Ellen Terry's often quoted and misattributed remark "I don't care what you do as long as you don't do it in the street and frighten the horses" could well be the cornerstone of an enlightened society's policy on sexual behavior. Adults should be free to engage in any form of consensual sex when such freedom is tempered by the privacy of the behavior (not in the streets) and the form of the behavior which should not be destructive on the social order (frighten the horses).
These two qualifications on sexual freedom have to date been reasonable. For example, most communities have laws prohibiting public sex. While such laws may deter some from engaging in public sex, to others the risk of being arrested becomes the dominant erotic rush. The eroticism of the risk of being arrested often dominates the sexual experience of some in such a way that the risk becomes a fetish. The erotic pleasure of the fetish becomes more intense than the sexual act itself.
There is a more pernicious form of high-risk sex called "barebacking" which may threaten the social order. Barebacking is the latest sexual fetish in which the sexual act is eroticized by the risk of becoming HIV-infected or re-infected. If advertisements on the Internet and in some gay and other sex-oriented publications are any accurate indication, there are tens of thousands of individuals whose sexual gratification is based on the risk of the "gift" of HIV as it is officially termed in barebacking argot. The "gift" in some of these advertisements is often referred to in sacramental terms as if communion with the human immunodeficiency virus is somehow parallel to communion with God.
There have been a few voices chastising the soi dissant leaders of the AIDS and gay communities for their failure to take appropriate leadership in reducing the popularity of barebacking. However, leadership in general has been non-existent, possibly due to such leaders' failure to realize that sexual freedom, like all other freedoms, is not absolute. Freedom without responsibility is anarchy.
The anarchy of barebacking is the possible introduction of drug-resistant strains of HIV into a population who may not be helped by our current AIDS drug armamentarium as well as the introduction of HIV into a population who may be unable to access AIDS drugs. Mutual consent may not be a relevant issue. The harm that such deliberate activity may cause to the parties themselves as well as the consequences of such behavior on the public good may well supercede the individual rights of those engaging in such behavior. The anarchy of barebacking has frightened at least one old horse.
The popularity of barebacking also presents challenges to physicians on whether they should monitor their patients' sexual practices and what they should do if they learn that their patients practice barebacking. Our association is organizing an ad hoc committee of physicians and ethicists to address this issue.
Our silence on the anarchy of barebacking may well result in efforts to increase criminalization of such behavior. While attempts to criminalize sexual behavior may appear to some to be a reasonable response for the protection of the public good, others of us realize that laws prohibiting private behavior are never effective. There is no political system that can ever control man's cruelty to himself or to others.