Do I Need PrEP If I'm a Top? Learn The Answer 

A top is someone who is the insertive partner during anal intercourse. Generally, both partners have the same risk of getting sexually-transmitted infections (STIs) regardless of the type of intercourse, but for the top, their risk is lower than for the bottom.

It’s important to note that PrEP does not protect against STIs, so even if you're using PrEP, it's important to use condoms to prevent the spread of sexually transmitted infections.

In recent years, pre-exposure prophylaxis (PrEP) has become an option to reduce the risk of getting HIV, but do tops need PrEP too? Let's look into the facts to help you make an educated decision. 

PrEP: The Basics 

PrEP is a daily medication that is highly effective at reducing the risk of HIV. It is a combination of two medicines that have been found to block the virus from attaching itself to the system, called tenofovir and emtricitabine. When taken daily, PrEP can reduce the risk of becoming infected with HIV through unprotected sex by up to 99%. 

It works by stopping HIV from forming replication-competent virus cells. When an HIV particle enters the body, it is immediately blocked from forming these cells, which is where the infection begins. As a result, PrEP can be extremely efficacious in preventing HIV infection, which can decrease transmission rates. 

Do Tops Need PrEP? 

While PrEP is highly effective in preventing HIV, studies have not specifically been conducted on tops and whether they need PrEP. Generally, it is recommended that tops take PrEP to reduce the risk of HIV transmission, as both partners can carry and pass on the virus - even during insertive sex.  

Ultimately, the decision to take PrEP is up to the individual and should be done in consultation with a healthcare practitioner. PrEP can be a life-saving medication for some and should be considered for anyone who engages in behaviors' that might put them at risk for HIV. 

Why Are Bottoms At Higher Risk? 

Generally, bottoms have a higher risk of HIV transmission due to having more direct contact with bodily fluids, such as semen and rectal secretions. This contact increases the possibility of catching the virus from the other partner, making the bottom’s risk higher than the tops. 

For this reason, HIV prevention programs usually focus heavily on the bottoms, but it is still wise for tops to consider PrEP to help reduce the risk of HIV transmission, both to and from themselves. Bottoms are encouraged to use PrEP as well, as it can be a highly effective way to lower the risk of HIV. 

Ultimately, it is a personal decision and should be done in consultation with a healthcare practitioner. But both bottoms, tops, and those who engage in both roles should understand the risks and options available. 

Why Should Both Tops and Bottoms Take PrEP? 

While the odds are lower for HIV infection for a top, research still suggests that it is best for both to use PrEP. The risk of infection during anal intercourse is high regardless of role and can depend on the type of intercourse. 

Therefore, PrEP should be used if one or both partners are unsure of their HIV status. Unfortunately, no protection can eliminate the risk of HIV transmission, but PrEP can greatly reduce it. PrEP should also be used in combination with other HIV-prevention methods, such as condoms, to reduce the risk of infection further. 

The bottom line is that PrEP should be considered for both members of an anal intercourse partnership to help reduce the risk of HIV transmission, regardless of role. 

How Long Do You Have to Take PrEP Before It Works? 

PrEP needs to be taken for at least 7 days before it is effective, and it needs to be taken daily for it to remain effective. However, it can take up to four to seven weeks to reach its highest protective level, depending on individual factors. Therefore, if you plan on engaging in sexual activity, starting PrEP as soon as possible is important. 

If you think you've recently been exposed to HIV, PEP (post-exposure prophylaxis) can be taken within 72 hours to decrease your chances of becoming infected. Go to your nearest emergency room for more information about PEP. 

Conclusion: PrEP is for Both Tops and Bottoms 

In conclusion, PrEP should be considered for tops and bottoms to help reduce the risk of HIV transmission during anal intercourse. PrEP should be taken daily and should be taken for at least seven days before it is effective.  

Other HIV-prevention methods, like condoms, should be considered combined with PrEP. If you think you've recently been exposed to HIV, PEP can be taken within 72 hours to decrease your chances of becoming infected. 

Felix Team
Updated on:
February 27, 2023
Medically reviewed by
Dr. Sheila Wijayasinghe
Family Physician, MD, CCFP

The Felix Health Guide is educational content providing clinically-accurate, balanced information on different ailments and treatments. Some ailments, medications, and treatments mentioned in the content may not be offered by Felix.

The views expressed are those of the author and are not a substitute for professional medical advice, diagnosis, or treatment. If you have any medical questions or concerns, please talk to your healthcare practitioner.

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