Gays can’t have sex. We can have only “safer sex” or “protected sex” (where condoms or any other form of barriers are used). The sad part of “protected sex” is that it implies that sex between men is not safe, adding to the load of homo-negativity and internalized homophobia that we have to cope with on a regular basis in a straight-dominated world. This is one of the thin edges of the wedge that allows for the internalization of shame. And for members of ethnic minorities, that shame can resonate intensely. I prefer “safer” over “protected.” It carries less stigma and is less sex-negative.
 
Contrary to our heterosexual counterparts, if we (gay men) have sex with no condoms, no prevention, then we become barebackers. The word bareback comes with a whole bunch of negative connotations, as if the plain and simple act of two (or more) men having sex is evil, twisted and predatory. Fear-based HIV- and other STI-prevention campaigns have led me to believe that if I repeat the word bareback out loud three times, the ghost of AIDS past will make an appearance that will drive my anxiety all the way to a sexual health clinic. There I will sit in the waiting room between Shame and Guilt reminiscing about my early days doing psychotherapy in a hospice and out-patient clinic in Mexico City for HIV-positive people in the late 1990s — where 80 percent of my practice died of HIV/AIDS. 
 
When a gay man’s identity is in part connected to his sexual practices, and the sexual practices he engages in are considered “problematic,” then by definition a part of that gay man’s identity will be considered problematic, too. That’s what silences many gay men who struggle with their sexual health. No wonder that the decision of whether to wrap it up or go bareback can be so complex and anxiety-provoking that a lot of men decide to skip it and not think about it. 
 
The truth is that in 2013, most of the gay men I know still struggle with shame, guilt and self-hatred connected to their sexual identity and sexual practices. A lot of them report feeling judged and rejected by their peers when they talk about struggles with condom use or their ideas about engaging in sex without condoms. One of the problems that is left outside of the HIV/STI prevention equation is the impact that internalized homophobia (shame, guilt and self-hatred) in a straight-dominated world has on gay men’s sexual health. In my practice I find that once gay men work through feelings of shame and guilt it’s easier to tackle sexual-health concerns and risk-taking behaviours.
 
If we are going to engage in a conversation about why STIs like syphilis, chlamydia and super gonorrhea are on the rise in Ontario, we also need to consider the impact that sexual health has on the emotional health of gay men, and vice versa. For me, a strength-based approach to the STI dilemma involves focusing on funding priorities that carve a space for gay men to work through the immense amounts of shame and guilt that shut down sexual health conversations. Strengthening gay men’s mental and emotional health actually helps gay men’s sexual health. That’s where we can find hope. We need to question the narrative that says safer sex should be like a religion, where the condom becomes our beacon of hope and redeems us sinful homos, turning us into healthy gays and not a statistic for the Public Health Agency of Canada. 
 
While this might seem to an outsider to be simplifying the decision-making process for the gays — “You either wear a condom or don’t” — having only two options is bound to cause apprehension and complicate sex matters for any homosexual or man who has sex with men (you don’t need to be self-identified to be an MSM; you just need to like doing it with a dude). To work from a resilience position means that we need to change the pattern from restricting gay men’s choices to creating room for making informed decisions, and respecting them. 
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