In Tune With Safer Sex: HIV Prevention in Kink and BDSM Culture

Chris Raisbeck (Credit: Unsung Heroes: The Leather Community's Response to AIDS)
Chris Raisbeck
Unsung Heroes: The Leather Community's Response to AIDS

Chris Raisbeck walked naked through the lobby and into the ballroom of the Hotel Whitcomb in San Francisco, prepared to be on center stage -- literally. As dozens of kinksters looked on, Raisbeck's arms and legs were attached to a St. Andrew's cross. Then his play partner, known as Master John, placed 88 needles on either side of Raisbeck's shoulders, back and buttocks. Then he threaded those needles with string and, said Raisbeck, "he played me like a cello."

Then, just as carefully as the needles had been inserted, they were removed. Blood slicked Raisbeck's back and pooled on the floor. Raisbeck, who's been HIV positive since 2001, remembers the gasps cutting through the silence as he bled.

What that audience didn't see were the multiple conversations between Raisbeck and Master John in the weeks beforehand -- to build trust, to set expectations, to map out every step of the event. The audience didn't see the test run, the few needles placed in Raisbeck's thigh to see how he would react to the pain and the blood. They didn't see the needles being sterilized or the disinfection of Raisbeck's broad back, shoulders and ass, to make his skin as sterile as possible.

Nor did they see the aftercare in the hotel room -- how, with the adrenaline seeping out of Raisbeck's system, Master John and his assistant wiped and cleansed Raisbeck's back and ass. They didn't see them administer a solution usually reserved for surgery, one designed to help wounds heal quickly.

A few days later, it was as if the intense scene had never happened.

"I was all healed," he said. "Now, there are no scars at all."

Dr. Tony Mills (Credit: Positively Aware)
Dr. Tony Mills
Positively Aware

BDSM and kink are nothing if not a fantasy. But behind that fantasy is meticulous care and caution, say practitioners. Recent comments have linked BDSM to drug use and HIV acquisition, but people who talked to for this story disputed a link. Indeed, experts and practitioners alike said BDSM communities often practice more safely than swingers or the average guy you'll find on Grindr.

"There are people who live in the BDSM community, and then you have this other group of people who are dabblers -- people who haven't had significant experience with experienced people and they don't know the rules of the game," said Tony Mills, M.D. As a former International Mr. Leather and an HIV doctor in Los Angeles, he counts many kinksters among his patients.

"They throw a sex party, they dress in leather and there's lots of drugs involved. While they may engage in activities associated with leather, they are not in the leather community. A community takes care of itself."

It's not the kink, said Mills, on what increases risk, or even lack of experience. It's sexual shame and stigma that can get in the way of safety, he asserts.

Real Risk

Demetre Daskalakis, M.D., M.P.H., jokes that he has a "deep dark history": For years, Daskalakis, now assistant health commissioner of New York City's Bureau of HIV/AIDS Prevention and Control, spent nights at sex clubs, doing HIV tests.

Dr. Demetre Daskalakis (Credit: Santiago Phillipe)
Dr. Demetre Daskalakis
Santiago Phillipe

And he noticed something there. At the swingers clubs -- mostly vanilla, mostly straight -- almost no one paused to talk about health risks in general, let alone HIV risk, before starting to play. But at the dungeons, the "heavy scenes" full of mostly gay men doing mostly intense BDSM play, the floggers and clothespins, the spreaders and the Saint Andrew's crosses didn't come out until there was some training on safe play.

"Really, they [people in the BDSM community] go a step above," he said. "I feel like a lot of BDSM folks are in tune with safer sex because it's part of the culture. It's a totally different culture."

Research bears this out. While there are a lot of risk factors for HIV -- intravenous drug use; untreated sexually transmitted infections; condomless, receptive anal sex; and dating in a community with high levels of undiagnosed or untreated HIV -- BDSM practices are not among them. Indeed, the U.S. Centers for Disease Control and Prevention list biting and throwing bodily fluids as carrying a "negligible" risk for HIV transmission. And a lot of BDSM doesn't involve either.

Maybe BDSM practices are low risk for HIV because they don't necessarily involve sex or fluid exchange. But even when they do, the emphasis on safety can reduce risk. Take fisting, for example, said Daskalakis. The practice can inflict trauma on the rectum or vagina, creating the conditions that increase risk for HIV transmission. Indeed, in the single known case of sexual HIV transmission between women, rough sex and fisting were implicated in transmission.

"We don't have a randomized, controlled trial of fisters and nonfisters, but as long as people are using barriers, I don't see BDSM activity in itself as being a risk factor for HIV," Daskalakis said. "The message is: It's important to do everything safely. There's always going to be a novice out there who puts himself at risk, but for the most part, the message [of safety] is out there in the BDSM community."

Educating the Novice

So if BDSM isn't associated with HIV transmission, why is there a conflation of BDSM and HIV risk? If you ask Mills, the answer is stigma.

He points to data that show that, "no matter how hard we try," clinicians can't seem to get more than 80% of people living with HIV engaged in care.

"The reason we can't reach those 20% is because of stigma," he said.

Mostly, it's stigma about the virus itself. But there is also stigma about gay sex, period, plus the kind of sex guys want to have. If you've always identified as a top and your social and sexual life are built around that identity, but you have secret fantasies of exploring anal pleasure, stigma can keep you from being up front about it. That lack of transparency and self-acceptance can lead to behaviors that ratchet up HIV risk.

"If they can't actually look at that [sexual behavior they want to try] and think about that, that's what makes them think, 'If I do crystal, my feelings will be blunted and I won't hate myself,'" said Mills. "That's where the risk comes in. That's where I'd have the most concern."

Consent and Conversation

And, of course, drug use does happen among BDSM practitioners. But it's sometimes frowned upon, both Raisbeck and Mills said. Playing with someone who's high, who can't respond, isn't just risky, said Mills -- it's boring. You spend all your time babysitting, he said, and not doing what you came to do.

That's why, long before Raisbeck stepped on that stage at the Whitcomb, Master John instructed him that he was to be well rested, hydrated and "not have any toxins" in his system, said Raisbeck.

This kind of detailed conversation -- not just about drugs, but about every facet of a scene -- can seem the opposite of sexy. But negotiation and consent are core tenets of BDSM. In addition to ensuring safety, the top and bottom have to work out what each want, how they will do it and what they're comfortable with. That way, when it's time to play, people can relax and have fun, said Raisbeck.

Such intense negotiation may even breed a certain personality type, if a 2013 study out of the Netherlands is right. The study compared the personality and subjective wellbeing of 902 BDSM practitioners, compared with 434 people who practice vanilla sex. The results? BDSM practitioners were both less agreeable and less neurotic. They reported higher levels of wellbeing, were less rejection sensitive and, importantly, were more conscientious.

That could include the conscientiousness of a top watching his sub's hands to make sure restraints aren't cutting off blood flow. Or, it could be the conscientiousness of asking about HIV status and talking about safety.

Power and Pleasure

This level of communication and conscientiousness is not as typical in vanilla relationships, said Mills. If you find some hot guy on Grindr and invite him over, you don't know what he likes or if your sexual proclivities will mesh. You just don't know what to expect.

"That stuff doesn't happen in the BD community," said Mills. "It's, 'I like to do this. Do you like to do this, too? We both like to do this. Let's play.' That's why we call it play. The romantic level evolves because you played together and you really had fun, and he's a really nice guy."

For his part, Raisbeck said that the intense negotiation and communication made him trust Master John. Watching Master John and his assistant glove up and take pains to place the needles carefully -- and, if they weren't right for whatever reason, discard those needles into a sharps container on the stage -- helped him focus on the sensations and the experience.

The emotional and physical care the two men exchanged in the hotel room after the scene cemented that belief. Master John's actions were masterful, Raisbeck decided. And while blood play is not really Raisbeck's thing -- he's more into flogging other guys -- the message of safety is so important to him that you can sometimes find him training guys on safe sex at play parties or giving the occasional blessing at a Mr. Leather contest as Sister Jezebelle of the Enraptured Sling, one of the Sisters of Perpetual Indulgence. For him, risk reduction is a guiding principle.

Still, he was surprised how fun it was to be up on the cross at the Whitcomb Hotel, with strings being strummed from the needles in his back.

"It was cool to be in a position of power, and being very much the center of attention," he said of the scene. "But it's the way we addressed the physical and emotional needs of both parties immediately after the scene that was most important. It's how we take care of ourselves."