The Risk Sweet Spot
Michael Weinstein, President of AIDS Healthcare Foundation

We live in a world of balanced risks. Every time we leave the house, drive on the street, travel or have a sexual encounter, we are taking risks. A life without risk is a life not worth living. Determining where to draw that line is tricky, both personally and as a matter of public policy. The general standard that we have adopted as a society is to minimize risk while maintaining enjoyment.

Driving a motorcycle on busy freeways is an accident waiting to happen. We maintain the right to drive a motorcycle but require people to wear helmets. The degree of restriction of a helmet is balanced against the potential catastrophic effect of a head injury without protection. Society has decided that the trade-off between forcing people to wear a seatbelt and flying through a windshield is valid. We have somewhat arbitrary legal ‘drinking while driving’ limits based on blood alcohol content. Where do we draw the line when it comes to sex?

The only completely safe sex is masturbation. Every form of sex with a partner relies on them telling you the whole truth and nothing but the truth, or they themselves knowing their status—which is a significant risk. Oral sex without a condom is much less risky than anal and vaginal sex for HIV transmission, but not necessarily so for other STDs. But who wants to suck or be sucked on with latex? It’s a non-starter for almost everyone.

There is a simple mathematical equation when it comes to safer sex—the more partners, the more risk. Having sex with many partners who have sex with many partners means your chance of contracting an STD shoots up, if you know what I mean.

 Many of us who have worked in HIV prevention in the gay community for decades have made a calculated decision that trying to get gay men to have a limited number of sexual partners won’t work. Therefore, the risk calculation is, much like the motorcyclist, that we can avoid the most serious injuries, in many cases, by promoting universal condom use. If every gay man has protected anal sex with a condom every time, the number of STDs will plummet but not be entirely eliminated. Every other method we tried—not coming inside someone, sero-sorting, etc., has had disastrous results.

 We know that telling every gay man to use a condom won't work all of the time, just like all doctors and nurses won’t wash their hands between every patient. However, if we stop promoting condom use, matters will get much worse.

 We all want the green light to enjoy as much sex as we can without worrying about the risks. But the facts are that syphilis cases today are 10 times what they were in 2000 in Los Angeles. And every year that number goes up, and HIV infections have remained stubbornly high in the gay community.

 I don’t want to rain on your parade, but there are two proven methods for avoiding STDs, including HIV, if you are going to have anal sex: 1) have fewer partners and 2) use condoms. If having fewer partners is not an option, using a condom is a must. Obviously, you are an adult and you get to make your own decisions, but I think having these facts help.

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