The failure of medical community in delivering HIV messages
It has been more than 25 years that gay guys have been told to use condoms for sex. Yet many of us still sometime do not do what we are told. Almost no sexually active gay guys will say “I did not know I should use condoms”. So why do we still get the same message, for 25 years, that clearly is not working?
Sex is complex and there are a lot of emotions that are part of our sex lives. But the emotional part of who we are and the importance that sex plays in our lives, is not addressed. Our originations around the world still shout at us to “USE CONDOMS”. This message gets old and tiresome, yes we know that. Where are the messages that help us to understand why we are not using condoms?
HIV has for over 25 years been dominated by the medical profession. Medicine has done wonders at helping those of us who may be infected to have a healthier and better life. But medicine tends to take a scientific and logical approach to problems. Hence the simple message of “use condoms”. Medicine is not as good at dealing with complex emotional aspects of human behaviour.
I think it is time for medicine to step aside in addressing HIV prevention and give way to the social scientists to explore more effective messaging. It is also time for our organizations to focus more on messages other than “use condoms”.
If you ask gay guys why they sometimes do not use condoms they often have no more understanding than “I do not like condoms.” There was an effort to tell us that condoms were fun and sexy but that message did not go very far. So we may know that sex is better, more fun, easier, and more intimate without condoms. But we are not assisted much in understanding how we sometimes allow ourselves to not use condoms.
It seems that there has been an underling message of: “be afraid of HIV”, and then by extension that leads to fear HIV poz guys. Many gay guys have become so scared of HIV that they reject HIV poz guys. Messages of fear are not effective. Messages of fear have had the effect of marginalizing members of our community, not building a stronger community. We know too much about stigma in our community; we do not need any messages that promote stigma amongst members of our own community. We need messages of understanding, acceptance and support. Where are the messages that a poz guys with undetectable viral load is not going to transmit HIV? Where are the messages of support and understanding?
I have spent almost 20 years talking to guys about their sex lives and HIV. I have noticed a few trends in HIV infections. For over 10 years I would say “Guys are most vulnerable to get infected when a relationship ends.” In the last few years I have seen that perhaps this message is too narrow. It seems to me that guys are most vulnerable to get HIV when they are feeling their life is falling apart. That can be death of a parent or a loved one, job loss, depression, loss of home and loss of relationship, etc.
I do not pretend to have “the answer” to why we do not always use condoms but I feel I have some understanding of how bare sex happens. But let’s focus more on why we take risks, when we will take risks and how to support all of us to take better care of ourselves.