It’s no secret that sexually transmitted infections (STIs) are a serious problem and at a historic rise today; but to suggest that the only way to stop transmission is by not having sex or through monogamy isn’t practical at all. It’s also not realistic to say that men who have sex with men (MSM) should just wear condoms to avoid STI transmission. Many STIs can be contracted whether a condom is used or not, PrEP or no PrEP.
We need real solutions that resonate,and that don’t sound so sex-negative.
In looking back at the AIDS epidemic in the ’80s, we learned that taking a more compassionate and light-hearted approach to sexual health resonates with MSM, as opposed to the approach of local health officials in New York who simply stated that HIV was spread by anal and oral sex, justifying the shutdown of bathhouses and other venues where gay men had sex. It didn’t work.
So what can we learn from the past to help create messages that resonate around sexual health and STI prevention today in combating rising transmission rates?
First, it’s important to understand that there is a legitimate concern surrounding STIs, and it should be taken seriously. Though STIs today aren’t nearly as devastating as HIV was back in the ’80s and ’90s, they’re still a problem. In 2015, the combined cases of syphilis, gonorrhea and chlamydia were the highest they’ve ever been in the United States according to the CDC’s annual Sexually Transmitted Disease Surveillance Report.
There’s a long tradition in the media of demonizing gay culture, and shaming us for just being. The New York Times was guilty of such misrepresentations in the ’80s during the AIDS epidemic with the headline, “At Homosexual Establishments, a New Climate Of Caution.” In that article they depicted the gay scene as one of pornographic bookshops, sadomasochism clubs and back rooms. Though I’m proud to say that this is a part of gay culture, by only talking about this side of it within the context of the epidemic vilifies our community.
We still see this today with the crazed reactions to chemsex, as though drugs with sex was invented by the homosexual. “The chemsex party scene was reimagined as if it was akin to a gay suicide cult,” Richard Smith wrote in Vice, explaining how such a panic in the media has demonized gay men yet again.
Our community is still most at risk today. MSM are disproportionately affected by HIV and other STIs. The CDC links HIV and STI rates to us for, among other things apparently having multiple anonymous sex partners and substance use. Although these facts aren’t sex negative in and of themselves, it’s really a matter of how they’re presented. When this information is distilled by media, it can be counterproductive.
With the new drug-resistant strain of gonorrhea (which is found in the highest rates among MSM), the CDC suggests that the only way to avoid or reduce transmission is abstinence, monogamy or wearing a condom every time you have sex. This recommendation doesn’t acknowledge the realities of gay sex, and has the potential to shame and stigmatize men.
Since these are some of the messages coming out of public health, of course, to some PrEP has become the supervillain in the fight against STIs. The reason being that some who are taking it are motivated to start PrEP because because they want to have bareback sex, or so they can continue to do so safely. Blaming PrEP, however, does a huge disservice to fighting the STI epidemic, and it becomes a mere scapegoat for the real issues such as lack of comprehensive sex education, and access to testing and treatment.
“When it comes to the wonderful fantasy that people have that PrEP is responsible for the accelerated rates of STIs, that is something that the media has glommed onto and used as click bait on the internet to misguide and distort the facts as they are,” says Damon Jacobs, a renowned PrEP educator living in New York City.
STIs were well on the rise before PrEP was commonly used, but there simply aren’t enough people taking PrEP to have that sort of impact.
The Gay Men’s Sexual Health Alliance in Toronto launched a new website called, The Sex You Want, . It’s an anti-stigma, sex-positive, affirming campaign that delivers information about sexual health to MSM, including trans men.
“People appreciate the tone of the campaign,” Dane Griffiths tells me from Toronto. He is the acting director of Gay Men’s Sexual Health Alliance, and involved in the development of the campaign. “It doesn’t feel preachy and stigmatizing, and finger waving but it’s friendly, it’s accessible, and that people are enjoying their time on the site.”
He compares the experience of reading the information online to talking to a friend, which makes it less clinical and more approachable.
Griffiths confirms that the delivery is just as important as the information being presented, acknowledging that everyone has a different way of learning. For that reason, the campaign includes animated videos, web copy, colorful infographics, and hot sex comics to talk about things like condom use, the meaning of an undetectable viral load and STIs.
The site isn’t just fun — it’s a comprehensive resource. A lot of the content on there was vetted through focus groups with people living with HIV as well as those who are HIV-negative. The creators also worked with 30 different organizations in various communities in Ontario.
“Every piece of biomedical information on the site was vetted through a scientific review committee,” Griffiths explains.
What’s best is that they don’t act like sex isn’t an important part of our lives. It’s not something we want to stop having just so we can reduce national STI rates. And I personally don’t need to be told that sex leads to STIs any longer — I get it! We now need real strategies for the type of sex that we’re having.
“The dialogue I don’t think is new, but I think the way in which it’s being presented is fresh and different to other things you would see out in the world,” he adds. It definitely beats those horrible fact sheets.
When discussing HIV or STIs, what they’re saying is not necessarily anything that the CDC hasn’t already said but it has more impact because of their down to earth, and relatable. There’s a human quality to the whole campaign. And it’s not fear-mongering.
“Everyone should know better by now than to develop fear based campaigns and messages,” Griffiths tells me, “because they don’t work.”
PrEP School runs every other Monday on Daily Xtra. Columnist Mike Miksche explores and navigates the world of sex and PrEP.
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