Why a 'Just Use Condoms (and Now Shut Up)' strategy won't work (for everyone)
Simplistic slogans about condom usage and nothing else are not sufficient, instead gay men need to understand how HIV transmission works - in all its detail.
Frankly, I have been quite amused by the fierce reactions to my previous columns that dealt with sexual risk reduction for gay men. I learned there are a huge number of intolerant queens out there, who not only loudly oppose views that differ from their own - which is fine with me - but who do so by trying to undermine the credibility of the person airing these views - me, that is - using rather nasty (also quite funny sometimes) personal attacks. Many of these people tend to see sex as something harmful, dirty and risky. It should be stated here - there is no inherent harm in gay sex - but there is harm in HIV.
Many of the people responding to the columns seemed upset that I was discussing details of risk reduction strategies - making risk reduction more complex and varied, trying to make people think about different options for reducing risks for HIV in incremental steps, rather than promoting 'One Message / One Strategy Fits All'.
Instead, they want me to stick to their own view on HIV prevention, which is: JUST USE CONDOMS ALWAYS (AND NOW SHUT UP). I decided to honour these people, bestowing them the title of Condom Queens.
Many Condom Queens think that talking about incremental HIV risk reduction strategies makes HIV prevention more complicated, and that it can lead to confusion. Implicitly, they are suggesting that most gay men are not smart enough to base their behaviour on a more complex set of knowledge, suggestions and ideas. Therefore we should stick to one clear and simple message. I will repeat it here: Just Use Condoms (and Now Shut Up).
Didn't that also work well for smoking? (Oops... No, it didn't).
Your Majesties, allow me to address you here in my humble column. You can no longer ignore the reality of how HIV affects gay communities in Asian cities. The HIV epidemic is enormous and growing day by day. Your message (Just Use Condoms (and Now Shut Up) may be working well for you - although sometimes those shouting loudest about condoms may be the ones who in fact use condoms the least. However your message is definitely not working for a large group of gay men.
While your message is short and simple, you should realise that the transmission of HIV is not a simple issue. It links to taboo topics such as sex, submission / domination, power, drugs, passion, lust - things that are difficult to discuss or rationalise for many people. A recent study in Australia and data from Bangkok suggest that the occurrence of unsafe sex is related to socio-psychological and emotional problems that gay men face, including depression, fear of rejection, loneliness, alcohol and drug abuse, suicidal thoughts, fear for getting older - to mention a few. Therefore, if we want to change the parameters of unsafe sex, just giving knowledge can never be more than just one tiny component.
'Don't be silly, put that condom on your Willie', is what we said in the 1980-1990s. Right. That sounds easy! 'No condom, no sex.' A-ha. Everybody knows that. So why are so many people not doing just that? It is because the problem is not a lack of knowledge. It is more than that. We want love, we want to be loved. What we know is one thing, what we feel and what we (think we) need is quite something else. We need to discuss these feelings and needs in relation to our sexual behaviour. Only then can we make these behaviours safer.
Two decades after Silly Willie (and their Thai, Cambodian, Chinese and Vietnamese equivalents) 31 percent of gay men in Bangkok are infected with HIV. Incidence of HIV is highest in those under 22 years old. Infections in Singapore, Hong Kong, Beijing, Shang Hai, Guangzhou, Mumbai, Manila, Kuala Lumpur, Chiang Mai, Phnom Penh, Hanoi and other cities are all on the rise.
Instead of suggesting that HIV prevention activists, donors, Ministries of Health take a moment to ask ourselves whether what we are doing is right, or whether we might need to do something more or something different, the Condom Queens say: Just Use Condoms (and Now Shut Up).
My column of two weeks ago can basically be reduced to just one sentence, which is: "oral sex (yes, also without condoms) is safer than anal sex, so let's promote more oral sex and less anal sex". And look what happened! I was close to receiving death threats for saying it out loud. Shame on him! Pull a Condom Over His Head and may he Suffocate in Hell & be Doomed to 19 hours of Condomless Oral Sex Per Day Forevermore. Amen. (Where do I sign up??)
But seriously - we have known for ages that oral sex is much, much safer than anal sex. Why all the fuss? Well - many people I meet in my environment do NOT know this. Because they do not understand the ins and outs, the details of HIV and how it is transmitted. Based on the 'No Condom No Sex' - message, they think oral sex and anal sex are the same in terms of HIV risk. Since they often do not use condoms in oral sex, they may think that since they are at risk anyway, they may as well not use condoms in anal sex either. Telling them the truth, I am convinced, will lead to less people using condoms in oral sex and more people using condoms in anal sex.
The 'No Condom No Sex' message also implies that 'sex' equals 'penetration'. Is mutual masturbation, thigh sex or mutual licking or erotic massage / stimulation no sex? I think it is. Why don't we promote that as vigorously, or more vigorously, than using condoms? Why don't we promote solo masturbation, the safest technique of all? "Two Jerk-Offs Per Day Keeps HIV At Bay". Or something like that - I have never seen that one before. All these sexual techniques are perfectly safe. Fun too, especially in the shower. Why all the fuzz about condoms? Fuckers. I mean that literally.
The term 'Safer Sex: Needs Discussion' which I see on Gayromeo and Gaydar website profiles used to make me angry. Are the people who put this on their profile irresponsible? Or are they perhaps more responsible than the Condom Queens - who flatly deny the need for allowing discussion of additional ways to reduce risk?
"No Brain, No HIV Prevention".
What I am saying is: We should stop using these simplistic slogans to advise gay men on how they can reduce their risk of HIV transmission. We have to make them understand how HIV transmission works - in all its detail. We have to help them understand what makes them vulnerable,for example by linking HIV risk to socio-emotional well-being or states of mind. Doing so will provide them options on how they can reduce - or even eliminate - risk.
Yes, Your Majesties, reducing risk also includes condoms. But not exclusively.
In our communities, safer sex needs discussion - and urgently so. In that sense I am happy and grateful for the response my columns have sollicited. Thank you for your attention and for your views.
This article was first published on Fridae on Jul 28, 2009. Jan Wijngaarden has worked, in different functions and roles, on promoting HIV prevention, care and support for men who have sex with men (MSM) since 1994. He is also the moderator of MSM-Asia, an information network on MSM, HIV and human rights, with nearly 600 members from across the region. If you want to become a member of MSM-Asia, or for information requests or comments, pls contact him at email@example.com.