What’s wrong with barebacking, if there is something wrong about it.
 |
| Riding bareback: personal choice vs. social responsability? |
The recent decision by the IML’s (International Mr. Leather) executive committee to ban retailers at the group’s annual convention from displaying or selling any pornographic photos and videos which portray or promote unprotected sex, also known as barebacking, triggered a heated debate in the gay and HIV blogosphere. The most quoted response came from Tony Valenzuela who in part elevated the debate above that of accusation of fascism and censorship writing:
“Maybe the better question isn’t whether or not IML’s new policy is censorship – it is by definition – but whether censoring bareback porn from the IML marketplace, however offensively this may strike some of us, is worth the presumed outcome of “social responsibility” and health?”
First, it must be said that there is nothing wrong with barebacking if it occurs between two people who know for sure that they are sero-concordant (i.e. that they have the same HIV status, either positive or negative) with the notable exception that they may infect one another with other various Sexually Transmitted Diseases (STI) such as syphilis, gonorrhoea, Chlamydia, LGV and Hepatitis B to mention only a few, but these do not seems to trigger as much debate in the community.
What is really wrong or at least questionable with barebacking is when the performers do not know their status or believe that they know it, as in “I am negative, ok, my last test was 18 months ago but I am clean!” and willingly engage in barebacking when condoms are readily available and practical to use. Note that this is a fundamental point on which all the following line of reasoning hinges. Then, one is willingly putting itself at risk of being infected and the other is willing taking the risk of infecting his sexual partner. This is usually where personal responsibility, choice and right to enjoy one’s sexuality as one likes it enter the argument.
“Leave it to consenting adults to decide, no?” wrote Valenzuela. Answering yes to this question means that it is fine for people to get infected with HIV since they consented to it. But is it? and did they consent to it? This may be true as long as the people who engage in bareback know their status (see above) but what when this is not the case? What when the issue is not discussed? What when it happens for whatever reasons beyond a participant’s control or will (see below)? “Well people can talk about it” But do they? It is clear that this is certainly not the case! (See the feature article “Can we talk about HIV” in FS magazine).
“Well then we need to provide people with appropriate information and educate them so that they can make an informed decision about it!” But is this really what happens at this crucial point in time where an immediate decision is needed? There are many reasons to believe that this is not the case. Education or reason are no substitute for habit (such as putting on a condom) and can easily be silenced in the heat of the moment particularly when under the influence of alcohol, drug or simply love or fear of rejection.
The issue, and the debate, is much larger than that of bareback and it is not about bareback being dangerous or irresponsible or that it should be banned and it is certainly not about “The business of protecting you from your untrustworthy self has historically been the province of the right wing.” (Valenzuela, ibid.) The left wing control freak nanny state is not any better. The real debate is about an individual decision to favour personal freedom and right to satisfy one’s own pleasure or of a collective public health response to an epidemic that concerns all of us.
Let’s look at a nowadays less controversial debate, the ban on smoking in public places. Many smokers are well informed and well educated people and know the risk associated with their smoking habit. Nevertheless they still have an individual right to smoke should they wish to. So why ban smoking in public place and confined smokers in claustrophobic spaces where they can happily and willingly increase each other’s risks of developing lung cancer and receive treatment as the expense of the community (at least in Europe but not in the US where strangely enough barebacker advocates are most vocal)? Because their behaviour is damageable to the general public and is a public health issues, even in the US where they do not always have to receive treatment (because the idea of a universal health system is dangerously socialist, but this is a diversion).
Let’s consider another example. Would Polio have been eradicated in Africa if people had been offered the choice or not to receive the immunisation? The answer to this question can be found in the resurgence of measles in the UK following the decision of a few parents not to immunised their child by fear that the MMR vaccine was causing autism.
This is where individual freedom and rights are conflicting with the collective good. For some reasons, the response to the HIV epidemics does not to comply with standard principles of public health interventions. Why is a long story not yet fully uncovered and told but it will be an interesting one in a few decades.
What matters is that the issue of barebacking (and its promotion or acceptability) as well as many other must be discussed openly and publicly. As noted by Jim Picket, a gay men’s health advocate, “Gay men SHOULD be critically engaged in our collective health and wellness, and that includes being mindful of everything we consume, including porn.”
At no rate such issues should be ignored of brushed aside on the ground of personal choice or because “the term “barebacking” unfairly stigmatizes gay men who have unprotected sex” as the representative of the Gay Men’s Health Crisis (GMHC) decided in conclave. After all, barebacking and barebackers are names that were born out of the gay community; they have not been imposed by external forces.
In this regards rebranding bareback sex as “raw sex” is an exercise in tortured PC and is as dismissive of a reality that affects all of us as saying that it is fine because it happens between consenting adults. Let’s not burry our head in the sand even deeper.
The crucial debate is about choosing between shared responsibility and individual freedom. The answer to this is not easy, it is both personal and collective but it won’t be found if it can’t be debated honestly, openly and without the fear of name calling. Lest we forgot to bluntly dismiss other’s opinion is as stigmatising as dismissing their sexuality.
But there is definitively a point of agreement: barebackers must be included in health promotion and HIV prevention interventions.
Is the “cum-pig” set for PrEP?...
Are modern HIV campaigns failing younger gays?...
“Just Use Condoms (and Now Shut Up)”...
Disco dosing: when your Disco kills you, the Western Way....
HIV on the rise in the Philippines: Will condoms do any good?...
Related posts brought to you by Yet Another Related Posts Plugin.
Hi Peripheries, thanks for this article!
You write about 'barebacker advocates" and the promotion of barebacking. I think this kind of language subtly shifts the image of folks like me away from speaking to where people are at in order to meet their needs from a harm reduction perspective and replaces it with an image of folks like me promoting people to adopt a particular behaviour. This is a false representation and is unhelpful to the debate. This is also the same tactic used by opponents of needle exchanges, condom distribution and comprehensive sexual education from an early age. The argument goes that needle distribution encourages people to use more drugs intravenously (unfounded), that condom distribution encourages people to have more sex (unfounded) and that sex education encourages people to become sexually active from an earlier age (unfounded).
Similarly, speaking openly and honestly with people about the fact that they do not always use condoms for anal or vaginal sex – sometimes by choice, sometimes by accident – is not going to persuade them to suddenly do it more often or convince their friends that they should do it too. And just as forcing people to re-use needles will not stop them from injecting drugs, telling people to abstain will not stop them from having sex, and withholding sex education will not stop teens from banging each other in their parents' basements, suppressing "bareback" porn will not have much effect on the number of people fucking with condoms or the number of people fucking without.
I do understand that, in your opinion, bareback porn should be less available. Alright. But if we agree that this will have little impact on the actual amount of condomless sex occurring, I am curious to know what your bigger picture is — how are we to reduce the amount of HIV transmission by increasing men's capacity to consistently use condoms if that is a goal they have set for themselves? What tools should we give them to do that? Or conversely, from the approach you present here, what else should we censor in the hopes they will somehow be convinced of your line of reasoning?
Because ultimately, that is what you have presented here. A very sound line of reasoning on the ethics of condomless sex according to one individual with their own set of values, experiences, etc. But — and I mean this in a nice way — so what? The obvious answer is that some folks flat out disagree with you. And short of putting people in jail for condomless sex (bad idea!), I'm not sure what your suggestion is.
As an outreach worker who talks with gay men about these topics every day in bath houses, bars and online chat rooms, I don't really have the option of taking this philosophical view of condoms and anal sex. Men are seeking from me concrete tools to help them meet their self-defined goals and a non-judgmental space for them to speak honestly about their hopes, fears and desires. If I then presented them with a rigid line of reasoning like you have above, they would disappear, not return, and an opportunity for genuine health promotion would be lost.
You want men to stop having condomless sex for the sake of public health and collective responsibility — but what are your *realistic* and *practical* steps to making that happen?
Thank you for the opportunity for this sort of respectful dialogue! Talk more soon!
Dear Nico,
Thank you for your thoughtful comment. However I think we are both victim of misrepresentation. Thought I should not have used the words “bareback advocates” but rather, “people who say that bareback is fine when it happens between consenting adults” (longer but more accurate), I do not support banning bareback porn (and I say so in the above post) or even making it less available and it would not even come to my mind to suggest “putting people in jail for condomless sex”. I think the last sentence of my post clearly state my view on what to do with barebackers.
So that was for the misrepresentation.
The point of my post is to highlight how we are slightly but surely moving away from condom-based prevention on the grounds of personal rights and freedom of choice or on the ground that condoms do not work when in fact it is prevention interventions that do not work. Incidentally, such change in approach provides fodder for those who really advocate against condoms on religious ground. To promote condoms is now viewed as paternalist, and people even look at you suspiciously when suggesting using condoms, “Why? You are not safe?” This is part of my personal experience, as valid as anybody else.
Please remember that my line of reasoning applies to a very particular set of circumstance, emphasised at the beginning of the post, i.e. when condom are available and practical to use. It does not apply to other circumstances.
You will find throughout this blog that not only I support many other options than condoms when the circumstances demand them, but that I also oppose the “Condoms Queens” views on safe sex . But I personally refuse to give up on promoting what I see the best prevention tool against HIV and I think we should do more and do it differently and in particular bringing the people in (such as barebackers) and give them a stake in the fight against HIV.
I can’t answer your question about what to tell to men who seek from you “concrete tools to help them meet their self-defined goals”. Because I don’t know what their goals are. But I would be interested to know. I am sure you have different answers to different cases, which confirm the “not one size fit all” consensus. But when it comes to harm reduction strategies, they are what they are, they are not prevention strategies and a problem arises when the former are taken and assumed to be the same as the later.
Consider these two statements: (1) Harm reduction strategies are not designed to stop HIV spreading they are design to reduce the risk of HIV infection in circumstance where people cannot use adequate prevention strategy. (2) Harm reduction strategies are not designed to stop HIV spreading they are design to allow people to enjoy the sex they want.
Which one do you support? Which one should be push forward? Which one is being heard?
I am sure some would disagree “flat out” with me, and say that they have a right to assume their sexuality, but it’s my turn to then say “so what?” Will that protect them against HIV? Will that protect their sexual partners? Will that make their life healthier? I am not to tell tehm "No" to these question, but I would engage them into discussing these questions as I believ many have the answer within themselves. This reminds me of some biker friends of mine who don’t care about cars when on the road because in case of accident the driver will often be legally wrong, and I to add, “yes and you will be dead, right but dead.”
How do you persuade someone to use the best prevention strategy? It depends on individual circumstances and what I suggested once is that knowing “Why men use condoms?” was much more interesting than finding out “Why men don’t use condoms” and that there would-be lessons to learn here.
I do not have or pretend to have all the answers, but if we don’t hear the questions, if we don’t position the debate were it belong (i.e. public health), we won’t find the answers, we won’t be able to talk about the conflict between this that men wants and that that society needs. It is not about being right or wrong; it is about understanding human behaviour and needs and being able to change them, because yes, ultimately it is about change, social change like the one that lifted Thailand out of the epidemic in the 90s, and the lack of the same social change that left Thai MSM at the heart of the epidemics.
Very best and keep doing your good job in bathhouse, online and on your blog.
Dear Nico,
Thank you for your thoughtful comment. However I think we are both victim of misrepresentation. Thought I should not have used the words “bareback advocates” but rather, “people who say that bareback is fine when it happens between consenting adults” (longer but more accurate), I do not support banning bareback porn (and I say so in the above post) or even making it less available and it would not even come to my mind to suggest “putting people in jail for condomless sex”. I think the last sentence of my post clearly state my view on what to do with barebackers.
So that was for the misrepresentation.
The point of my post is to highlight how we are slightly but surely moving away from condom-based prevention on the grounds of personal rights and freedom of choice or on the ground that condoms do not work when in fact it is prevention interventions that do not work. Incidentally, such change in approach provides fodder for those who really advocate against condoms on religious ground. To promote condoms is now viewed as paternalist, and people even look at you suspiciously when suggesting using condoms, “Why? You are not safe?” This is part of my personal experience, as valid as anybody else.
Please remember that my line of reasoning applies to a very particular set of circumstance, emphasised at the beginning of the post, i.e. when condom are available and practical to use. It does not apply to other circumstances.
You will find throughout this blog that not only <a hrf="http://www.peripheries.org/2009/04/08/condoms-are-no-%e2%80%9csilver-bullets%e2%80%9d/"> I support many other options than condoms when the circumstances demand them, but that ,a href="http://www.peripheries.org/2009/07/28/just-use-condoms-and-now-shut-up/"> I also oppose the “Condoms Queens” views on safe sex . But I personally refuse to give up on promoting what I see the best prevention tool against HIV and I think we should do more and do it differently and in particular bringing the people in (such as barebackers) and <a hrf="http://www.peripheries.org/2008/10/30/msm-in-cambodia-a-personal-stake/">give them a stake. in the fight against HIV.
I can’t answer your question about what to tell to men who seek from you “concrete tools to help them meet their self-defined goals”. Because I don’t know what their goals are. But I would be interested to know. I am sure you have different answers to different cases, which confirm the “not one size fit all” consensus. But when it comes to harm reduction strategies, they are what they are, they are not prevention strategies and a problem arises when the former are taken and assumed to be the same as the later.
Consider these two statements: (1) Harm reduction strategies are not designed to stop HIV spreading they are design to reduce the risk of HIV infection in circumstance where people cannot use adequate prevention strategy. (2) Harm reduction strategies are not designed to stop HIV spreading they are design to allow people to enjoy the sex they want.
Which one do you support? Which one should be push forward? Which one is being heard?
I am sure some would disagree “flat out” with me, and say that they have a right to assume their sexuality, but it’s my turn to then say “so what?” Will that protect them against HIV? Will that protect their sexual partners? Will that make their life healthier? This reminds me of some biker friends of mine who don’t care about cars when on the road because in case of accident the driver will often be legally wrong, and I to add, “yes and you will be dead, right but dead.”
How do you persuade someone to use the best prevention strategy? It depends on individual circumstances and what I suggested once is that knowing “Why men use condoms?” was much more interesting than finding out “Why men don’t use condoms” and that there would-be lessons to learn here.
I do not have or pretend to have all the answers, but if we don’t hear the questions, if we don’t position the debate were it belong (i.e. public health), we won’t find the answers, we won’t be able to talk about the conflict between this that men wants and that that society needs. It is not about being right or wrong; it is about understanding human behaviour and needs and being able to change them, because yes, ultimately it is about change, social change like the one that lifted Thailand out of the epidemic in the 90s, and the lack of the same social change that left Thai MSM at the heart of the epidemics.
Very best and keep doing your good job in bathhouse, online and on your blog.
PART 1 of 2
Hello again! Thanks, Peripheries, for taking such a measured approach in pointing out the mistakes I made about your opinions on these topics. Your lengthy reply lets me understand more how you see things – thanks!
You perceive a subtle but certain shift in HIV prevention away "from condom-based prevention on the grounds of personal rights and freedom of choice or on the ground that condoms do not work when in fact it is prevention interventions that do not work."
So, I'll put myself out there as an example of how one HIV prevention worker goes about his work with men who have sex with men. My intention here is to describe that if such a shift exists, it is based on a false binary: condom-based prevention VS. an approach of sexual harm reduction that is supposedly fearful to tell men what to do with their bodies or whether or not to use condoms. I guess I am suggesting we can have our cake and eat it too — and I'm curious to see if you agree or not.
So what I am posting below is the template I use when chatting with gay men in online chat rooms. When I enter the chat room, I post a message in the common chat space that says, "Hey guys! I work for the AIDS Committee of Ottawa answering health questions like: Fastest & easiest place in Ottawa to get tested? Risks of oral? What activities are high vs. low risk? Harm reduction tips if you choose to bareback. Fisting? Safer PNP?… PVT me. Thanks!"
So then a guy will private chat me about one of those topics or something else he has on his mind. And it's quite common that a guy will start off saying, "Harm reduction tips if I bareback?? I thought that was high risk??" or "Is there really a way to fuck without condoms and have it be safe??" or "You're an asshole for talking to guys about barebacking in that way. If guys would just put on a condom on before they fuck we wouldn't be in this mess."
So that opens a space for some conversation where there wasn't one before. And the template I use for that conversation, goes like this:
____________________________________________
A lot of guys ask me about that phrase "Harm reduction tips if you choose to bareback". And I understand why — most of us have learned that anal sex without condoms is high risk. And that is 100% correct. I'll explain a bit about what I mean by "harm reduction for barebacking" and please feel free to stop me along the way to disagree, ask questions, ask me to explain stuff more, etc…
The Canadian AIDS Society classifies anal sex without condoms as a HIGH RISK activity for HIV transmission – for both the top and the bottom. There’s no way around this fact.
A lot of guys ask me, "Is the risk different for the top vs. the bottom?"
Here’s what the Canadian AIDS Society says:
"Any notion that the top partner in [unprotected] anal sex has a low risk of infection is untrue. Although more cases of transmission have been attributed to the bottom partner, the number of infections among tops is significant enough to make this a high-risk activity."
Here’s what San Francisco Public Health says:
“Unprotected anal sex is a very high risk activity for a bottom, much more so than for a top. The risk of HIV transmission to a bottom during unprotected anal sex is 15 in 1,000 versus 3 in 10,000 from a bottom to a top.”
Nevertheless, tops still become infected at rates high enough that it qualifies as a high risk activity.
Is bottoming more risky than topping? Yes.
Is topping without condoms still a high risk activity? Yes.
How can I reduce the potential harm of unprotected anal sex?
Studies show a majority of Ontario gay men consistently use a condom for anal sex. That said, some of us don't manage to use a condom every single time – even when we had every intention to. And also: a minority of guys are simply comfortable with that high risk of transmission and opt not to use condoms.
No matter how you do it, anal sex without condoms is a high-risk activity for HIV. But within that high risk category, there are things that guys can do to keep the potential harm at its lowest potential. It is STILL HIGH RISK, but it makes sense to reduce potential harm as much as possible.
This is NOT a set of HIV prevention guidelines. It is intended for men who have already decided not to use condoms for anal sex and are aware that it is high risk for HIV transmission. It is also for men who intend to use condoms and sometimes – for all kinds of reasons – struggle to make that happen. As well, a lot of these tips still apply even when you ARE using condoms.
PART 2 of 2
(…this is a continuation of the template I use while chatting with guys online…)
1.So first thing: If you want to know, *ask* about his HIV status and *ask* when he was last tested. Better yet, start by offering that info yourself. It makes a big difference WHEN he was last test. Here's why:
11% of Ottawa gay men are HIV+ and about 30% of them don’t know it. 50-70% of new infections result from this 30% who don’t know their status, NOT from guys who know they are positive.
So if he says he’s HIV- but hasn’t been for a test recently, it means he doesn’t know his actual status.
If you’re both poz, you may not have the same strains of the virus with the same reactions to meds. Some poz guys are comfortable with that risk, others are not.
2.Get tested for HIV and STIs regularly.
The HIV part of testing can seem obvious, but regular STI testing is just as important. Here's why… STIs make HIV positive men more infectious and HIV negative men more vulnerable to infection. And it is common to have an STI without knowing it. Your best bet is to get tested for both STIs and HIV regularly.
3.Bottoms can protect both themselves and the guy topping them by taking care of their ass.
The lining of the ass is very delicate and can be damaged easily. If it’s damaged and you fuck without a condom, there is more chance of HIV being transmitted – for both top and bottom. Also, if your ass is damaged, the body's defences will spring into action, and these are the cells that HIV infects.
For this reason, fucking someone who has just been fisted or had some rough fingering, or had sex toys shoved up his ass, makes it more likely that HIV will be passed on. If you take the time to relax someone's ass before fucking them, by gently playing with them, then you are less likely to damage the lining of their ass.
4.Use LOTS of lube. Then use some more. Then follow that up with more lube. In conclusion, USE LOTS OF LUBE.
Lube reduces friction, and that reduces the number of micro-tears in the sensitive tissue in your ass. Tears can bleed and HIV can enter the bloodstream.
5.It’s safer for the top to pull out before cumming.
6.For those who know their status: HIV-positive guys might choose to get fucked rather than fuck. Men who KNOW they are HIV-negative guys might choose to fuck rather than get fucked.
7.Fucking or getting fucked: the more men, the more chance of transmission. Some guys choose to bareback with just one or two ongoing, stable barebacking buddies and use condoms for all their other partners.
8.The longer and harder the fuck, the bigger the risk.
9.Try to avoid poppers & Viagra when you’re barebacking. They dilate blood vessels in the rectum, making it easier for viruses to enter your bloodstream. (And they can have a dangerous combined effect on blood pressure.)
10.The bottom should try not to douche right before or right after fucking. Better yet, try not to douche at all….
11.Get vaccinated for Hepatitis A and B. It’s free for gay guys in Ottawa.
____________________________________________
Thoughts?
My goal is to open up a space for safe conversation for men who ALWAYS use condoms, men who NEVER use condoms, and all the variations in between. I don't back down from telling guys that condoms (with lube) is absolutely their best prevention method for HIV transmission during anal sex. I remind guys that a majority of men who have sex with men in their community ARE consistently using condoms. And I offer harm reduction tips, the majority of which are applicable and useful whether you are fucking with condoms or not.
I enjoy chatting with you, Peripheries. Apologies in advance if I've again misunderstood something you've written — set me straight and we'll keep on talking : )
Hi Nico,
Thanks for keeping the debate alive. You asked if I see a binary approach to HIV prevention putting condom-based prevention against harm reduction. The short answer is no. There is no binary but a continuum with condom as a starting point.
What may explain that we are sometimes talking pass each other is that there are different levels to approach the debate. Though I am very much interested in grass-root activism, the original post was aimed at policy and decision makers. The difference is between what institutions and society should aim at and what happens in the real world. I will accept that this is not an immediate concern for grass root activists.
Let me now ask you, how do you answer the guy who tells you “You're an asshole for talking to guys about barebacking in that way. If guys would just put on a condom on before they fuck we wouldn't be in this mess". Do you understand, and accept, where he comes from? If you have the time, have a look at the comments posted in response to Jan’s articles about oral sex and harm reduction on Fridae.
What is important to keep in mind is that there are a lot of guys out there who are using condoms and have been using them consistently for some time. But suddenly, a different set of messages comes out of the “HIV prevention hat”. Some people react aggressively because they don’t understand the need for these messages, some are confused because they are faced with what they understand as mixed messages, some are curious and start wondering what all the fuss about condoms is about, and some feel vindicated for not using condoms (this is a non-continuous continuum and I can’t cover all the possibilities, but I am sure you will get the gist). Anyway, at the end of the day, there is some confusion, a confusion that some (not you, I believe) deny strongly, saying that people are clever enough to know the difference. If that were true, there would not be so much debate around this issue. Ignoring the clearly visible confusion (that you have yourself experienced and that I am sure you are aware of) is a dangerous form of denial.
Existing condom-based prevention intervention failing, how are we to send a clear message without mudding even more the water debating these? In short: we need to be clear in what we say and start from the start of the prevention continuum, i.e. condom. As an aside, did you ever noticed or wondered why in the official literature HIV is always described as “the virus that causes AIDS”? Look at the front page of the Avert web site for example. Don’t we all know that HIV is the virus that causes AIDS? I let you ponder about that…
Read more in part 2 …
And now part 2….
Now as an activist you are put in a situation where you have to answer questions such as “Harm reduction tips if you choose to bareback" and you dutifully provide very good answers and support, but what is stopping you asking “What would make you choose to barekack?” Not why, but what and note that the keyword here is “choose”. Of course you can’t ask that bluntly, you wouldn’t probably get an answer, but you are an experienced prevention worker and can find a way to make people reflect on their choice of sexual practices. That’s very different from lecturing them about using condoms (something you kind of accused me of in your initial comment) and is based on the belief that indeed people can reflect on what they do, why they do it and can be the agent of their own change (sorry, I am being theoretical again…).
Imagine someone asked you “Any pain reduction tips if I choose to kill myself?”, would you start by suggesting sleeping tablets before hanging, or would you try to find out what is leading someone to chose to kill himself? That’s a crucial step prevention has forgotten but is remembering with the “re-discovery” that HIV affect mostly specific groups that have been forgotten for the past 20 years.
That’s what I call giving people a stake in the fight against HIV. It is active prevention instead of response-mode prevention. It starts long before the promotion of condoms or harm reduction.
Two weeks ago I attended a workshop on Black MSM in London. It was very interesting and you know what, we did not talk about condoms, we did not talk about harm reduction. What we talked about was the role and importance of the Black community and how to change it when it comes to its views on MSM, we talked about finding way for Black MSM to meet and discuss freely about what matters to them, and we talked about housing problem and unemployment. What all that has to do with HIV prevention? A lot, and it is being slowly rediscovered and brought frontstage. I am aware that this is still remote from your daily work (it aims at the policy makers again), but is it that remote that it stops you engaging your interlocutors in some of these issues and to “reach to reach their deeper self”?
Some years ago, a friend of mine asked why he should go for an HIV test. I believed he knew he was positive and his reasoning was that knowing for sure would only make his life more complicate. He was right. It did make his life more complicate, for a while, but then he went onto treatment and now lives a much healthier and happier life. I did not convinced him to get tested, he convinced himself with my help, based on self questioning not on lecturing, and not on freedom of choice which hinges on what you want rather than why you want it.
Your work is crucial and very important and I can't disprove of any of your goals. You clearly say that you don't back down from promoting condoms and this is what we should all start to say when we engage in this debate and repeat at regular intervals. But somehow all this is a curative appraoch rather than preventive (at list in spirit). As long as we need people to do your job, it means we have failed in our approach prevent HIV.
I stop here for now. There is much to say and the internet is not the best place to say it, because it can easily be misconstrued and willingly or ideologically be misunderstood and misinterpreted.
Vb.
Hi Nico,
Thanks for keeping the debate alive. You asked if I see a binary approach to HIV prevention putting condom-based prevention against harm reduction. The short answer is no. There is no binary but a continuum with condom as a starting point.
What may explain that we are sometimes talking pass each other is that there are different levels to approach the debate. Though I am very much interested in grass-root activism, the original post was aimed at policy and decision makers. The difference is between what institutions and society should aim at and what happens in the real world. I will accept that this is not an immediate concern for grass root activists.
Let me now ask you, how do you answer the guy who tells you “You're an asshole for talking to guys about barebacking in that way. If guys would just put on a condom on before they fuck we wouldn't be in this mess". Do you understand, and accept, where he comes from? If you have the time, have a look at the comments posted in response to Jan’s articles about oral sex and harm reduction on Fridae.
What is important to keep in mind is that there are a lot of guys out there who are using condoms and have been using them consistently for some time. But suddenly, a different set of messages comes out of the “HIV prevention hat”. Some people react aggressively because they don’t understand the need for these messages, some are confused because they are faced with what they understand as mixed messages, some are curious and start wondering what all the fuss about condoms is about, and some feel vindicated for not using condoms (this is a non-continuous continuum and I can’t cover all the possibilities, but I am sure you will get the gist). Anyway, at the end of the day, there is some confusion, a confusion that some (not you, I believe) deny strongly, saying that people are clever enough to know the difference. If that were true, there would not be so much debate around this issue. Ignoring the clearly visible confusion (that you have yourself experienced and that I am sure you are aware of) is a dangerous form of denial.
Existing condom-based prevention intervention failing, how are we to send a clear message without mudding even more the water debating these? In short: we need to be clear in what we say and start from the start of the prevention continuum, i.e. condom. As an aside, did you ever noticed or wondered why in the official literature HIV is always described as “the virus that causes AIDS”? Look at the front page of the Avert web site for example. Don’t we all know that HIV is the virus that causes AIDS? I let you ponder about that…
Read more in part 2 …
Hi Nico,
Thanks for keeping the debate alive. You asked if I see a binary approach to HIV prevention putting condom-based prevention against harm reduction. The short answer is no. There is no binary but a continuum with condom as a starting point.
What may explain that we are sometimes talking pass each other is that there are different levels to approach the debate. Though I am very much interested in grass-root activism, the original post was aimed at policy and decision makers. The difference is between what institutions and society should aim at and what happens in the real world. I will accept that this is not an immediate concern for grass root activists.
Let me now ask you, how do you answer the guy who tells you “You're an asshole for talking to guys about barebacking in that way. If guys would just put on a condom on before they fuck we wouldn't be in this mess". Do you understand, and accept, where he comes from? If you have the time, have a look at the comments posted in response to Jan’s articles about oral sex and harm reduction on Fridae.
What is important to keep in mind is that there are a lot of guys out there who are using condoms and have been using them consistently for some time. But suddenly, a different set of messages comes out of the “HIV prevention hat”. Some people react aggressively because they don’t understand the need for these messages, some are confused because they are faced with what they understand as mixed messages, some are curious and start wondering what all the fuss about condoms is about, and some feel vindicated for not using condoms (this is a non-continuous continuum and I can’t cover all the possibilities, but I am sure you will get the gist). Anyway, at the end of the day, there is some confusion, a confusion that some (not you, I believe) deny strongly, saying that people are clever enough to know the difference. If that were true, there would not be so much debate around this issue. Ignoring the clearly visible confusion (that you have yourself experienced and that I am sure you are aware of) is a dangerous form of denial.
Existing condom-based prevention intervention failing, how are we to send a clear message without mudding even more the water debating these? In short: we need to be clear in what we say and start from the start of the prevention continuum, i.e. condom. As an aside, did you ever noticed or wondered why in the official literature HIV is always described as “the virus that causes AIDS”? Look at the front page of the Avert web site for example. Don’t we all know that HIV is the virus that causes AIDS? I let you ponder about that…
Read more in part 2 …
Hi Nico,
Thanks for keeping the debate alive. You asked if I see a binary approach to HIV prevention putting condom-based prevention against harm reduction. The short answer is no. There is no binary but a continuum with condom as a starting point.
What may explain that we are sometimes talking pass each other is that there are different levels to approach the debate. Though I am very much interested in grass-root activism, the original post was aimed at policy and decision makers. The difference is between what institutions and society should aim at and what happens in the real world. I will accept that this is not an immediate concern for grass root activists.
Let me now ask you, how do you answer the guy who tells you “You're an asshole for talking to guys about barebacking in that way. If guys would just put on a condom on before they fuck we wouldn't be in this mess". Do you understand, and accept, where he comes from? If you have the time, have a look at the comments posted in response to Jan’s articles about oral sex and harm reduction on Fridae.
What is important to keep in mind is that there are a lot of guys out there who are using condoms and have been using them consistently for some time. But suddenly, a different set of messages comes out of the “HIV prevention hat”. Some people react aggressively because they don’t understand the need for these messages, some are confused because they are faced with what they understand as mixed messages, some are curious and start wondering what all the fuss about condoms is about, and some feel vindicated for not using condoms (this is a non-continuous continuum and I can’t cover all the possibilities, but I am sure you will get the gist). Anyway, at the end of the day, there is some confusion, a confusion that some (not you, I believe) deny strongly, saying that people are clever enough to know the difference. If that were true, there would not be so much debate around this issue. Ignoring the clearly visible confusion (that you have yourself experienced and that I am sure you are aware of) is a dangerous form of denial.
Existing condom-based prevention intervention failing, how are we to send a clear message without mudding even more the water debating these? In short: we need to be clear in what we say and start from the start of the prevention continuum, i.e. condom. As an aside, did you ever noticed or wondered why in the official literature HIV is always described as “the virus that causes AIDS”? Look at the front page of the Avert web site for example. Don’t we all know that HIV is the virus that causes AIDS? I let you ponder about that…
Read more in part 2 …
Now as an activist you are put in a situation where you have to answer questions such as “Harm reduction tips if you choose to bareback" and you dutifully provide very good answers and support, but why don’t you ask “What would make you choose to barekack?” Not why, but what and note that the keyword here is “choose”. Of course you can’t ask that bluntly, you wouldn’t probably get an answer, but you are an experienced prevention worker and can find a way to make people reflect on their choice of sexual practices. That’s very different from lecturing them about using condoms (something you kind of accused me of in your initial comment) and is based on the belief that indeed people can reflect on what they do, why they do it and can be the agent of their own change (sorry, I am being theoretical again…). Imagine someone asked you “Any pain reduction tips if I choose to kill myself?”, would you start by suggesting sleeping tablets before hanging, or would you try to find out what is leading someone to chose to kill himself? That’s a crucial step prevention has forgotten but is remembering with the “re-discovery” that HIV affect mostly specific groups that have been forgotten for the past 20 years.
That’s what I call giving people a stake in the fight against HIV. It is active prevention instead of response-mode prevention. It starts long before the promotion of condoms or harm reduction.
Two weeks ago I attended a workshop on Black MSM in London. It was very interesting and you know what, we did not talk about condoms, we did not talk about harm reduction. What we talked about was the role and importance of the Black community and how to change it when it comes to its views on MSM, we talked about finding way for Black MSM to meet and discuss freely about what matters to them, and we talked about housing problem and unemployment. What all that has to do with HIV prevention? A lot, and it is being slowly rediscovered and brought frontstage. I am aware that this is still remote from your daily work (it aims at the policy makers again), but is it that remote that it stops you engaging your interlocutors in some of these issues and to “reach to reach their deeper self”?
Some years ago, a friend of mine asked why he should go for an HIV test. I believed he knew he was positive and his reasoning was that knowing for sure would only make his life more complicate. He was right. It did make his life more complicate, for a while, but then he went onto treatment and now lives a much healthier and happier life. I did not convinced him to get tested, he convinced himself with my help, based on self questioning not on lecturing, and not on freedom of choice which hinges on what you want rather than why you want it.
Your work is crucial and very important and I can't disprove of any of your goals. You clearly say that you don't back down from promoting condoms and this is what we should all start to say when we engage in this debate and repeat at regular intervals. But somehow all this is a curative appraoch rather than preventive (at list in spirit). As long as we need people to do your job, it means we have failed in our approach prevent HIV.
I stop here for now. There is much to say and the internet is not the best place to say it, because it can easily be misconstrued and willingly or ideologically be misunderstood and misinterpreted.
Vb.
Now as an activist you are put in a situation where you have to answer questions such as “Harm reduction tips if you choose to bareback" and you dutifully provide very good answers and support, but why don’t you ask “What would make you choose to barekack?” Not why, but what and note that the keyword here is “choose”. Of course you can’t ask that bluntly, you wouldn’t probably get an answer, but you are an experienced prevention worker and can find a way to make people reflect on their choice of sexual practices. That’s very different from lecturing them about using condoms (something you kind of accused me of in your initial comment) and is based on the belief that indeed people can reflect on what they do, why they do it and can be the agent of their own change (sorry, I am being theoretical again…). Imagine someone asked you “Any pain reduction tips if I choose to kill myself?”, would you start by suggesting sleeping tablets before hanging, or would you try to find out what is leading someone to chose to kill himself? That’s a crucial step prevention has forgotten but is remembering with the “re-discovery” that HIV affect mostly specific groups that have been forgotten for the past 20 years.
That’s what I call giving people a stake in the fight against HIV. It is active prevention instead of response-mode prevention. It starts long before the promotion of condoms or harm reduction.
Two weeks ago I attended a workshop on Black MSM in London. It was very interesting and you know what, we did not talk about condoms, we did not talk about harm reduction. What we talked about was the role and importance of the Black community and how to change it when it comes to its views on MSM, we talked about finding way for Black MSM to meet and discuss freely about what matters to them, and we talked about housing problem and unemployment. What all that has to do with HIV prevention? A lot, and it is being slowly rediscovered and brought frontstage. I am aware that this is still remote from your daily work (it aims at the policy makers again), but is it that remote that it stops you engaging your interlocutors in some of these issues and to “reach to reach their deeper self”?
Some years ago, a friend of mine asked why he should go for an HIV test. I believed he knew he was positive and his reasoning was that knowing for sure would only make his life more complicate. He was right. It did make his life more complicate, for a while, but then he went onto treatment and now lives a much healthier and happier life. I did not convinced him to get tested, he convinced himself with my help, based on self questioning not on lecturing, and not on freedom of choice which hinges on what you want rather than why you want it.
Your work is crucial and very important and I can't disprove of any of your goals. You clearly say that you don't back down from promoting condoms and this is what we should all start to say when we engage in this debate and repeat at regular intervals. But somehow all this is a curative appraoch rather than preventive (at list in spirit). As long as we need people to do your job, it means we have failed in our approach prevent HIV.
I stop here for now. There is much to say and the internet is not the best place to say it, because it can easily be misconstrued and willingly or ideologically be misunderstood and misinterpreted.
Vb.
And now part 2….
Now as an activist you are put in a situation where you have to answer questions such as “Harm reduction tips if you choose to bareback" and you dutifully provide very good answers and support, but why don’t you ask “What would make you choose to barekack?” Not why, but what and note that the keyword here is “choose”. Of course you can’t ask that bluntly, you wouldn’t probably get an answer, but you are an experienced prevention worker and can find a way to make people reflect on their choice of sexual practices. That’s very different from lecturing them about using condoms (something you kind of accused me of in your initial comment) and is based on the belief that indeed people can reflect on what they do, why they do it and can be the agent of their own change (sorry, I am being theoretical again…).
Imagine someone asked you “Any pain reduction tips if I choose to kill myself?”, would you start by suggesting sleeping tablets before hanging, or would you try to find out what is leading someone to chose to kill himself? That’s a crucial step prevention has forgotten but is remembering with the “re-discovery” that HIV affect mostly specific groups that have been forgotten for the past 20 years.
That’s what I call giving people a stake in the fight against HIV. It is active prevention instead of response-mode prevention. It starts long before the promotion of condoms or harm reduction.
Two weeks ago I attended a workshop on Black MSM in London. It was very interesting and you know what, we did not talk about condoms, we did not talk about harm reduction. What we talked about was the role and importance of the Black community and how to change it when it comes to its views on MSM, we talked about finding way for Black MSM to meet and discuss freely about what matters to them, and we talked about housing problem and unemployment. What all that has to do with HIV prevention? A lot, and it is being slowly rediscovered and brought frontstage. I am aware that this is still remote from your daily work (it aims at the policy makers again), but is it that remote that it stops you engaging your interlocutors in some of these issues and to “reach to reach their deeper self”?
Some years ago, a friend of mine asked why he should go for an HIV test. I believed he knew he was positive and his reasoning was that knowing for sure would only make his life more complicate. He was right. It did make his life more complicate, for a while, but then he went onto treatment and now lives a much healthier and happier life. I did not convinced him to get tested, he convinced himself with my help, based on self questioning not on lecturing, and not on freedom of choice which hinges on what you want rather than why you want it.
Your work is crucial and very important and I can't disprove of any of your goals. You clearly say that you don't back down from promoting condoms and this is what we should all start to say when we engage in this debate and repeat at regular intervals. But somehow all this is a curative appraoch rather than preventive (at list in spirit). As long as we need people to do your job, it means we have failed in our approach prevent HIV.
I stop here for now. There is much to say and the internet is not the best place to say it, because it can easily be misconstrued and willingly or ideologically be misunderstood and misinterpreted.
Vb.
PART 1/2
Thanks again, Peripheries. I sense you're ready to bring this particular conversation to a close so I won't make my reply very long here. All great, insightful thoughts you've brought to the table, many of which I'm still thinking over so won't respond to here and now.
1) You asked:
how do you answer the guy who tells you “You're an asshole for talking to guys about barebacking in that way. If guys would just put on a condom on before they fuck we wouldn't be in this mess". Do you understand, and accept, where he comes from?
2) You also asked:
what is stopping you asking “What would make you choose to barekack?” Not why, but what and note that the keyword here is “choose”.
For your first question, when a man in an online chat room messages me to say he is upset that I am offering harm reduction tips and expresses worry that I am sending mixed messages and potentially encouraging people toward riskier behaviours, I use the exact same template I posted above. (Of course, I personalize the chat and I ask other questions – but the template is the base). And truthfully, in three and a half years doing online outreach, I have yet to have one of those men exit the conversation as worried or angry as he was at the beginning. It's hard to find much controversy in what I share. I explain very clearly that unprotected anal sex is high risk and the vast majority of sexual HIV transmission between men occurs this way – both top and bottom. I explain that a majority of gay men are consistently using condoms for anal sex. I admit that, despite our intention to, some of us sometimes have sex without condoms. As well, some men – a minority – have chosen to forego condoms altogether. I then offer a list of harm reduction tips that are useful whether you use condoms or not.
There isn't so much for a guy to get or stay angry about there. And usually that guy who started out confrontational or surprised at my approach, admits that all of these tips make sense and it is smart to share them with guys. I frequently use personal disclosure about moments when I intended to use a condom but didn't and how, in that instance, I would rather have unprotected sex while employing these tips than not. And I can also use this as a starting point into a conversation about some of the reasons *why* I don't always manage to use a condom when I intended to – from alcohol and drugs to my self-esteem that day to calculated risk taking to a willingness toward self-sabotage after hitting a saturation point dealing with homophobia…. I find self-disclosing about my struggles with these things often creates a safe space for guys to express why they feel anxious about harm reduction messages. So I'll hear stories about men who nursed a lover dying of AIDS through the early nineties and feels so much rage and grief or numbness about it that he can't take one more friend becoming HIV+. Or I'll hear about how he had a great business and later lost it through chaotic use of crystal meth and how, while he's not trying to blame anyone else, he does wonder why the friends he was hanging with at that time seemed to keep it all under control yet his life spun downward for a while and —- I'm sure you see my point here: discussing harm reduction strategies, including condoms, in a skillful way can open doors to all kinds of conversations, many of which I sense from your last reply, you wish more prevention workers would have with their clients.
PART 2/2
Which sort of leads into your second question: what is stopping me from asking “What would make you choose to bareback?” Not why, but what and note that the keyword here is “choose”.
And the answer, of course, is: nothing. I have that conversation with men all day every day. The way it usually happens is, after I've gone through some of the *factual* info in the template I listed above, I'll ask a guy, "What do you think?" And often the answer will be something like, "Well, it all makes sense." And I'll usually say something like, "At least written down on paper, hey?" Which might make him laugh and there's a softness opened up there. I'll usually then ask something like, "Can I ask, respectfully, and simply because I enjoy these conversations and want to understand more: what do you *like* about sex without condoms? What pulls you toward it? What's in it for you?" And then the conversation goes off on paths talking not only about the immediate and sexual ("It just feels better" "Condoms are too tight" "I like the heat that's transferred without condoms"), but also the psychological ("The idea of fucking a guy raw gets me so hard" or "It feels so much more intimate that way" or "I really love the idea of some dude dumping his load in my as"), and of course also emotional ("I find it's a release for me — the feeling is so good that it's like an escape from……").
This is the skillful work that all prevention workers are aiming for when they go in to work each day. I might enjoy heated debates (I do! A lot!), I might use my personal blog as a safe space to vent my frustrations (I do! A lot!), but when I go in to work to connect with men and talk about all of these complicated issues on a soulful level, I cannot be an ideologue and succeed in the work.
I do see the distinction you are making between institutions and public policy vs grass roots activists and front-line workers. But in some ways, I feel like the difficult frontline work I do each work day is devalued by an implication that workers like me are too afraid to "promote condoms" or cannot simultaneously juggle personal freedoms with collective responsibility while engaging men in conversations about their lives, their desires and their need for intimacy with other men. We can and we do. And if *we* are capable of having these nuanced, complex conversations while remaining focused on the goal of improved wellness for all queer men, our clients are no less capable of having them too.
Thanks, as always! And without any willfulness to misinterpret you — I realize we're talking through an odd medium here and I realize I am sometimes misunderstanding you. It's not intentional.
Hi Nico,
Thanks again for responding. There is much to say and I'd like to continue this conversation on the next posting on harm reduction.
But in the meantime, I would like to say it was very enjoyable, and I would like all potential readers to appreciate how Nico and I started from very opposite positions but that fundamentally we have the same understanding.
The wall that was between us was built on a lack of time and space to proper communicate and most unfortunately, this wall is very much present on the internet and in the real world. We all ground firmly our points in ideology but can go over it and reach each other when taking the time for a civil conversation. This is what good prevention is about, reaching other.
Very best
[...] let’s stop pussy footing for a moment: barebacking is a privilege in those countries where condoms, VCT and medical care are readily available. [...]
Wow, I really enjoyed reading through this exchange. However, I wanted to pick up on this thought, from your first response post peripheries: "condoms do not work when in fact it is prevention interventions that do not work".
I would also argue that maybe it isn't that our interventions don't work, but that we've stopped doing them. At least that is my experience in the part of the US where I live. Outside of my little town, where I know for a fact that my staff actively distributes tens of thousands of condoms and lube to MSM in a variety of settings every year, I am often hard pressed to find any condoms or condom-promoting materials in any gay bars in the larger cities that are in proximity to me. When I called and spoke to HIV prevention agencies in those areas–and even public health officials in those cities–I was given glib responses of "well, men don't want to use condoms anymore" or "those bars won't let us give out condoms there". If we stop giving out condoms or promoting condoms, why are we then surprised that men aren't using them?
thanks to making my point !
Leave your response!
Recent Comments
StatPress
Visits today: 8Monthly turn over: 9063
RSS Feed by Feedburner
Blogroll
Contributors
Tag cloud
Support IRMA Scholarship
Archives
Most Commented
peripheries bookshelf
Planned books:
Current books:
The Bottom Billion: Why the Poorest Countries are Failing and What Can Be Done About It by Paul Collier
Recent books:
View full Library