How you can reduce the risk:

• Use latex gloves and lubricants that won’t degrade the latex or rubber (See “Condoms” and “Lubricants”)
• Trim and file your fingernails.
• The asshole does not self-lubricate and sometimes trans men have difficulty producing lubrication in the front hole. In both cases, lube can really help prevent rips and tears. If you’re using latex gloves, make sure you use water-based lube.

Fisting (Handballing)
Fisting is when your partner inserts their entire hand into a front or asshole. Like finger fucking, putting your hand into someone’s front or asshole is negligible risk.  However, fisting can easily cause tiny tears and rips in the front or asshole that can last for two weeks. This means that the person getting fisted needs to be aware of an increased risk during other sexual activities for some time after fisting. The person doing the fisting is also at negligible risk of HIV transmission, but cuts or sores on their hands may increase the risk, making the use of latex gloves a safer sex strategy.

How you can reduce the risk:

• Use latex gloves.
• Use lubrication (water based lube if you’re using latex gloves) to reduce areas of sore, ripped or otherwise weakened skin.  Some gay male fisting cultures associate better fisting with oil-based lubricants, such as Crisco.  If you use oil based lube make sure you don’t use it with latex. Instead, use polyurethane because it won’t break down.

Rimming (Ass licking, Rim job, Tossing the Salad)
So you want to lick ass? Regardless of what you call it, rimming is described as oral contact with the anal opening and region. Many of us enjoy licking and sucking around the asshole. While this is not considered a high-risk activity for HIV transmission, giving is high risk for Hepatitis A and B, intestinal parasites, HPV, Syphilis, Gonorrhea, and Herpes.  Receiving is high risk for Gonorrhea, Hepatitis B, Syphilis and Herpes.

How you can reduce the risk:

• Get vaccinated for Hepatitis A and B
• Wash thoroughly with soap and water around the asshole before rimming. Note: getting soap up your ass is an irritant so be careful.
• If a dental dam or latex barrier specifically for the purpose of oral stimulation is unavailable, you can improvise. Split a non-lubricated condom lengthwise and use it as a barrier between your ass and mouth.
• Regularly check your mouth, lips or ass for cuts and sores.
• Some guys like to douche their ass or front before sex for hygiene reasons.  Douching is not recommended because it can wash away the natural flora that can actually help protect you against infections and it can also drive infections further up into your ass.  If you do douche, use warm water only and gently rinse inside your ass or front.  Do not use commercial douches that use chemical products as these can irritate the lining of your ass or front and increase your risk for HIV and other STIs.

Blow Job (Giving Head, Sucking Cock, Fellatio)
Many of us enjoy sucking cock. Sucking or licking a non-trans man’s cock without using a condom is low risk for HIV, just a few people have been infected this way. Also, ‘deep throating’ (taking the cock to the back of your throat) can increase your risk for some STIs, which in turn can increase your risk for HIV.

How you can reduce the risk:

• Use a condom. You can find thin condoms and experiment with different flavoured condoms (but avoid spermicide such as nonoxyl-9)
• Make sure you don’t have any cuts or open sores in your mouth. Don’t floss or brush your teeth at least 30 minutes before giving a blowjob.
• Avoid taking cum or pre-cum into your mouth. Consider alternatives such as having your partner cum on other areas of your body (avoiding areas where fluids may still have the potential to enter your bloodstream.  Tell your partner to let you know when he is about to cum so you can stop sucking and stroke him off.
• If you decide not to use a condom, avoid deep throating. Using one or both hands, lubricated, to stimulate the cock in addition to the mouth can take the place of deep throating.
• Suck and lick the shaft and balls but avoid the head.

Blow Jobs for trans men
trans men can get blowjobs too but some people use different language to describe the act of having someone’s mouth and tongue on their genitals. It doesn’t matter if you’ve had any surgery or not, you should call it whatever makes you feel most comfortable.

A blow job on a transguy is the same basic principle as a blow job on a non-trans guy.  It is low risk.  Even if you still produce fluid in the frontal area (you have not had the front opening surgically closed), and someone sucks you off, it is low risk to them and even lower risk to you.

Some trans men can ejaculate. There hasn’t been any research done on the HIV risk of ejaculate that comes out of female assigned people, but it is pretty safe to assume that, like cum and vaginal fluids, ejaculate going into the front or assholes is higher risk then having it in your mouth.

How you can reduce the risk:

• Use a barrier. (See “How to Make a Barrier”)
• Don’t floss or brush your teeth at least 30 minutes before or right after giving a blowjob.
• If possible, try to pee after oral sex.  This can flush bacteria and viruses out of your urethra and assist in avoiding getting an STI.

Ass Fucking
A lot of people like to get fucked in the ass. This penetration might happen with a flesh cock, a strap-on, dildo or other instruments. If you have unprotected sex with a flesh cock, you are at higher risk for HIV.

There is a misconception that the person topping is at no or low risk.  Both the top and bottom are at high risk for HIV when they fuck without a condom.  HIV can enter the body through the head of the cock, especially during fucking when there is friction against the skin causing irritation.  This is also true for trans men who have had genital surgery and are able to penetrate their partners.  If your surgery involved urethra repositioning, you are also at risk for transmission to occur directly through the lining of the urethra (the opening at the tip of the cock). To date, there are no studies done on trans men, genital surgery and HIV transmission.

If you get fucked by a non-flesh cock (strap-on, dildo or something else) without a condom, you are at high risk for HIV and STIs when the toy (or instrument) has been used on other people and not properly cleaned. Sharing sex toys without properly cleaning them between partners is high risk for HIV. Fluids that are still on the sex toys or instruments can be transferred just as easily, particularly if the toy was shared recently (See “Sex Toy” section for more details).

So, you can fuck as raunchy as you want, but there are ways to keep it safer.

How you can reduce the risk:

• Use condoms. Try some different kinds to find out which ones suit you.
• Use plenty of water-based lube on the opening to the ass and inside the hole.  Lube feels good and reduces friction, making it less likely to tear a condom or cause irritation and damage to the lining of the ass.  If you fuck without a condom, lube may help reduce risk although there is no evidence to support this.  Condoms really are the only proven way to protect yourself from HIV when you fuck.
• Avoid douching (rinsing out your ass) before anal sex. Douching/enemas removes the protective lining in the inside of your ass, making small tears and rips to the skin more likely when you are being fucked.
• Avoid sharing sex toys, or use condoms on your toys (remember to change the condom if you share toys).

Frontal Fucking
Some of us like getting fucked in our front holes (Some of us don’t want anyone or anything near that area). Penetrative frontal sex often occurs with flesh cock, a strap-on or dildo. If you are fucking a flesh cock without a condom, you are at high risk of HIV and STI transmission. Some guys use the “pull out” method, removing the cock before ejaculation, in an effort to reduce their risk. Unfortunately, research shows that this can still lead to HIV infection, likely due to pre-cum.

Just as with ass fucking, if you are being fucked in the front hole, even by a non-flesh cock (strap-on, dildo) - without a condom, you still have the transmission risk of its fleshy counterpart. HIV and STIs can still be contracted if the sex toy has been used on other people and not properly cleaned. (See “Sex Toy” section for more details)

Sometimes, the use of testosterone can mean that the front hole does not self lubricate that much. Without lubrication, you are at a higher risk for rips and tears that make HIV and STI transmission easier.  Use plenty of water-based lube on the entrance to and inside your front hole when you fuck.

How you can reduce the risk:

• Use Condoms: If you are using flavoured condoms, keep in mind that some are sugar based and increase your chances of getting a yeast infection if you are being penetrated. Make sure to check prior to using.
• Use lube: The best idea is to use water-based lube with a condom.
• If possible, try to pee to after sex.

Sex Toys
They’re called toys for a very good reason. Sex toys can be exciting, fun and really complement a good fuck. There are lots to try including butt plugs, anal beads, vibrators, dildos and strap-ons. Some of us have particular attachments to our silicone, rubber or cyberskin™ cocks and do not really consider them “sex toys” at all, but rather extensions of our bodies.

If you are using sex toys that come into contact with bodily fluids these need to be properly cleaned before they are used again, to reduce the risk of HIV and STI transmission.

How you can reduce the risk:

• If you’re using the toy with different partners or it’s in contact with front or assholes use a new condom each time.
• Clean your toys properly after each use. Make sure to follow the care instructions for each type of sex toy, as improperly cleaning or treating the material of a sex toy can increase the risk of it transmitting HIV and STIs. This is due to pitting or degrading of the material that allows it to retain fluids more easily.
• Use lots of water-based lube.

Cleaning
Silicone toys can be washed with a mild antibacterial soap and water, boiled for up to five minutes or put in the top rack of a dishwasher. Silicone toys can last a long time if they are taken care of properly. Make sure you use a non-silicone based lube.

For rubber and cyberskin toys you can wash or wipe them down. However, you cannot sterilize them because the material is too porous. For this reason, it’s good to use a condom every time you fuck with these toys.

Condoms
Condoms are a good way to reduce the risk when you’re getting it on. They can be used for oral, frontal and anal sex. Luckily, they can also be used on all kinds of cocks, not only on flesh ones but also rubber/silicone/cyberskin ones. A condom drastically reduces your risk of HIV and other sexually transmitted infections by creating a barrier to cum and blood. Although it is the most effective way to prevent HIV transmission if you have sex, condoms are not 100% reliable: they can break or be improperly used.  Condoms don’t have to be boring.  You can find thin ones that increase pleasure, not to mention all the different flavours and textures.

Some tips on condoms:

• The first thing you should do is make sure the package around the condom is intact. Press in the middle.  It should feel like air is trapped under your fingers.
• Check the expiry date on the back of the condom.
• Tear along one side of the foil (no teeth) and be careful to not rip the condom inside.
• If you are putting a condom on a flesh cock you need to make sure it’s hard before you put it on (for guys who had metaidoioplasty/meta or a centurion, you may need to get creative to make things fit). Practice on your own first to get used to how best to do it.
• Put a small dab of lube on the inside tip of the condom.  This will reduce friction on the inside of the condom when you fuck and will also feel better, less like the guy is wearing a condom. 
• Squeeze and hold the tip before you put the condom on. You can put a dab of lube on the inside tip of the condom to reduce friction and increase pleasure.  While still squeezing the closed end, use your other hand to unroll the condom down the full length of the cock, all the way to the base.
• Make sure there are no air bubbles between the cock and the condom.
• Use water-based lube and apply regularly.
• Occasionally check that the condom is not rolling off during sex.
• If you fuck for a longer period of time, change the condom.  This can be a particular issue when guys fuck on crystal meth or take erectile enhancing drugs like Viagra or Cialis.
• When you’re finished getting it on, throw the condom away.
• Never use Spermicides. They have been proven to increase the risk for HIV transmission because they cause irritation on the lining of the ass or front.

Some people are allergic to latex condoms, which cause serious irritation and rashes. This usually means they have an allergy to spermicide or latex. There are non-latex and non-spermicide options. Check the packaging of condoms. Non-latex condoms will usually state that they are made from polyurethane or from other non-latex materials and they are stronger, more expensive and do not stretch in the same way that latex does.

How to Make a Barrier
Oral sex is low risk for the transmission of HIV. This means that there are reports of people becoming infected this way but it is relatively rare.  For people who want to be extra safe you can buy these barriers in the store as “dental dams.” Barriers should be used on any holes (anal, frontal) that you might be performing oral sex on (licking or sucking) You can buy these barriers in the store as “dental dams” or for a cheaper option, non-microwavable plastic wrap. The non-microwavable part is important, since microwavable plastic wrap has tiny holes that make it less effective as a barrier as fluids can get through.

You can also make safe and effective barriers easily yourself as a cheap and creative option. All you need are condoms or latex gloves.

For Condoms:   

Tip: Use unlubricated condoms and make sure they don’t have spermicide (it tastes bad and can actually increase your risk of HIV because it irritates.

For Gloves:

How to Make it Better
Put a few drops of water-based (latex-friendly) lubricant between the barrier and the hole. It will make it more sensitive and holds it in place better.

Lubrication (Lube)
Fucking without lubrication can increase the risk of ripping and tearing in either front or assholes.  The anus never lubricates itself and some trans men find it difficult to produce natural lubrication from the front hole, frequently because of testosterone usage.

• Water-based lubricants (K-Y Jelly, Astroglide, Wet, etc.) are the safest option as they do not have any damaging effect to latex condoms, barriers, toys and people.
  
• Avoid oil-based lubricants (like Vaseline, Crisco, Baby Oil,butter etc.) because they dissolve latex, sometimes within minutes of fucking, and will reduce the effectiveness of latex condoms, which raise the risk of HIV and STIs. Oil-based lubricants are safe with polyurethane plastic condoms or the Reality (‘female’) condom, which are good options for people with latex allergies.
• Silicone lubricants are another option. They tend to retain lubrication longer than water-based lubricant and most are safe to use with latex condoms. Always check the label of the lubricant before use. Importantly, silicone-based lubricants are not recommended for use with silicone-based sex toys. This is because silicone lubricants dissolve the surface of the toys, making them sticky and causing them to slowly disintegrate.
  

BDSM (Sometimes just called S/M or S & M)
Some of us are really into BDSM. BDSM stands for Bondage & Discipline (BD), Domination & submission (DS) and Sadism and Masochism (SM) and encompasses numerous activities, many of which are not strictly sexual. BDSM should be based on informed consent, with an emphasis on being safe, sane and consensual. This applies to you if you are in a 24/7 D/s relationship or if you are interested in exploring spanking. A lot of BDSM activities are no or low risk in terms of HIV transmission such as the use of leather, whips, chains, floggers, paddles, clamps, masks, gags, and anything else that does not include the exchange of bodily fluids from one person to another. However, keep in mind that some of these tools can break the skin and create a site where HIV can enter your bloodstream.  As well, you should never use these tools on more than one person without first properly cleaning them.

That being said, BDSM can also include activities like cutting and medical submission, play piercing, suspension and other activities that include blood. These activities are higher risk if one person’s blood enters another person’s bloodstream. Some people also enjoy scat play (involving human excrement), which can put you at risk for Hepatitis A and parasites.

If you are having oral, frontal or anal sex as part of a BDSM scene you are at the same risks as anyone else if it is unprotected.

How you can reduce your risk

• Avoid direct contact with blood, shit or other bodily fluids (Golden Showers/Getting peed on is no risk)
• Use(d) sterilized equipment (like needles, knives, blades, piercings) and don’t re-use them on other people.
• For piercing, branding, or shaving, any drops of blood should be wiped away with sterile cotton balls.
• Use condom and/or other barriers with water-based lube for frontal or anal fucking, blow jobs/oral sex, rimming/ass worship, finger fucking, and fisting.

Non-Monogamy/Polyamory
Monogamous relationships are the current Western societal norm. That is, you marry or have one relationship with one person at a time and that you get your emotional, intellectual and sexual fulfillment solely from them. Certainly, this works for many people, trans men included. However, there are other ways of having relationships that challenge monogamy as the only option. Non-monogamy refers to different types of interpersonal relationships in which some or all of the people have multiple romantic or sexual partners. This might mean you are fucking several people at the same time, have threesomes or group sex or have multiple partners with an emotional attachment. That last example is more precisely called polyamory, and refers to the desire or practice of having more than one loving and intimate relationship at a time.  Most people who practice polyamory put a lot of emphasis on communication and the consent of everyone involved.

A lot of sexual health materials and workers promote monogamy as a way of preventing HIV and STIs. But remember, it’s not about how many people you sleep with but about what you’re doing. If you decide not to have safer sex, be clear that this is happening so your partners can make an informed decision about their bodies and risks.

The majority of unsafe sex between men happens in relationships.  Monogamy can put you at risk for HIV when one partner has sex outside the relationship and then fears the consequences of informing their primary partner.  This may be especially true when the primary partners do not use condoms for fucking.  It can be pretty hard for the ‘cheating’ partner to then insist on condoms without arousing the suspicion of their partner.  And this is where the risk comes in.

For some guys, dating and relationships can also lead to risk when they fear that insisting on condoms will lead a new partner to mistrust them or think they are having sex with other people.  This can be especially true when you think a new partner is a potential longer-term relationship.  Some guys see the removal of condoms as a sign of trust and intimacy in a new relationship.  Taking condoms out of the relationship safely requires a great deal of planning, communication, openness and trust.  If you are in a relationship and considering dropping condoms, speak to a sexual health educator or counselor about how to do it in a safer way.

trans men and Pregnancy
In the last few years there has been more visibility for trans men who are pregnant. It is impossible to tell whether there are more or less trans men getting pregnant than before, nonetheless, it is a decision made by some of us.

For trans men who are HIV positive, it is important that we consider the risks of vertical transmission from parent to child. People with HIV can have children with very little risk of transmission if they have proper pre-natal care with an experienced HIV physician.  If you are HIV positive and considering having children, speak to an HIV physician about your options.

Breast Milk
Another issue that affects certain trans men who have given birth and who are still lactating is the issue of breast milk. HIV can exist in breast milk in large enough quantities to allow for transmission to a baby. Baby’s mouths aren’t as developed as adults and can leave them at a higher risk.  For adults drinking breast milk, the possibility for HIV transmission is low. Furthermore, parents who are actively feeding infants may have cracked nipples that bleed, allowing the transmission of HIV. Recent studies have shown the importance of the parent and child bonding associated with breast feeding. If you are a trans man who is HIV positive, speak to an experienced HIV physician about breast-feeding as there is a risk of transmission to your baby

Sharing Needles

Hormones
Many trans men take hormones through injection. This means inserting a needle into your butt cheek or thigh and injecting the testosterone directly into the muscle.

Sometimes we will decide to share our needles with other trans men. There are lots of reasons why this might happen; to share an experience, because you only have one needle, you don’t know where to get more needles or you can’t afford to buy new ones regularly. However, sharing needles is high risk for HIV and Hepatitis B and C infections. This is because a needle’s syringe is vacuous (without air) and HIV infected blood can survive for a period of time in a used syringe. Hepatitis C can last even longer in the needle and syringe.

The best way to reduce your risk is to avoid sharing needles. However, if you do decided to re-use needles you should clean them with bleach. This is NOT 100% effective in killing HIV and does NOT kill Hep C.

Intravenous Drug Users (IDU)
Some of us take drugs like cocaine, heroine, amphetamine (speed, meth) and ketamine (special k) with needles. If you are injecting regularly or even just once, you are at higher risk of HIV and Hepatitis infection if you share injection equipment. The HIV virus can live in the water and cooker as well as remaining present in the blood in a used needle and syringe. Not only are you at risk for HIV transmission, but also other blood-borne viruses, such as Hepatitis B and C which can last even longer in the needle, syringe and other equipment.

It is high risk to share needles and drug works (cookers, filters).  If possible, use a new needle every time you inject and never share.  There are free needles available at needle exchange programs or you can usually purchase needles at a drug store. However, if you do decided to re-use needles you should clean them with bleach. This is NOT 100% effective in killing HIV and does NOT kill Hep C.

Using Bleach
Getting a new needle or not sharing your needles is the best way to reduce your risk of HIV and Hepatitis C. If you can’t get a new needle then you should consider cleaning it with bleach. As mentioned above, bleach is not 100% effective in killing the HIV virus and does NOT kill Hepatitis C. Still, if you don't have a new needle and you are sharing them, using bleach between users is the best option to protect yourself.

Here is how*:

1. Rinse the fit with water by drawing water all the way up to the top of the barrel, then squirting it
down the drain.
2. Do this twice.
3. Then do the same with the bleach. The bleach must be full strength to work best. Draw the bleach up to the top of the barrel, and shake it around for 30 seconds. Squirt the bleach down the drain.
4. Do this again. Do not squirt the dirty bleach back into the bottle.
5. Rinse the syringe 2 times again with new water (like in step 1)
6. If you have time to take the rig apart after you've cleaned it, and let it dry in the air, this can also help reduce your risk.

If you do the above steps immediately after you have used the needle and before the blood has a chance to dry out inside the fit - your cleaning system will be much more effective.

* Info courtesy of Keeping Fit: A Prisoner’s Guide to Syringe Care (PASAN)