“Always wear a condom” Isn’t Enough
by James Dawson | 22nd August 2014
It’s some thirty years since the AIDS pandemic began to decimate the gay community. Anyone who survived that time, or, like me, watched on in fear, will never forget the very simple message disseminated at the time: Always Wear A Condom.
How is it then, with such a simple rule to follow, HIV acquisition rates, especially among young gay men, are rising, not falling? Something’s not quite connecting and this was something I wanted to address in This Book Is Gay, the first guide to sex and relationships for young, modern LGBT people.
It’s my job, I believe, to not sugar-coat or pretty-up sex for young adults. I don’t think that’s helping. So here’s the truth no-one dares utter: Sex feels better without a condom. A contact describes sex with a condom as ‘like wearing a rain coat in the shower’ and he has a point. The new question becomes ‘is sex so much better without a condom, it’s worth gambling your health?’ Of course the answer is NO, but we can’t rule out this most basic of reasons why some gay and bi men choose to eschew condoms.
That’s not the whole story. The post-pandemic generation was sufficiently scared into condom-compliance regardless of how much better sex might feel. I’d argue poor education is chiefly to blame, and is certainly the impetus behind This Book Is Gay. By this I mean both school based sex education and general health messages. Now that there are effective treatments for managing HIV perhaps emphasis has slipped as a public health issue.
I interviewed a young man who wished to remain anonymous as part of my research. A pupil at a Catholic school, he received very little sex education at all and didn’t feel able to talk to his parents about sex. As such, with little media awareness, he truly believed AIDS was something that affected women in Africa. He tested HIV positive through unprotected sex aged nineteen.
I don’t know if pornography is to blame, but it certainly doesn’t help. Post AIDS, nearly all gay porn depicted condom use (even if the condom does magically appear, hands-free, seconds before penetration). However, with a little time, bareback fetishism crept into pornography and you don’t have to look far at all to view condom-free porn. And let’s not even get into ‘bug chasing’ – that’s a whole other issue.
The problem with porn is that it isn’t sex education. If sex education isn’t robust, young people will turn to the internet for advice, and porn provides only fantasy.
So what can we do to reduce infection rates? I think while we must continue with the Always Wear A Condom mantra – as this is by far the most effective way to halt the spread of any STI and prevention is better than no-actual-cure - we need a second layer of education. Namely: Get Tested A Lot.
Knowledge is power, and, HIV carriers are at their most infectious when they don’t know they’re carrying the virus. Once a patient is receiving medication, the viral load (the amount of HIV in their system) can be reduced to ‘undetectable’ levels. Basically, they are lot less infectious. If everyone knew their HIV status every time they had sex, I think we could reduce infection rates greatly.
Guidelines suggest that sexually active gay and bi men (a high risk demographic) should be tested approximately every six months. I would suggest this should be a minimum. A finger-prick HIV test takes five minutes, you can do them yourself at home or at a sexual health clinic. It’s pain free and the results are instant. When writing This Book Is Gay, the only reason I heard to not get tested was from a man who was simply terrified of the result.
The next step is likely to be PrEP – Pre-Exposure Prophylaxis. High-risk groups in the US are now being given a truncated version of HIV treatment to prevent converting to HIV positive. It’s not a vaccine, however, and it’s only effective if taken routinely. Trials are still underway in this country, but it seems likely to be made available on a voluntary basis soon.
It’s my hope that This Book Is Gay will help drag HIV into the 21st Century. Young people must be made aware of HIV, the risks, and taught the lessons we learned in the nineties but also how to approach HIV without fear and stigma, but knowledge and protection. As HIV campaigner Kristian Johns so eloquently said: ‘HIV is no longer a death sentence, but it’s one hell of a life sentence.’
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