About fifteen years after most gay men figured it out, Mark Joseph Stern stumbles onto the truth that, with HIV no longer a death sentence in developed countries, the era of simply scaring gay men away from unprotected sex is over. And, unlike so many well-meant public health campaigns, he is prepared to tell the obvious truth:
Bareback sex feels better for both partners. At some point, almost every gay man will learn this fact—so why lie about it?
Indeed. That one fact combined with one other – that middle-class gay men can suppress the virus indefinitely with the cocktail – has to be integrated into a sane, safer sex message. I’ve been banging on about this for years, of course, and there have been initiatives, in San Francisco particularly, where these insights have indeed been integrated into public health campaigns. And they’ve been among the most successful in restraining infection. But Stern goes one step further:
If we don’t give gay men the promise of the reward, a foreseeable end to the hassles of condoms, they’re bound to get frustrated and either slip up or give up. Giving men the goal of a committed relationship—and with it, the perk of unprotected sex—might convert barebacking from a forbidden fruit to a reward worth working toward.
Yes, and no. First off, can we retire the term “barebacking” and simply refer to it as sex without condoms, i.e. the activity formerly known as sex? Stigmatizing latex-free sex as “barebacking” may have had some logic in the plague years, but it can be psychologically toxic today. It renders the most intimate of sexual interactions a pathology, and that can’t be right.
Second, the prize of non-rubbered sex in a monogamous relationship is a little more fraught than Stern makes it out to be. It makes huge sense if both men are HIV-positive. In that case, there is no danger that sex outside the marriage – sometimes lied about, or hidden, or unspoken – can lead to indirect infection, because both men are infected already. But if both men are negative, it puts much more pressure on monogamy and on a marriage than might be wise. One slip and you’re not only betraying your partner, you could also be deeply damaging his health. Although it’s noble as an ideal, the standard here may be simply practically too high, certainly over a lifetime, for most men to achieve. And the consequences of failure can be terrible for a relationship.
I think we should leave it to married couples or committed lovers to figure their way through this – and avoid harshness and easy judgment. We’re all human and in sexual desire, more human and flawed than in most other areas. But, as a practical matter, you don’t have to restrict non-rubbered sex solely to monogamous married couples to have an impact on infection rates.
The more important goal is for HIV-positive men to have sex mainly with other HIV-positive men, restricting the virus to a pool of the already infected. This is called “sero-sorting” and it has happened for years (it was my strategy back in the day for making sure I never put anyone at risk). It has cut infection rates markedly where it has prevailed. But for the HIV-negative, sero-sorting is a lot trickier. You simply cannot know if your sex partner is positive or not. He may not even know. Leaving rubbers behind is a big risk always in this context, even though it is far, far smaller than it once was. A more practical option for HIV-negative men is to go on Prep – take preventive HIV drugs to make infection far less likely even without condoms, and to use condoms outside a truly monogamous relationship or marriage.
So add it up: tout the intimacy of rubber-free monogamy for some; encourage HIV-positive men to have sex with other HIV-positive men; get as many HIV-negative men onto preventive drugs that can drastically lower the risk of infection; and, above all, encourage disclosure and testing so that gay men, rather than being treated like children, can assess all the information and make informed choices. This wouldn’t be a panacea, but it would be a constructive way forward.
(Photo: By BSIP/UIG Via Getty Images.)
The Dish 