The Empowered Bottom: Safer Sex in the Time of PrEP

Until recently, condoms were considered the only viable option for safer sex practices among gay and bisexual men. Once it was first discovered that HIV was a sexually transmitted infection, condoms became the centerpiece of safe-sex culture. Although this tool kept many gay and bisexual men HIV-negative through the worst of the epidemic, but the use of condoms has dropped dramatically over the years. Even among those most adherent, the use of condoms to prevent HIV has often perpetuated  an inequality among gay men; one that looks upon the receiving partner in intercourse as more subservient. It's an inequality apparent in the very terms we use: tops and bottoms. Tops are on top and bottoms are on the bottom — not just in terms of sexual acts.

In other words: the tops had all the power.

Sure, many gay men often identify as versatile when questioned about sexual positioning. Even so, most usually have a general proclivity to one position or the other. Generally, some people are good at topping while others make for better bottoms. Yet, when it comes to mutual respect, sexual health, and protection, tops and bottoms aren’t, or weren’t always, treated as though they were created equally.

“I've definitely felt belittled for identifying as a bottom. As if being a bottom meant being something ‘less’ in our community,” said Joshua Collins, a PrEP user from Phoenix, Arizona. “I also feel like we have certain expectations of someone who identifies as a top and expect them to take control in sex. I've definitely felt like the top was more in control within the sexual dynamic.”

A top is also physically in control of wearing a condom. A bottom can only negotiate the use of a condom. You might think that this doesn’t necessarily create an inequity. After all, a bottom can walk away from a sexual encounter just as easily as a top. But in the throes of passion when the clothes are off and there are mere inches between “everything-but” and full-on penetration, the power is greatly weighted in favor of the top.

As the bottom partner, my HIV status was always contingent on someone else's decisions,” said Damon Jacobs, founder of the popular Facebook group, PrEP Facts. “I had to rely on the top to make sure the condom was used, or didn't fall off, or didn't fall in, or didn't break, or didn't 'magically disappear' as condoms sometimes do.”

A gay or bisexual man who primarily tops is also less at-risk for HIV infection (but not immune). But this is not the inequality that condoms create. A top who engages in condomless sex isn’t held nearly as responsible as a bottom often is when it comes to safe sex, yet the top is the one who must physically wear the condom in question. The relationship between gay men, condoms, and HIV can be directly paralleled with that of birth control, heterosexual sex, and pregnancy. And PrEP is to the empowered bottom the same way that birth control is to the empowered woman — including the slut shaming that both parties have often experienced as a result of their choice to take control of their health.

“PrEP is the first opportunity bottoms have ever had to be in full control of our HIV status,” said Jacobs. “It allows both partners, in either sexual position, to be 100 percent responsible for their pleasure and protection.”

Colton Ferrell is a young PrEP user from Austin, Texas. He didn’t think too much about the inequality of his preference for bottoming until he found himself in his own sexual quandary.

“So, I never really thought of there being an imbalance dependent upon sexual position, until one time recently when the guy and I discussed using a condom,” said Ferrell. “We agreed to use the condom, he grabbed the condom wrapper, I laid down on my stomach, and we had — not so enjoyable — sex. Something, as a bottom, I've noticed is that I can rarely feel the difference as to if the guy is wearing a condom or not, and it turned out, that in this circumstance, he wasn't, and he actually came inside of me. Aside from feeling very violated and pissed, I was less worried than I feel I would've been, because I was on PrEP, and wasn't as concerned about HIV, while still knowing I needed to get checked for everything else.”

Ferrell’s experience is just one example of how the one who is at risk is often left without control in a situation of protection. The use of Truvada as PrEP, the HIV prevention pill that is 99 percent effective at eliminating the risk of HIV infection when taken correctly, has the potential to revolutionize the gay sexual experience. Now, a bottom has the option to enter into the intercourse that he chooses with the knowledge that he has taken action to protect himself from HIV, regardless of the top’s preferences or agreements. Furthermore, he is involved in preventative care with his healthcare provider and taking responsibility for his own sexual health.

But most importantly, he is allowed to enjoy the pleasures of sex without experiencing any added shame for his preferred position or fear of a possible HIV infection.

“I think I can sum up how PrEP has changed the way I feel about sex in one word: wow!” said Collins. “I've personally never been that adherent with condom usage and I would always feel very guilty and irresponsible. I've had many a time I'd nervously awaited an HIV test result hoping and praying. With PrEP, I don't worry about it anymore and just enjoy the moment. Now I let my sexual partners know I'm on PrEP and I've had some really great experiences with guys who are positive and who I probably wouldn't have approached. I would say I'm a lot more aware of my sexual health now because I get tested every three months.”

So what does PrEP mean to the empowered bottom? It means living in an environment where the fight to stay sexually healthy is held on more of an equal playing field. It means less shame and fear and a greater sense of self worth and sexual pleasure.

“I'm a child of the 1980s,” said Eric McCulley, a PrEP advocate. “And for the majority of my life, all I've heard about sex is that it is dangerous and that it might actually kill you. So it's nice to not be afraid of sex anymore. And to be in control of my own sexual health is empowering and affirming.”

As the arguments over the use of PrEP continue to dissipate and the science and validity of the HIV prevention pill continues to increasingly resonate within the gay community, it is now a matter of accessibility and affordability for those who need it so that more bottoms become empowered by the other little blue pill.

Here’s to a new kind of sexual revolution.