures over time to allow any potential damage to your ass to heal.

■Be aware of pain levels. Fucking may cause discomfort or sensitivity, but it shouldn’t be painful. There doesn’t have to be blood for there to be damage.

■Early withdrawal does not reduce the risk for HIV transmission, as pre-cum can also contain HIV. Early withdrawal also does not prevent the transmission of other STIs (like syphilis).

■Don’t fuck if you have open sores on your dick.

■Don’t get fucked if you have sores around your ass.

■Before getting fucked, relax your asshole as much as possible: try anal massage, get finger-fucked or rimmed (lots of foreplay!). Repeated deep breathing helps your hole open up and makes it feel good.

■It's best not to put anything (like a dildo or butt plug) that has been in another person's asshole, in your ass.

■Douching (rinsing inside the ass) makes sense. Fecal matter (shit) doesn’t make good lube! Here are some tips we’ve collected that will make your experience more pleasurable:

 o Use warm water only. Douching removes the natural protective fluids in the mucosal membranes of the ass.

 o It’s best to wait at least 60 minutes following douching before insertion to allow time for your ass fluids to regenerate.

 o If you douche often, it helps to replace the good bacteria (microflora or probiotics) in your gut. This restores balance and aids digestion and absorption. You can get probiotics from yogurt or in capsule or powder from your local health food store. We don’t recommend packaged enemas you buy at the pharmacy. Not only will this solution irritate your mucosa, it will make you shit more than you need to. If you are concerned about your bowel movements, a diet rich in fibre and plenty of water can increase your overall ‘fuck-a-bility’ in a much healthier way than regular douching.

■Urinate (piss) immediately after fucking. This can help to clean out the urethra (piss slit) and may help to flush out any bacteria.

■If you are a trans guy and are getting fucked in your front hole without a condom, be aware that you may be able to become pregnant.

■If you are HIV negative, get regularly tested for STIs and HIV. If you are HIV positive, you should be aware that STIs are infections that can have a fast and negative impact on your health and your HIV viral load, so you should also consider getting regularly tested for STIs and Hepatitis C, as many STIs often have no noticeable symptoms. Talk to your doctor, local HIV/STI information line, sexual health clinic or AIDS service organization for more information on STIs and how they impact HIV.

Some questions you may have about bareback sex.

1. How risky is barebacking for HIV transmission?

 Let’s break down the possibilities.

■If you and your partner are both HIV negative, then there’s obviously no risk for HIV transmission. However, you may not really know the HIV status of your partner, or you may be assuming that his HIV status is the same as yours. In addition, you might think that you are HIV negative because you got tested: but when were you last tested for HIV? Six months ago? A year ago? Longer? Have you had unprotected anal sex with others since your test, and as a result become infected with HIV? You might have HIV and not know it: studies have shown that almost 20% of gay and bi men who think they are HIV negative actually have HIV.

■If you are HIV negative while your partner is HIV positive, unprotected anal sex is high risk for HIV transmission. The Canadian AIDS Society’s HIV Transmission Guidelines define "high-risk" practices as those presenting the real potential for HIV transmission because they involve an exchange of body fluids such as semen, vaginal fluid, blood or breast milk. In addition, a significant number of scientific studies have repeatedly associated those practices with HIV infection.

2. How safe is barebacking for other sexually transmitted infections (STIs)?

There are several STIs that you are at risk of getting if you have bareback sex. These include chlamydia, gonorrhea, Hepatitis B and C, genital warts, herpes and syphilis. Having an STI can weaken your immune system, which is a concern if you are living with HIV. Having an STI also increases the risk of HIV transmission. We've seen a dramatic increase in syphilis among gay and bisexual men in Toronto and other parts of Ontario. Syphilis can be easily spread through bareback (condomless) anal sex.

 3. Is it true the ‘top’ is at less risk for getting HIV than the ‘bottom’?

Yes, you are less likely to be infected as the top than the bottom, but the risk isn’t eliminated. According to a study in Australia, around 1 in 5 men who recently contracted HIV were tops. In a research study published in 2007, among a sample size of 102 gay and bi men who were recently diagnosed HIV-positive, 10 of them were infected despite being the top.

4. I have weighed the pros and cons of barebacking, and I’ve decided to do it. Is there anything wrong with that?

Bareback sex is not morally “wrong”. There are a many things really hot about it; however it does have greater risks. These may or may not be worth it to you. We believe knowledge is power. If you chose to bareback, we encourage you to be as informed as possible. Use the information here and in the suggested resources to be as informed as possible and reduce the risks to you and others.

5. I’m HIV positive and I choose to bareback. Why don’t other guys take responsibility for protecting themselves if they want to?

Well, some men assume that if their partner doesn't tell them they are HIV positive then they must be HIV negative. If you are HIV positive, and you don't tell your partner, and he assumes you are HIV negative, you are putting him at risk for HIV infection. Everyone should take responsibility for protecting themselves and their sex partners. If you are HIV positive, you should be aware that you could be charged for failing to disclose (tell your sex partner) your HIV positive status. Find out more about this issue here. 

There are many reasons why guys will consent to bareback sex without knowing the HIV status of their sexual partner:

■You might think that bareback sex is hotter than sex with a condom and so it's worth the risks;

■You might assume something that a guy said in his online profile indicates he is into barebacking (e.g. if he says he likes it "wild" or is into "pig play")'

■You might be HIV positive and assume that your partner is also HIV positive;

■You might be HIV negative and assume that your partner is also HIV negative;

■You might assume that your partner actually knows his HIV status;

■You might have an allergy to latex;

■He might be so hot that you feel like you don't care if you use condoms;

■You may be uncomfortable or afraid to mention condom use for fear of being rejected;

■You may be anxious about using condoms for fear of losing your erection;

■You may be really turned on during sex and decide, at the moment, that it’s worth the risk;

■You may be drunk or high;

■You may have been rubbing your dick against his hole, and slipped it in for a bit and decided to just keep going;

■You or he may not be fully aware of the risks.

6. I’m HIV negative and I choose to bareback. Wouldn’t someone who is HIV positive tell me before having sex?

Some guys might think they are HIV negative (because their last HIV test was 'negative'), but may have done something since that last test to cause them to become infected with HIV. They assume they are HIV negative, but in fact they aren't. Studies have shown that most new HIV transmission happens between guys who both think they are HIV negative, but one of them has been recently infected with HIV and doesn't yet know it. Studies have shown that when someone is newly infected with HIV, they have very high amounts of HIV circulating in their blood, semen, rectal and vaginal secretions, making HIV transmission likely.

Also, not all men may disclose that they have HIV before having sex with you. There are many reasons for this. They might assume that since you didn’t ask to use a condom, you are also HIV positive. It takes a lot of guts to tell someone you have HIV. Often, HIV positive men are rejected once they reveal their HIV status, but if they don’t say anything, they won’t get rejected. In a casual sex encounter, what would you do?

7. I’m HIV positive and I only bareback because I feel I will be rejected if I tell my potential partners of my status.

This is a valid concern. We all know that discrimination happens against people who are HIV positive - even within the gay community. Remind your partner that people who are HIV negative should also be using condoms, as someone could be infected and not know it - people have often had risky sex since their last HIV test.

8. I’m HIV negative and I’m worried that if I ask to use a condom, my partner might believe I am HIV positive.

That could happen. But what if your partner is HIV positive and assumes that you are also HIV positive since you did not ask to use a condom? You could tell your partner that you’re HIV negative and you would like to use a condom. If he then says ‘if you know you’re HIV negative, why not forget the condom’, you can tell him that there are other STIs to think about. You can also tell him that research studies show that up to 20% of gay or bi guys who think they are HIV negative, are in fact HIV positive but don't know it: they may have been tested quite some time ago, and got HIV since their last test. They think they are HIV negative, but in fact they aren't.

9. My partner and I are both HIV positive. Why shouldn’t we bareback?

It’s your choice to have condomless sex together. We’re not saying you should or shouldn’t do it. You should talk to your partner (if you have sex with other people) about the kinds of sex you have with others. STIs, like syphilis, are still a risk to you, and can compromise your ability to fight HIV. STIs increase your viral load (a measure of the amount of HIV in your blood), and certain STIs can progress much more rapidly in people living with HIV. If you are HIV-positive and have bareback sex, it's important to get tested regularly for STIs and Hepatitis C.

10. I feel guilty whenever I bareback. Why do I sometimes slip up and have unprotected sex?

We’re all human. Nobody is perfect. Try to better understand the situations in which you get involved in unprotected sex. Where are you usually? How are you typically feeling? What reasoning do you use to make it more acceptable for you to have unprotected anal sex? Does your partner pressure you?

Just because you might occasionally 'slip up' and have unprotected sex doesn't mean you are necessarily a 'barebacker'. Some guys feel that sex without a condom is more care-free, more pleasurable and exciting. Others are worried about rejection, or about losing their erection. If you really want to be using condoms for anal sex (and there are many good reasons to do this!), there are ways you can experience intense pleasure and intimacy. And, you can learn to wear a condom and keep your dick hard.

11. I bareback because it’s an intimate feeling; I feel closer to my partner.

Some believe having unprotected anal sex is the ultimate, most intimate, sex act. There’s nothing wrong with believing that. But what about other sexual acts that might give you the same, or nearly the same level of intimacy with your partner? There are many different ways to feel intimacy with a partner and anal sex without a condom is only one of them. Try exploring other aspects of your sex life.

12. I am HIV positive but I take anti-HIV medications and my viral load is undetectable. Doesn't this mean that barebacking is OK because I can't transmit the virus?

While anti-HIV medications can dramatically reduce the amount of virus in your blood (and other body fluids), therefore reducing the likelihood of an HIV positive person passing on HIV to an HIV negative sex partner, there remains the possibility of HIV transmission.

Viral load is the amount of virus in a specific sample amount of blood. When a viral load is so low that it can’t be measured with common testing procedures, it is called ‘undetectable’. Some people call this ‘zero viral load’, but the virus is still present - it just means the number of copies of HIV is too low for routine tests to detect. Although it's quite rare, research studies have shown that some people with an undetectable viral load in their blood may have a viral load in their cum (or rectal secretions, or vaginal secretions) that is high enough to pass HIV onto their partners. Most of the time, guys with undetectable blood viral loads who are taking their anti- HIV medications as prescribed, and get regularly tested for STIs (and treated for STIs if need be!), also have undetectable viral loads in cum and rectal secretions. Having an undetectable viral load clearly reduces the likelihood of HIV transmission, but we can't rule out the possibility that HIV transmission still can occur. Condoms can provide that additional protection.

Photo credit © Doodkoalex | Dreamstime.com

This article is based on a report by Greta Bauer, Nick Redman and Kaitlin Bradley for the Trans PULSE team. E-Bulletins, presentations and articles available at www.transpulseproject.ca To contact Trans PULSE: This email address is being protected from spambots. You need JavaScript enabled to view it. or 1-877-547-8573

The Trans Pulse study says about two-thirds of trans guys are gay or bi men who have sex with men, and are attracted to or sexually involved with either trans or non-trans men. Trans guys already exist within gay men’s communities, gay bathhouses, and gay men’s bedrooms. Yet, their sexual health concerns are rarely made visible. No  assumptions can safely be made about how an “average” GB-MSM trans guy may act, what he may do in bed (or not do in bed), or what other psycho-social stressors he may or may not have to deal with.

The report concludes “Sexual health and HIV-related prevention and testing programs and materials need to incorporate trans guys’ issues and needs, and to reflect the potential for gay or queer bodies to be trans bodies.”

Trans guys include those who identify as transgender, transsexual, or have a history of transitioning medically or socially to male, or to another identity such as Two-spirit or genderqueer. A broad definition of “trans” was used in the study; participants were not limited to particular identities, and were not required to have begun or completed a social or medical gender transition. A total of 433 participants were recruited over a 12-month period,

Trans PULSE is a Canadian Institutes of Health Research-funded, community-based, research project to understand and improve the health of trans people in Ontario.

The survey included items on health-related measures, including social determinants of health, psycho-social measures, health care experiences, and sexual health. Participants were trans people age 16 and over who lived, worked, or received health care in Ontario.

The research team gathered data which indicated  diversity in the sexual orientation of trans guys and this data is shown in Table 1 (right) Trans guys identified across a full range of sexual orientation identities, with only about one third identifying as straight. As a group, trans guys had cis (cisgender, or non-trans) partners and trans partners who identified as men, women, and genderqueer.

This diversity clearly challenges assumptions that trans guys transition to be straight men, as even many of those who were currently partnered with a woman did not identify as straight, and there were many who were attracted only to women (sometimes only to cis women) who still identified as queer.

63.3% of trans men fit into the GB-MSM category, the focus of this report, which defined GB-MSM trans guys as those who had a sexual minority identity (e.g. gay, bisexual, pansexual, queer) and were not exclusively attracted to women, or those that had sex with a cis or trans in the past year, regardless of how they identified.

Relationships, Sex, and HIV Risk of GB-MSM trans men

Table 2 (right)  provides details on the relationships, sexual activity, and HIV-related risk for GB-MSM trans guys.

While not every trans guy used all of his body parts for sexual activity, trans guys engaged in all types of activity, including receptive genital sex. These sexual behaviours do not correspond to HIV-related risk, however, as not all involved “flesh genitals”, but may have involved prosthetics, toys, or fingers, for example, and even where flesh genitals were involved, condoms or other barriers may have been used. Proportions engaging in high-risk activities were much lower than those representing any engagement in activities. 

The primary contributor to HIV risk was unprotected receptive genital sex, an activity some may assume trans men are unlikely to engage in. Most HIV-related sexual high risk related to having cisgender male partners, as exposure to ejaculate is required to qualify as high risk. For this reason, overall HIV-related risk among trans guys was entirely borne by the sub-group of trans guys who are GB-MSM. About one-third of GB-MSM trans guys had a cisgender man as a partner in the past year, and 1 in 10 had engaged in high-risk activity; roughly three-quarters engaged in low/moderate risk activities.

While a fair amount of research exists on trans women who engage in sex work, participation by trans men is infrequently acknowledged. Researchers  found that 15.8% of GB-MSM trans guys had engaged in sex work or exchanged sex for money or goods. While proportions engaging in sex work were similar to trans women, it’s not known if trans guys are similar with regard to the frequency of sex work activities, or the length of time spent in the trade.

While it is not clear how or if it relates to HIV risk, results indicate a high proportion of GB-MSM trans guys had never been tested for HIV, while 1 in 5 had been tested in the past year.

Psycho-social Factors that may Impact Sexual Health

Table 3 (right) presents data on several psycho-social factors that may impact sexual risk taking.

GB-MSM trans guys were no different from other groups of trans people in the study with regard to sexual satisfaction. Sexual body image worries were assessed using a scale developed by Trans PULSE to capture trans-specific concerns such as not being seen as one’s gender when naked. Low relates to never or infrequently having this range of worries, while high related to often having such worries. For about 1 in 5 GB-MSM trans guys, these worries were very frequent, while for another 2 in 5 they were common.

Depressive symptoms are common among trans guys. Researchers found that trans guys had a decreased risk of depression if they experienced greater sexual satisfaction, and an increased risk if they experienced high levels of transphobia or were in a period of planning but not having yet begun a medical transition.

The majority of GB-MSM trans guys in fact  scored as “depressed”. However, the measurement scale used has not been validated for trans people, and given the extreme stresses trans people can be subject too, it’s considered unlikely that for most such trans guys, that this indicates what would be considered as clinical depression. However, this does indicate a high burden of depressive symptoms.

An estimated 16.9% of Ontario’s GB-MSM trans guys have experienced physical or sexual assault that they attribute to being trans. Many trans guys also reported experiencing assault, but were unsure as to whether it was a transphobic attack. An additional 36.1% experienced harassment or threats, but not assault. This indicates an extremely high level of violence that trans guys are subjected to, in addition to other types of violence they may have experienced in their lives.

Illustration © Dawn Hudson | Dreamstime.com

I wrote this piece for my own blog last June. As I review and expand on it I realize that at its core, it is still as true today as it was when I originally wrote it, in fact even more so.

What prompted me to write this post was hearing my father’s diagnosis of prostate cancer. I had already been thinking of writing a post dealing with grief. However after hearing about my father’s health, I was overwhelmed with fear, sadness and anxiety about what his future held. Writing this at that time was an impossible task for me. I’m not going to bore you with the details of my dad’s health any more than to say that he’s had surgery, has had radiation and is currently cancer free, so far as they can tell. At the time however, it was very much a hurry-up-and-wait game. These events resonated very strongly with me in light of my own transition.

I remember when I first came to realize (that is, had the language to explain) that I identified as trans; my very first reaction was simple denial. I spent some time trying to convince myself that I was just searching for something to blame for the lifelong dis-ease I had felt. Maybe I wasn’t one of those happy people I saw around me day in and day out. Content to live their lives in the best ways they knew how. After all, I am a recovered alcoholic/addict and one of my recurrent lifelong themes is that I almost NEVER take the easy road so I simply figured this was another way for me to avoid dealing with things.

That only lasted a couple of weeks and then I decided that MAYBE this was just a phase. Perhaps this was something for me to try out and try on while I got my bearings. To that end, I packed away all my ‘girl’ clothes and said that if I hadn’t gone back to them for very practical reasons within 6 months then perhaps this thing had legs. That was almost 3 years ago, and I only went back to the clothes once for a sweater. I’ve decided it’s not a phase.

I’d like to say that everything from there on out was all fine. I want to tell you that I lived happily ever after in my new tranny identity and it was all smooth sailing. If I told you any of that however, I’d be lying through my teeth. As much as I talk about the physical and social challenges of transition, I very rarely talk about the emotional ones.

Transition has a price and that price is my life, my identity and my past. In order to become the person I believe I am, I must, in many ways, walk away from the person I once was. I must die to myself and to my past in order to become the person I am becoming.

I grieve the loss of my identity. While I have all this history locked up in my head, sharing it with new people in my life becomes an exercise in anxiety and trust. Do I trust the person I’m talking to enough to reveal my other gendered past? Can I share that history in a way that removes all gender references? What happens if they find out?

The loss of self that I grieve isn’t just for my past; it’s also for my present. Here I am, presenting as a fully-grown (but still short) adult male and I have almost NO points of reference from my childhood to fall back upon. For better or for worse, we as parents often raise our male-bodied children with certain social cues. Even if we decide not to, society will provide the male-bodied child with reminders and cues about how they should behave.

I’m not here to debate the rightness or wrongness of this. At present, it is what it is and what it is not is the cues and lessons taught to me as a child. I am a man without a boyhood and I grieve this. Growing up female as I mentioned in an earlier post, the best compliment I could receive from a roomful of men is that I blended right in, and rendered invisible. Now, the men invite me to participate and I have absolutely no idea how to do that ‘as a guy’. My female identified friends tell me ‘you’re such a guy’ while some of my male bodied friends say ‘you still socialize like a girl’. I struggle to make my place in the world and leave a legacy of strength, flexibility, sensitivity and warmth in my wake. Often I don’t strike that balance and I lie awake at night wondering when I will learn.

Recently I’ve become involved in a men’s circle and the experience has been profoundly terrifying and rewarding at the same time. To my knowledge, I am the only trans man in the circle at present and this has brought no small amount of fear into my life in a way that stands sharply contrasted to the general fear I live with every day. The brave men who attend commit themselves to radical honesty, supported self-awareness and ask of themselves a level of emotional engagement that simply astounds me. There are men who are taciturn and men who are boisterous; men who come from many walks of life and bring with them years of accumulated shame and guilt and self-loathing. Within the circle, these men share some of those hurts and fears and hopes and ask the others in the circle to hold them safely while those emotions flood through them and are released into the ether so that peace, joy, love, honesty, openness and the experience of being present can enter in. Emotions and qualities I want for myself.

In order to become that man, I must first wrestle with my past. I must own my own history with its disjointed narrative and surreal feeling. I must become ok with experiences that, for years, are ones I raged against and tried so very hard to reject fully. Most importantly, I must learn to silence that voice inside of me that says I don’t belong. The one that chatters constantly to remind me that I am an interloper, a fraud and that I do not belong. I have told the men in my circle about my physical past. They welcomed me in my present self into the circle; I need to do the same.

I need to put my past to rest for I am not that person any longer and yet, those experiences have shaped me into being the man I am today. It is time to let that part of me die a graceful death, to mourn and thank my past for giving me the gifts I bring to my every day. To do this, I must grieve. And that, my friends, is what I need to learn how to do.

I first heard about this group from PositiveLite.com publisher John McCullagh in a post he wrote, which you can read here, where he interviewed Jody Jollimore, the program manager at the Health Initiative for Men (HIM), a gay men’s health organization in Vancouver, and Rui Pires, Gay Men’s Community Education Coordinator at AIDS Committee of Toronto (ACT). Both leaders described it as a leadership program for young gay men where we can learn about love, life, sexuality, sexual health and how we can apply this knowledge in our community.     

Intriguing, I thought, so I might as well register. I soon received an email advising me of the program schedule. We were set to meet for four full-day Saturday sessions. I wasn’t too sure about giving up my Saturdays for four consecutive weeks but I figured that I should check it out and see how I felt after the first session. 

Not knowing what to expect, I approached the first session with a hint of caution. The lay out of the room was well done and I was greeted warmly by the facilitator Rui Pires. I was overcome with a bout of absolute shyness at first as we went around the table giving brief introductions about ourselves and what we hoped to get out of the group. I was pleasantly surprised to hear that I wasn’t the only one hoping to learn how to connect with other gay guys outside of the bar setting with no pressure to get sexual. 

After our intro’s Rui told us a bit about himself and the work he has done with the gay/HIV community. It was safe to assume that we were in good hands. We then launched into an interactive workshop on coming out. We gathered around the room in the order of who was out the longest and we each shared a little about our coming out process. This exercise was enlightening and the stories were amazingly diverse.  Rui then gave some tips on coming out and being supportive to others who are coming or thinking of coming out. 

Throughout the duration of the program we had the opportunity of hearing from various community leaders ranging from health and mental health professionals to community activists. We also got to learn about the dynamics of different types of gay relationships. And there are quite a few that I wasn’t aware of! We got first hand testimony about the importance of getting involved in different aspects of the community, like the fight against HIV. We even had a crash course on flirting and cursing! 

So without giving too much away about the program, I would strongly recommend it to anyone between the ages of 18-26 who wants to learn about the gay community and the issues that affect us, as well as develop great communication and leadership skills. Above all it’s a safe space where guys can come to have fun and engage in conversations on a variety of topics that affect us today.

The next session of Totally Outright takes place in June. For more information, you can visit www.actoronto.org/to or you can contact Rui Pires at This email address is being protected from spambots. You need JavaScript enabled to view it.

Who says senior years mean an end to sex?.  Studies have shown shown that more than 80% of 50-90 year olds are sexually active.  But for the same age group, sexually transmitted infection rates have doubled in the past decade in Canada, the U.S. and the U.K., says a recent study.

According to a CTV News story, there has also been a significant increase in the number of older adults accessing HIV care, up 82 per cent since 2001. While much of that increase is due to HIV patients living longer because of new treatments, new HIV diagnoses in adults over 50 doubled between 2000 and 2009 in the U.K.

Says CTV News  "The statistics also show increases in incidents of syphilis, chlamydia and gonorrhoea in adults in the 45-to-64 age bracket. “Over the last 10 to 15 years, we were seeing in this (over 50) group that . . . (sexually transmitted) infections were really rising . . . across the board," one of the study's authors, Rachel von Simson, told CTV News. "In some cases, they now form a larger group of infections than those aged 15 to 29.”  Statistics show in Canada that in adults over the age of 45, they are seeing more cases of syphilis in them than in adults aged 15 to 29. They theorize that the increase in the use of erectile dysfunction drugs has allowed men to stay sexually active longer, increasing the amount of time a man can put himself and his partners at risk.  Von Simson says doctors should look at older patients the same way they do younger patients, and examine the possibility that they may have an STI.”

"Doctors don't really particularly expect to see (older) patients at risk, so they might not be picking up infections like HIV early on when they need treating and that might mean a greater spread," von Simson said. "(Doctors) are very afraid they may offend older adults by speaking about it."

All of which makes the US-based website Safer Sex for Seniors so much sense.  It’s chatty site lacks pizzaz but nevertheless sports a nifty video that has been raising  eyebrows all over the net.  And it seems decidedly straight – true, ther is a nod to bisexuality here  and even transgendered people here but nothing at all about gay sex.  Still, what’s here is solid enough, even though its message “There’s Only One Way to Safety – Use Condoms” lacks the nuanced approach we’ve come to expect of our safer sex menus that nowadays tend to stress individual decision making rather than edicts.

But I’m being picky.  Any website that features seniors working their way through the Kama Sutra can’t be all bad.  You be the judge.

This profile was fiist published on the Universities Without Walls (UWW) website. 

Name: Zack Marshall

Affiliation: PhD at Memorial University Consultant, Griffin Centre, UWW 3.0

Interests: Grassroots, community-based organizing, health care ethics, marginalized communities, sexuality, sexual health, intersectional analyses, critical social science perspectives

Influences: Community activists, people who bridge academic research and community environments

If I wasn't doing all of this... I would be doing similar work outside of the university environment. I would still be doing CBR, community organizing, and raising money.

Somewhere during the 600 kilometers between Toronto and Montréal, Zack Marshall realized that the Friends for Life Bike Rally was a good analogy for the collaborative work he loves to do. He saw teams riding in groups, taking turns expending energy as the leader of the pack and later using the team's momentum while drafting behind the group. This is exactly the approach Zack takes to the community-based research he does as a PhD student at the Memorial University of Newfoundland and through his UWW Field Mentorship Placement (FMP) with Dr. Mark Tyndall at the University of Ottawa.

Zack got his start in the HIV field as a volunteer – "I started out as buddy volunteer with AIDS Community Care Montreal (ACCM) in 1993 with someone in the later stages of AIDS – very isolated, with no family around and just a few friends. He only lived two weeks after I met him but the connection we made had a big impact on me." He later supported the development of support services for HIV-positive women, and got involved with groups focusing on sexual health and reproductive rights. The development of personal connections was something Zack, a gay trans man, was already well acquainted with from his involvement in LGBT communities where community work often takes the form of a very personal kind of activism. He explains that these relationships and grassroots processes are what fuel his ongoing involvement in engaging communities to work towards social change.

Zack has done some pretty amazing things with the communities he works with and lives in. As a member of the Gay/Bi/Queer Trans Men's Working Group, Zack was instrumental in developing Primed: The back pocket guide for trans men and the men who dig us, a project spearheaded by James Murray through the Ontario Ministry of Health and Long-term Care AIDS Bureau. "It's been an amazing project to be a part of and such a highlight to see the impact it's had around the world. It's been translated into 7 languages now." At a recent global health meeting in San Francisco a delegate from South Africa told Zack about the one dog-eared copy, well-used by his community for education and advocacy purposes.

Zack's involvement in a research project about HIV prevention among youth labelled with intellectual disabilities brought him on to a diverse team of community members, researchers, and service providers. The team really fostered intellectual creativity, and ultimately led to Zack's decision to pursue his PhD, nearly a decade after completing his MSW at Wilfred Laurier University. After traveling to St. John's in 2010 to lead a workshop on creating accessible services for LGBT youth that lead to the development of the Coalition for LGBTQ Inclusion, he felt drawn to the island. "When I got accepted into the PhD program at MUN, I knew this is where I needed to be."

Zack credits his early involvement in the HIV field with his introduction to community-based research (CBR). Today, CBR and bridging the gap between research and communities are integral to his work. Through his doctoral studies and his FMP, Zack is addressing ethical issues in HIV CBR. The main project he has been working on in collaboration with Dr. Tyndall involves issues surrounding injection drug use and barriers to health care in Ottawa. While this is the first time he has worked with this aspect of HIV prevention and transmission, Zack says that the knowledge and experience he is gaining is opening up possibilities for the future. He is discovering his strengths in new areas of work, including knowledge translation and exchange, and peer engagement, and looking for ways to integrate these skills into upcoming work. Zack isn't the only person delving into new areas of research as a product of his FMP. As a result of the connections he's made with research teams in Ottawa, he has had the opportunity to initiate an HIV Primary Care and Ethics team including researchers from St. John's and Saint John, and to bring representation on a range of issues to the Atlantic.

Zack's positive experience with his FMP isn't all – he can't say enough about how great his involvement in UWW 3.0 has been. The online delivery format of weekly UWW webinars has allowed him to get involved with people and issues from across the country – an opportunity that doesn't always come all the way to Newfoundland. Through UWW, Zack has connected with both new and familiar faces, learned how the complexities of HIV research are positioned in a variety of different disciplines, and received feedback on writing successful grant applications. He particularly appreciates the support provided by other fellows and mentors involved with the program: "When facing barriers to implementing CBR, UWW reminds us, 'hey, there are a whole bunch of other people who see the value of this approach to research'. It's a form of moral support."

Recently, Zack's experiences in innovative CBR were recognized by a successful funding proposal to CIHR's Operating Grant in HIV/AIDS CBR competition as a co-principal investigator. The project, entitled the Trans MSM Sexual Health study, aims to use qualitative interviewing to collect in-depth information about the sexual health issues, concerns, sexual decision-making processes, and the social context of the lives of TMSM in Ontario and relate this information to HIV prevention and sexual health needs. The project will contribute to our understanding of the extent and scope of social exclusion in this community and the impact on sexual health, HIV risk, and access to HIV prevention services.

What is UWW?

UWW is the educational and training arm of the CIHR Centre for REACH in HIV/AIDS. We provide a national interdisciplinary learning and mentorship program, connecting academics, community members and policy makers to explore HIV research together. The program is funded by a Strategic Training Initiative in Health Research (STIHR) grant from the Canadian Institutes of Health Research (CIHR) and housed at the Ontario HIV Treatment Network (OHTN).