For many of us, the definition of “safe sex” was shaped decades ago. In the 1990s and early 2000s, condoms were the standard and they were usually non-negotiable, lifesaving, and deeply ingrained in how we thought about protecting ourselves and our partners. And we hated them while lamenting what it must have been like in the wild bathhouse 1970s era before AIDS decimated our community.
Today, that conversation looks very different.
Advances in HIV treatment and prevention have transformed the norm. Medications like PrEP, along with the understanding that people living with HIV who are undetectable cannot transmit the virus (U=U), have dramatically reduced the risk of HIV transmission. At the same time, newer tools like doxycycline post-exposure prophylaxis (Doxy-PEP) are emerging as additional strategies to reduce the risk of certain bacterial STIs.
As a result, most gay and bisexual men are navigating a new reality where condomless sex is the default understanding when hooking up, and prevention looks less like a single tool and more like a combination approach.
So the question becomes: what does “safe sex” mean now?
For some, condoms are still an essential part of their routine regardless of being on PrEP because they want to avoid STIs. And for the vast majority of gay men, safe sex now means being on PrEP or HIV meds, staying up to date with testing, and using Doxy-PEP after higher-risk encounters.
What is Considered a “High-Risk” Sexual Encounter?
The answer is different for everyone. Some people may consider sex with a partner whose HIV or STI status is unknown to be higher risk. Others may think about anonymous hookups, multiple partners, condomless sex, group sex, or fun debaucherous weekends with increased sexual activity as “risky.”
Ultimately, what feels high risk depends on your comfort level, your sexual practices, and the conversations you have with your partners. The most important thing is understanding your options, knowing your status, and having access to tools like HIV and STI testing, PrEP, DoxyPEP, condoms, and open conversations with a trusted healthcare provider.
Is this new approach working? In some ways, yes. We’ve seen remarkable progress in reducing HIV transmission and the stigma that goes along with being HIV positive thanks to educational movements like U=U (undetectable equals untransmittable). It’s safe to say that PrEP and medical advances for people living with HIV has ushered in a new era of condomless sex practices that disrupt the default use of condoms. Just ask the guy who’s been cleaning up the sex club for 10 years how many used condoms he sees nowadays compared to years past.
It’s also safe to say that condomless sex has caused STI rates to rise to new levels in many communities and that is a fact that many gay men have to weigh if they embrace the condomless movement. While many think it’s worth the risk, many more have added DoxyPEP to their health regimen or stepped up their STI testing regimen to stay on top of their health. No single strategy is perfect and prevention requires ongoing attention, education, and access to care.
Making the Right Decisions for Your Sexual Health
What’s important is that we make space for honest, stigma-free conversations about these choices. Not everyone will feel the same level of comfort with newer approaches, and for those who lived through earlier stages of the epidemic, shifts in norms can bring up real and valid feelings.
There isn’t a one-size-fits-all answer. But there is a shared responsibility: to stay informed, to care for ourselves and our partners, and to meet each other with respect rather than judgment.
At Spectrum Medical Care Center in Phoenix, AZ, we believe that sexual health should be grounded in knowledge, access, and empowerment. Whether that means PrEP, Doxy-PEP, condoms, or a combination of approaches, our goal is to support everyone in making the choices that are right for them. You can be honest when you talk to our clinicians about your sexual health practices (they’ve heard it all and they don’t judge) and you’ll feel confident as you leave our clinic that you’re making your best informed decisions.