When Condoms Ain't Enuf ... What to Do With a Sex-Phobic Society in a "Post-AIDS" Era?
November 28, 2011
"I also want to mention that we are increasingly becoming better at incorporating conversations about 'harm reduction' into the realms of substance use (needle exchanges, safe injection sites, pill testing, etc.), but we often fail to adequately translate this model when speaking of communicating risk reduction in sex (strategic positioning, sero-sorting, viral load suppression, etc.). My question back to the group then is, how do we more effectively communicate to young people the abstract concept of 'harm reduction' for sex within the context of a sex phobic society?"
This was a question posed by Jamie Forrest of Vancouver, Canada in the North America, Western Europe, and Caribbean CrowdOutAIDS Open Forum on Facebook. CrowdOutAIDS is UNAIDS new collaborative online youth-led project. He posed this question to the group after people were discussing what they considered to be the main reasons for HIV infection among young people.
Reading the responses on Facebook gave us one of those jolted reactions. The dominant message about sexual health in relation to HIV prevention has been focusing on condom usage. Jamie's question was one that I saw as challenging; given the propaganda that the HIV/AIDS field has been pushing around what it means to have safer sex. My colleague at the Harm Reduction Coalition, Michael T. Everett, was also raising this same question especially among young men who have sex with men (YMSM) of color given that their rates of infection have been steadily increasing while rates of infection among injection drug users has been on the decline.
The question for us became what (besides the exchange of needles) was accounting for the decrease in transmission of HIV among injection drug users, and how could we use what works in harm reduction messaging and education when it comes to drug use (if anything) for other high-risk populations greatly affected by the epidemic through sexual transmission. We considered this in light of the following:
The place to begin the conversation around the idea of prevention of at-risk behaviors like having unprotected sex is a great place to start. We need to engage an intentional conversation concerning the reality that the message of safe-sex, by way of condom usage, may not resonate with people because it is limited and does not allow one to ponder the spectrum of other possible harm reduction practices. The point is: we want people to still live a healthy life without causing further harm to themselves and others. The spectrum of harm reduction practices includes everything from prevention to helping those who are most affected by the collateral consequences of their at-risk behavior. The spectrum does not begin or end with condom usage only.
As a society many people hold the moral belief that people should suffer for the consequences of their own actions. This is why in the United States syringe exchange programs were illegal for so long. We had evidence-based science that told us that it was a viable intervention to decrease the spread of HIV and Hepatitis C among injection drug users, but we watched people suffer despite the evidence.
This moral belief undergirds prevention measures. But, what many of us name "prevention" is a far cry from a spectrum of diverse prevention methods that are responsive to individual's contexts and sexual choices. Many systems fail to acknowledge the reality that not everyone uses condoms and that there are also viable options outside of condom promotion that could still protect people from acquiring HIV. Many young people of color are being infected with HIV at alarming rates because they are not being informed about their full spectrum of options. "Meeting people where they are at" has lost meaning in this context. Our world is not one dimensional and, therefore, our strategies cannot be one size fits all.
We need to re-imagine ways to resist holding the current prevention paradigm at the center of our work. In response, we would like to provide the following questions from a capacity-building perspective as we begin to further this dialogue around harm reduction practices that could be useful in empowering people to protect themselves from HIV.
Thirty years into the epidemic we attempt to coexist in a sex-phobic society that intentionally and unintentionally endorses guilt, shame, and secrecy around sex thus driving sexual transmission of HIV. We cannot afford the delusion of prevention. It has no place in HIV prevention particularly when so few voices of the most at-risk communities are a part of dictating what works for them.
Translating harm reduction into safer-sex practices is about an awakening of our asset-based practices. We must reframe our approach to prevention and incorporate opportunities to promote the multiplicity of people, an acknowledgment of a continuum of behaviors, and a spectrum of options that enhance quality of life.
Allen Kwabena Frimpong is the online community organizer at CrowdOutAIDS in North America, Western Europe, and the Caribbean and Michael Terry Everett is the Team Leader for Capacity Building Assistance at the Harm Reduction Coalition.
This article was provided by TheBody.
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