No Glove, No Love

By Dirk Sander1.01.2011Global Policy

Contrary to the mantras repeated by the press, HIV infections are not increasing. We need to move away from activist scare tactics and towards complex risk management strategies.

Every year on December 1, tragedy strikes again as journalists around the world conclude their search for dramatic stories to commemorate World Aids Day. The stories are always the same: Infection rates are on the rise as fewer people protect themselves from HIV because of inadequate options. People are becoming for careless, the disease cannot be contained. The popularity of this proposition is astonishing simply because it is wrong. The truth is: Infection rates have stabilized for the past few years. According to numerous surveys, protective behavior is still relatively high. By no means is “carelessness” increasing among vulnerable groups.

Complexity of causes

It is also true that new infections from homosexual intercourse were increasing during the first years of the last decade. The reasons for this are more complex that most people realize. There has been, for example, an increase in syphilis which raises the possibility of a simultaneous transmission of the HI virus. Adding to this is the fact that safe sex has become “individualized”. In order to meet the need for sex without a condom, men are applying different strategies in order to protect themselves. This is understandable. Who would want to use condoms all their lives? Heterosexual couples would definitely not be very fond of this idea. But this development is no sign of carelessness. Gay men try to ponder when a condom is necessary and when it is not. A popular strategy is “negotiated safety”: After a mutual HIV test, the partners are abdicating condoms. In that case, traditional “safe sex” strategies apply. Such risk management strategies have de facto been enabled by improved HIV therapies that have reduced the fear of infection. We should not necessarily condemn this development. It is something very pleasant that fear plays a minor role in sexuality again!

The need for risk management

This should not be confused with carelessness. To the contrary: During sex, complicated decision making processes are taking place during which men try to conciliate their wish for unchecked sexuality with concerns – literally – about their health. If we dismiss the risk management strategies as “careless”, we run the danger of gambling away all influence over the target group. Prescriptive prevention strategies do not always have the same appeal and the same real-life impact. Studies support the commitment to risk management strategies without a wagging finger. The immediate response must not be dismissal but an indication of potential mistakes in the risk assessment. For example, sometimes men are too quick to dismiss condoms although neither confidence nor HIV tests exist as a basis for the non-protective sexual relationship. Some men rely on myths like “HIV is a problem of the cities” or “during anal sex the one penetrating cannot get infected”. These myths need to get replaced by facts. Talking about “carelessness” in this context is immensely dangerous. A lot of gay men believe in these myths and must be convinced that they are factually wrong – not a sign of “careless” behavior. Psychology has taught us that people tend to adapt their behavior to the presumed behavior of the majority. To lament carelessness could lead to it actually arising; as a self-fulfilling prophecy. The campaign “I know what I am doing” from the German AIDS-help has been pursuing this approach since 2008 and focused its strategy on open and sophisticated communication. HIV-negative and HIV-positive role models report from their dealings with love and sex, risk and protection – with all strengths and weaknesses that people have.