Bare Reality Facing HIV Organisations

Bareback sex is emerging as the first choice for gay men, presenting HIV prevention organisations with new and complex challenges, including political ones, in their fight to reduce HIV infection.

Breed me. Seed me. Pound me raw. These desires overshadow once scary and fatalistic television advertisements that today just don’t cut it. The reality is that cultural norms have shifted, as gay men no longer consider condoms a life or death choice.

Discussing this topic is immediately sensitive. Just as the publishing of suicides was once a media taboo, talking about this topic is controversial. Assumptions are that gay men are making deliberate or reckless decisions to contract HIV. Nothing could be further from the truth.

The Pleasure And Sexual Health Report (the Pash Report) summarises the problem:

“There are two different but related domains of desire at work here. The first involves wanting to avoid infection, and what makes that possible. It is constituted around disease, condom use and risk, and a desire for no disease, no risk and no need for condoms. The second involves what counts as sexually desirable, and how that desire may be satisfied. It is constituted around pleasure. These two domains are potentially present when sex is negotiated circumstantially. Both are involved in care of the self and others.”

What the report shows is an emerging trend, where men who have sex with men increasingly prefer sex without a condom, pitted against a desire to not harm themselves and others.

Thanks to Queensland’s sudden de-funding of the Queensland Association of Healthy Communities (QAHC), other state based HIV health promotion organisations are now on notice. The paradigm has shifted, and the government can replace them if they don’t toe the line.

In a far ranging interview with Paul Martin, head of QAHC, he explains the complex nature of sexuality, the feelings of normality that come from “condomless” sex and how all of this interplays with men that are HIV positive, negative or unsure.

The wearing of a condom is inherently unnatural, Mr Martin explains. Some men claim it kills their erection, while for others it is akin to a big neon sign linking the intimacy of sex with a disease. The psychosocial implications of this can literally lead to impotence, or to the aggressive rejection of “safe sex” because it flies in the face of everything natural.

First off the blocks Mr Martin discounts the desire of some negative men to become positive, saying those who “purposely seeking out unsafe sex to get HIV is a very small number – a tiny subset of a subgroup”.  But because of the controversy this small group generates,  experts are extremely keen to get the word out that they are not a significant issue.

What all this means is that simple safe sex messages are no longer enough.  There is a need for far more nuanced messages when talking to men who choose sex without a condom. Mr Martin tells The Stirrer, “Health promoters need to recognise that (sex without a condom) is natural. Rather than coming out and judging and labelling men, they need look at the strategies men use around these risks”

Professor John De Wit from the UNSW National Centre in HIV Social Research also weighs in saying, “Health promotion is about giving up something you value, to avoid getting something you don’t want. This classic self-regulation dilemma, of foregoing pleasure now for health later, continuously affects all health decisions. Different people will find different trade-offs acceptable, and that will also change over time and circumstances.

“Condom use remains gay men’s most important response to HIV. This is followed by disclosure of HIV status. But positive men who disclose, and (they) mostly do, are not congratulated with it, but can be ostracised through rejection. This illustrates the pervasiveness of stigma that people with HIV experience, mostly from potential sex partners.”

This is the context of an online world of websites and applications dedicated to bareback sex, including GPS. Others provide a place where men can market or seek out others interested in sex without a condom. Now you can get laid quicker than Dominos will deliver your pizza. Quick decisions around sex may not weigh up risk and reward appropriately.

There is another problem. Take Queensland, where the peak body for HIV awareness (QAHC) was ripped of the majority of its funding, and health promotion was brought in-house, under the minister.

How does a minister’s office manage the political fall out from health promotion messages? How does a minister’s office communicate to a stakeholder group using smart phones for “long wired action with three or more guys for hot raw sex”?

Health promoters have to talk about topics that the Country Women’s Association might have a little mouth-chuck over. HIV prevention groups talk to groups that may be breaking the law and taking risks that you don’t chat about over high tea (such as drug use and promotion).

Should the mainstream press start taking an interest in these marketing efforts, they could cause significant political harm. This creates an awfully big incentive to stop controversial messages ever leaving the minister’s office. Public health gets stymied by politics.

Which is why, as Professor De Wit explains, the World Health Organisation (WHO) believes health promoters should be in the community, not in politics. “A critical component is that (the health promoter) is apolitical. They should be community run and done with the involvement of the relevant community. The WHO recommend this is because they know it is better,” he says.

Now is a tense time for health promoters. Their health promotion message has to be more nuanced and targeted. The cloud of defunding is now over their heads.

Will HIV health promoters be able to meet this challenge or will the fear of defunding render them impotent, with measurably less successful outcomes, making them yet more vulnerable to defunding or closure.?

About the author

Miles has worked as an advocate and mediator for most of his life. His previous career was focussed on employment and discrimination cases. He now is a journalist and writer with a keen interest in LGBTI affairs and national politics. He plays on Twitter under @mileshef.