“Messages that focus solely on condom use do not engage with the psychological and social issues that inflame people’s desires to engage in risk-taking behaviour,” writes Angelus Morningstar.
In June, the World Health Organisation released a statement regarding targeting high risk demographics with gaining access to PrEP (Pre-Exposure Prophylaxis, whose most common form is known as Truvada) as a means of managing and preventing the spread of HIV. One of those demographics was men-who-have-sex-with-men (MSM, a term designed to focus on sexual activity, rather than presume identity). This was sometimes misreported as being about the WHO saying all gay men should be on PrEP. However, it has sparked some controversy, particularly as there are increasing numbers of people who are embracing PrEP as a supplement or even replacement for condom use, with a movement known as Truvada Whores.
This discussion is opening up into a large array of social and cultural problem that many young men in the queer communities are grappling with. As we enter into the third decade of the AIDS epidemic, messages about safer sex are becoming increasingly complex and sometimes difficult. Part of the problem is the way that we cannot honestly discuss the prevailing desire amongst young men who have sex with men to seek barebacking. I use this term deliberately because it is an incredibly erotic word, which nevertheless provokes a sense of discomfort for many. This article necessarily discusses unprotected sex practices relevant to the gay community and for men-who-have-sex-with-men (MSM). In doing so, I hope to address the silence on on a highly taboo subject. The longer this conversation remains unspoken, the greater the numbers who take uninformed risks.
While messages of safer sex still remain necessary, particularly for those in the 20s demographic, an overly simplistic message of condom use is failing to address these complex desires, and a broader problem of stigmatisation around HIV status. What is being discussed here is not just individuals who occasionally indulge unprotected sex, but also individuals that actively seek it out (whether they are HIV+ or not). The reality is that such desires are deeply complicated, and represent the site of a convergence of cultural, sexual, medical, and even historical influences. Effectively, this is an article that discusses the semiotics of barebacking; that is, the meaning we come to individually and collectively ascribe to condom use and their absence.
Michael Shernoff’s book, Without Condoms, explores the psychology surrounding these sex practices. His main finding is that barebacking, as a sexual practice, is contextual, to the point that it mostly describes a specific experience of unprotected sex between men that is casual and/or anonymous. He noted that the gay communities had embraced hedonism as statement of sexual liberation, and were subsequently slow and resentful to accept the reality of the health risk epidemic created by HIV. Specifically, he highlighted a number of factors that inform the desires and choices regarding barebacking. These can include aversions to condom use or other safe sex, the ‘sanctity’ of a committed relationship, alienation from mainstream gay identities that produce a desire for deviant experiences, internalised homophobia, fatalism of eventual infection, and substance use.
Similarly, Hélène Joffe, in her article ‘Intimacy and Love in Late Modern Conditions‘, identified a strong correlation between unprotected sex practices as part of the formulation of committed relationships between male partners. The transition away from condom use signified the development of emotional ties and intimacy: she suggested that condom use signified a given sex act as public and impersonal, but the lack of condom use construed the act as personal and intimate. She argued that the condom has come to signify a barrier against intimacy. Where sex signifies an expression of love and intimacy, than the discontinuing condom use signifies the establishment of trust, which transforms the relationship from the casual to the stable, while continued use undermines the sense of exclusivity and commitment. What is important to take away from her work is that an aversion to condom use may indicate a desire for the achievement of emotional intimacy, which she found was experienced most viscerally through seminal transmission.
Both Shernoff and Joffe describe the way that individual desires can override prevailing instinct for self-preservation. Moreover, both of them talk about the way that our modern social arrangements can exacerbate or inflame these desires. There are increased levels of anonymity and we are surrounded by a constant flux of environmental stimuli: that which is private becomes authentic, and that which is public creates alienation. As a result, we come to cherish those encounters, spaces, and experiences that we consider to be private as they are experienced more authentically than the public. One of the strategies that we sometimes employ to offset that alienation as experienced in our casual sexual encounters is to indulge in the sense of intimacy that can be created in unprotected sex.
Of course, this is simply one aspect that informs our desires, but it is subtle and pervasive. Beyond the relevance of forming transitory relationships, and the incidents of unsafe sex that occur due to drugs and alcohol use, there are many other factors that drive risk-taking and risk-seeking sex. Attitudes regarding casual barebacking range from an ambivalence towards the health implications, right up to a fatalism experienced about STI infection. Ironically, the issues of stigmatisation around HIV transmission are one of those factors that can feed these self-destructive behaviour as they inflame fear, self-loathing, and anxiety. For some, this manifests as an underlying desire to reject the symbolic loss of liberty created by safer sex regimes. For others, it stems from an experience of exclusion from the gay scene, and finding solidarity with similarly stigmatised people. Some are also intentionally or unconsciously self-destructive and nihilistic.
At their most extreme, these experiences can manifest as people who deliberately seek HIV infection (so called bug-chasers). However, before commenting, it is important to note that in Shernoff’s study of barebacking, that even though a fairly large number of the men sampled were willing to risk infection, the actual number of those who intentionally sought to transmit the virus was infinitesimally small. The motivations of those deliberately seeking to become positive are a complex tangle of conscious and unconscious motivations. In some circumstances, the anxiety experienced over the possibility of future infection was so intense as to be debilitating. To then proactively control the situation in which they become positive and to finally have concrete knowledge of their status gives such persons a sense of empowerment they lacked from the state of limbo created by uncertainty of status.
In addition, because the experience of HIV is so viscerally experienced, criminalisation and stigmatisation of HIV is directly experienced by HIV+ persons. Being diagnosed as HIV+ can dislocate people from social networks. Criminalising HIV transmission provides strong disincentives not to test or disclose. Studies show that HIV exposure is not deterred by criminalisation. One third of high-risk sexual subjects never test, preferring not to know their status and thereby making them feel absolved of social and legal responsibilities. Many HIV+ persons fail to disclose their status to primary partners, with only one-half disclosing to casual partners.
Having unpacked the range of problems we face in tackling safer sex, some thought must now be given as to how to address it. Firstly, condom use remains the best means of preventing the transmission of most sexually transmissible diseases, to the point that most of the sexual health sector would encourage its use even amongst long-term committed relationships. However, messages that focus solely on condom use do not engage with the abovementioned psychological and social issues that inflame people’s desires to engage in risk-taking behaviour. It is not like condom use is not a message that isn’t already out there.
Even though condom use plays an important role in safer sex, an over-reliance on it shifts the issue away from the issues of desire and aversion, and does nothing to speak to the underlying causes of risk-taking sex. So any approach that fails to grapple with these complex issues relegates the legitimacy of those desires into the taboo. When something becomes taboo it becomes shameful and stigmatised. Moreover, the denial of these desires creates a sense of forbidden fruit, and that tends to excite and inflame those desires. When such desires cannot be discussed publicly without shame, discussions go underground. It is little wonder that men who have sex with men and who are hungry for this type of risk taking behaviour are finding ways to meet in a discreet manner outside of the gaze of a disapproving public.
By making it harder for people to speak candidly about their experiences, their acts, and their risks, it actively discourages them to approach and access public health service. It means that people who don’t normally partake in risky sex acts, or perhaps indulge in one after normal judgment is impaired by alcohol, have a huge disincentive for approaching sexual clinics for services like PEP (Post Exposure Prophylaxis), or even PrEP (Pre-Exposure Prophylaxis).
So where does one finish an article like this, which has covered a lot of complex social, legal, and cultural contexts? Making sense of all of these issues can be intensely taxing. If there was any message that I think people should walk away with, it’s that there is no simple line that cannot be crossed, but rather there exists a broad and ambiguous no-man’s-land between safe and unsafe sex practices. There is no single solution, but to start it’s best to think in terms of safer sex, rather than safe sex. No sex is completely safe, and so any approach to condom use must be accompanied by a humanisation of desire and transmission. STIs are fundamentally a human problem, and if we approach that problem with only a clinical solution we begin to dehumanise the people involved.
Silence leads to erasure, victim-blaming, and a breakdown of community.