Overview
Harm reduction techniques that are appropriate for many other types of harmful behavior are much more difficult, but not impossible, to apply to drug and alcohol abuse and addiction. The very nature of addiction to any drug or behavior means that half measures to reduce consumption in some way will always lead to relapse. For someone addicted to drugs or alcohol, the only real solution is to abstain completely and get into treatment, a difficult process that involves the commitment to quitting coupled with extensive social, medical and rehabilitative support.

Harm reduction measures applied to addictions are always intended to reduce in some small way the harm that uncontrollable addictions always cause. Harm reduction also aims to keep the addict healthy and alive long enough for them to “hit bottom” and make their own decision to get into treatment and to begin dealing with the addiction on a long-term basis.

For those who may not yet be addicted to drugs or alcohol but who feel their level of use is harming their health, their relationships or their quality of life in general, harm reduction techniques that aim to reduce consumption of harmful substances to moderate levels are always appropriate. Reduction of alcohol or tobacco use that falls short of complete abstinence is “harm reduction” that is better for one’s health and wellness than doing nothing at all.

For more information on harm reduction as it applies to drug and alcohol addictions, please visit Greater Palm Springs Crystal Meth Task Force.

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  Sexual Activity
Abstinence from all sexual contact is the ultimate in harm reduction behavior, even though it is completely unrealistic to ask anyone but a monk to do so. Abstinence may be a valid harm reduction technique for very young men (or anyone for short periods of time) but sooner or later sexual activity will start (or resume) and exposure to serious risk will then be involved, especially gay young men in the age of AIDS. Every out gay man of whatever age should be fully aware of the only HIV and STD harm reduction technique we currently have available in the male condom. Condoms are not 100% effective in preventing the transmission of HIV and other STDs but it is the only method we now have to reduce risk and serious harm to our health. Topical ointments or treatments to kill viruses and bacteria are still in the early stages of development but one day give us all one more choice to reduce the risk of HIV and STDs. But what about those times that condoms are not an option or what about men who choose to have sex without condoms regardless of the risks involved? Are there any ways to reduce risk that do not involve using condoms? It turns out that many gay men have been reducing their risk of HIV transmission for many years by using one or more of the following techniques:

1. Serosorting is a technical sounding word that refers to the practice of having sex with other men who have the same HIV status. A great deal of serosorting now goes on with the Internet which is one reason why this method of risk reduction is much more popular now than when most hookups for sex were done in bars where discussion of HIV status rarely takes place. Serosorting is used by both HIV-positive and HIV-negative men to reduce the risk of transmitting HIV to each other, however, it does not reduce the risk of transmission of other STDs.
   
2. Oral Sex or Toy Play instead of unprotected anal sex is perhaps the most common HIV harm reduction approach practiced today because there is little or no exchange of semen involved. The only risk of HIV transmission during oral sex is for the receptive partner and only then if the receptive partner has open sores or cuts in his mouth. As with serosorting, oral sex or play that involves dildoes or other sex toys does not reduce the risk of transmission of other STDs.
   
   

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3. Negotiated Safety refers to agreements between two HIV-negative men who are in a relationship and who go through the process of preparing not to use condoms when having sex with each other. Partners usually agree that both only have protected sex until each receives an HIV-negative test result several months after each partner’s most recent unprotected encounter. Agreements usually involve promises not to have any unprotected anal sex outside the relationship and if either one does, the whole process starts over to confirm HIV-negative status. Research indicates this practice is widespread in Europe and Australia and has been adopted by many American gay men to reduce HIV risk. Partners in these studies were adherent to their agreements 90% of the time, but the remaining 10% who were not raises issues of trust and honesty between partners in all negotiated safety agreements.
   
4. Strategic Positioning is most often used to reduce HIV transmission risks between an HIV-positive and HIV-negative man or between men where at least one of them does not know his HIV status. Strategic positioning refers to the practice of the HIV-positive man taking the role of bottom during unprotected anal sex and the uninfected partner takes only the top or insertive role. Unprotected anal sex as a bottom is the single greatest risk for infection with HIV while tops only rarely are infected during unprotected sex. As with most other sexual harm reduction techniques, strategic positioning does not reduce the risk of transmission of other STDs for either tops or bottoms.
   
5. Withdrawal refers to the practice, used by men for thousands of years to prevent impregnating their female partners, of an HIV-positive partner pulling out before ejaculation into an HIV-negative partner. Withdrawal before cumming avoids putting large quantities of HIV into the anus which reduces the risk of HIV transmission. Pre-cum is known to have small amounts of HIV but this can vary from top to top and so is difficult to judge how much risk is being reduced. Another type of withdrawal called “dipping” is preferred by some men. Dipping involves inserting for a short amount of time, maybe only a few strokes, before withdrawal. Again, withdrawal does not reduce the risk of transmission of other STDs.
   
   

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6. Viral Load Calculating is a complicated sounding term that refers to the practice of using information about the viral load of an HIV-positive top to make decisions about whether or not to ejaculate inside a partner. With today’s anti-viral drugs many HIV-positive men have no detectable virus in their blood and others have relatively small amounts of HIV. South African studies have shown that the chances of transmission from HIV-positive men to their wives is greatly reduced if the man’s HIV levels are undetectable. However, other research in San Francisco shows that viral load levels in the blood may be lower than in the semen and HIV viral loads can change over days or even hours so that viral load calculating appears not to be a very reliable way to reduce the risk of HIV transmission and it certainly does not reduce the risk of contracting other STDs.
   
7. Discussion and Disclosure of HIV status before having sex remains one of the most underrated of harm reduction practices among gay men. HIV harm reduction is essentially about informed, individual, adult choices about having sex. The more an individual knows about his own attitudes and values about unprotected sex and the options available to reduce risk, the more likely that he will choose a health-affirming strategy. That is why just talking about HIV status before two men get caught up in the heat of the moment is such a powerful tool for harm reduction. If two gay men are given the information about each other’s status, even if it is unknown, they can more accurately gauge their risks and decide whether they are acceptable or not. There is plenty of gay sex wherever you go and each man must have the information necessary to make his own choices and decide whether this particular hookup is working for him or not.

For more information on the risks of HIV and STD transmission, go to the following sites: www.gayhealth.com or www.gayhealthchannel.com

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