PrEP School
4 min

Are public health recommendations sex-negative? (Part 1)

While their guidelines are effective, they sometimes don’t feel realistic for queer people

Mike Miksche says that public health recommendations on having safer sex can sometimes feel restrictive. Credit: Ocskaymark/iStock/Thinkstock

According to the Centres for Disease Control (CDC), the only way to reduce the risk of contracting sexually transmitted infections (STIs) including gonorrhea is to avoid vaginal, anal or oral sex altogether. That’s not an option for most of us, particularly those on pre-exposure prophylaxis (PrEP) who want to enjoy their sex, carefree. 

So then what?

If one must have sex, the CDC suggests that you can lower your chances of getting gonorrhea by being in a mutually exclusive, long-term relationship with a partner who’s been tested for STIs too, and of course, use a condom every time (which we know does not and will not happen). To me, these suggestions are not always realistic or helpful for some queer people. 

While these recommendations are effective for preventing STIs, these guidelines sound an awful lot like all that heteronormative bull that’s been shoved down my throat my whole life. It also sounds sex-negative, and sterile.

We are currently facing an STI epidemic. The combined cases of syphilis, gonorrhea and chlamydia hit record highs in 2015 in the United States, so it’s not entirely fair to say that the CDC is sex-negative. But is there a way for public health get the message about safer sex out there holistically and in a sex-positive way that’s also inclusive of PrEP and treatment as prevention (TasP), while being realistic and effective too? 

It’s worth looking back to the early ’80s to see how our elders dealt with the AIDS epidemic, and sex-negative information from public health. During the first couple of years after the “gay cancer,” now known as HIV, emerged, the cause of it was still unknown. Nor did they know what was being transmitted. What they did know was that it was transmitted sexually and although there was no concrete proof, it seemed like it was done so via semen.

“AIDS hit my little group very early on, and no one knew what it was,” said writer and activist, Larry Kramer, in an interview with New York magazine. “But it was very obvious what was causing it, and I said that if you had a brain, you should start cooling it. And that made a lot of enemies. You couldn’t say those things, then or now.” And by, “cooling it” he meant that people needed to stop having — in his words — “careless sex.” 

The San Francisco Sisters of Perpetual Indulgence, an organization of queer nuns focusing on community service and outreach, took a very different approach. They created pamphlets during the crisis called, Fair Play, which, in part, was the invention of safe sex for gay men. What made this effective was their use of humour, compassion and relatability to explain how to prevent STIs and basic hygiene, especially during a time of fear and uncertainty.

 They were the first to suggest condom use at the time, which was less than popular (gonorrhea and syphilis were curable with the advent of antibiotics, and other STIs were manageable). They also highlighted  the importance of knowing your partner (or at least their name), safe rimming and using sex toys, in non-judgmental and sex-positive ways.

“I think the Sisters of Perpetual Indulgence did this really well,” says Damon Jacobs, a renowned PrEP educator and marriage and family therapist living in New York. “At least from the documents that I could see, which is to start from: Sex is good, sex is healthy, sex is great. We’re not telling you not to have sex. We love you. We respect your choices and we’re really worried that based on what we understand with our very limited knowledge that right now semen or blood exchanges could be deadly.”

 In the ’80s and early ’90s, the government began decimating the gay sex scene in places like New York City in what seemed, to me, to be a blatant attempt to control gay sexuality — in the name of public health.

In 1985, local health officials in New York were permitted by the state to close gay bathhouses and other venues where “high-risk sexual activities” took place. Dr David Axelrod, the state health commissioner at the time, told the Public Health Council that “AIDS” was spread by anal and oral sex (although we know now that the risk of contracting the virus through oral sex is extremely low), and if they delayed in shutting these places down,  more illness and death would ensue. The message was aggressive and callous. New York City’s health commissioner Dr David J Sencer criticized this approach, calling it “coercion” and claiming that it would do very little to control the virus. “The issue is human behavior, not where the behavior takes place,” he said. 

The infamous New York sex club, Mine Shaft was the first venue to go. New York City’s then-mayor Ed Koch had said that shutting down the Mine Shaft was not an attempt to impose restrictions on sexuality, but rather to save lives. However, many opposed to the shutdown said it would not only do little to curb such sexual activity, but that this was one step towards government regulation of private behaviour. 

Jacobs thinks back to similar events in San Francisco during this period: “It was coming from that paternalistic ‘cover-your-ass’ thing from health departments because they were definitely not interested in working in a harm-reduction framework,” he says. “A harm-reduction framework would’ve been: These bathhouses are here, we know people are going to fuck, so let’s give them a safe place — not only physically and legally safe — but let’s see what we can do to help them make healthier choices that won’t result in death. That would’ve been harm reduction.” 

“Instead, they went for the all or nothing thing as if they can control people’s sexual behavior by closing down bathhouses.”

So what can we learn from all this in order to help create messages around STI prevention to combat the rising rates that might actually work? . . .