Sex between guys can be very complex. Often when guys begin a sexual encounter they do not know how it will unfold, will it include: sucking, ropes, handcuffs, fucking, rimming, piss, electricity, alcohol, drugs, lots of alcohol, sounds, scat, tit play, other guys, fisting and many others. The creative play between two guys exploring where their sex will go it part of the fun.
Reducing safe sex messaging to a simple prescription of “use condoms” is not very helpful, because we already know that message but who helps us to make the decisions in a complex playful experience of having sex. The medicalization of safe sex messaging has not served us well. Almost all new HIV infections now have emotional and psychological reasons as a main cause for lack of condom use. The medical professional is not trained to integrate the emotional and psychological causes of problems, they are trained to look for medical causes. Where is the messaging that helps us make the decisions we are comfortable with?
Let me give an example of how a psychosocial messaging may be more helpful for guys
A while ago a guy asked me, if he as poz bottom with long standing undetectable viral load could be fucked without condoms by his boyfriend who was negative.
I, as a person trained in psychology, made a few suggestions as follows:
1. Consider how upset would your boyfriend be if he became poz.
2. Also consider how upset you would be if your boyfriend became poz.
3. Some people think that if either you or he have an STI that HIV transmission is more likely, so you could decide to not have unprotected sex outside the relationship.
4. Some people think that if he cums and/or pees after fucking it will clean out the urethra and reduce the chances of getting HIV.
5. If you (the poz guy) get a cold or some other infection your viral load MAY go up; you may wish to be more careful at these times.
6. The spectrum Health website (the largest group of doctors treating gay men and HIV poz guys in BC, suggests that without an undetectable viral load there is 1 in 1,666 chance of getting infected as a top for each fuck. (6.5/10,000) We can assume that with an undetectable viral load these odds are much less. The exact chance of getting infected is not known but it may be 1 in 10,000 or maybe 1 in 100,000. (BC is spending $50 million to reduce HIV poz guys viral load in an effort to reduce transmission; so they must believe that this will have a big effect in reducing the number of new infections.) (The cynic in me thinks that it is not $50 million being spent because they care about the welfare of poz gay guys, or other poz persons.)
So by using the complex information above they can make decisions about the kind of sex they choose to have.
Notice that none of the above are “shoulds” but only things to consider when making decisions. Medicine is good at “shoulds” and “musts” – at prescribing – a behaviour. He did not want a prescription, but he really wanted to know was “what do I need to consider if we proceed with not using condoms” (if that is our choice). He knows the normal message of use a condom, that is not what he is looking for and if no one helps him to know what to consider and give him an understanding of what are the risks and how to reduce those risks of transmission he/they will be “fucking in the dark” – so to speak
What is interesting about this question is why he did not go to a medically trained person to ask this question. I believe that he would have gotten a medical response that is prescriptive and not really useful for their decision making. The medical profession has done wonders at supporting, treating and educating all of us on HIV. But, the medicalization of HIV safe sex messaging has run it course.
It is time for medicine to step aside with the less than useful messages. We need a psychosocial approach that will help us makes decisions that fit in our complex lived sexual experiences. What is needed is to understand that only pushing condoms is not effective. What we need instead is messages to help guys to make informed decisions around their complex sexual decisions.
If there was more space I would add the following:
We need help to understand when and how we find ourselves vulnerable to take risks that are outside our comfort level. For some it may be when drinking, for others it may be when depressed, for others it may be when horny, or lonely, or he is hot, or any number of things that we all need to understand more about how we put ourselves in situations where we are not comfortable afterwards. In my experience the general pattern is when a person feels their life is falling apart, (job loss, boyfriend break up, money problems etc.) then they may do things that later they wish they had not done.