Michael Weinstein, President of AIDS Healthcare Foundation
Whether you are seeing more and more gay bareback porn, reading ads for men looking for condomless hookups or looking at stats from the CDC, there is little doubt that unprotected sex among gay men is on the rise. There are too many different explanations to cover them all here. However, what we do know is that this generation didn’t live through the holocaust of the ‘80s and ‘90s. And listening to their elders talk about the ‘bad old days’ resonates about as well as our parents talking about how poor they were during the Great Depression.
We know that young people think they are invincible and that self-esteem plays a huge role in sexual risk-taking. It is not a surprise that gay men—as do all men—prefer intercourse without condoms. Knowing what we know, what should we do about it?
There is a line of argument that promoting condom use is a lost cause. According to some, even if we talk ourselves blue in the face, no one is listening. We are supposed to come up with a whole new strategy—sero-sorting, PrEP, risk-reduction, etc. It all sounds so sensible. The problem is that it won't work.
The idea behind sero-sorting is that if men only have unprotected sex with partners of the same HIV-status they will be safe. This has been tried—and failed. While it might work for a few individuals, when it is applied community-wide, it leads to more infections, because men may lie or not realize they have turned positive since their last test.
PrEP, which is giving HIV medications to negative men to prevent infection, has also failed to protect the majority of men in every clinical trial. Relying on negative men to take this medication every day just doesn't happen most of the time. And the idea that you can significantly reduce your risk by withdrawing before coming has no evidence to back it up. If you have multiple partners over a long period of time, without condoms there is a very high likelihood that you will turn HIV-positive and contract other STDs. Sorry to deliver the bad news.
Mutual monogamy, masturbation and confining yourself to hand-jobs or even blow-jobs drastically reduces your risk. Anal sex without a condom greatly increases it. Reducing the number of your sexual partners also improves your odds.
So, despite the rise in unsafe sex, bareback videos and ads for bare hookups, condom promotion remains the best strategy we have to protect our community. Now, when the fear of HIV has receded because of the improvements in HIV treatment, it is more important than ever to promote safer sex. We won't reach everyone (although the majority of gay men still do use condoms), but if we let our guard down and give up on safer sex, it is guaranteed that many more men will become infected.
The battle for LGBT equality dates back to the late ‘60s. Bringing down rates of smoking has taken even longer. No one said that health promotion was supposed to be easy. It may not be fashionable to tell gay men that they need to use condoms, but it is the only strategy that has proven effective over the long term.