The other day a poz bottom with a long-standing undetectable viral load asked me if his negative boyfriend could fuck him without a condom.
Note that he didn’t go to a medically trained person for a standard risk-assessment answer. He asked me, a person trained in psychology.
I don’t think he wanted the typical medical answer admonishing him to stay away from risky activities. He wanted to know what emotional questions he might want to consider when contemplating condomless fucking.
I asked him how he thought his boyfriend might feel if he became poz as a result of their unprotected sex. I asked him how he would feel if his boyfriend got HIV from him.
Only then did I offer some information on the complexities of transmitting HIV and mention some factors that could increase his viral load (like catching a cold or fighting an infection) that he might not be aware of. I didn’t leap straight for the stats. I started with the emotional component of safer-sex decision making.
I started from the assumption that guys expose themselves and others to HIV not because we don’t know the stats and what we’re supposed to do to stay safe, but because we don’t always make decisions based on logic. We often make decisions based on our emotions and spur-of-the-moment assessments that a hot hook-up is worth it.
Medical professionals are not well trained to integrate the emotional and psychological causes of problems; most medical professionals are trained to look for and address strictly medical causes.
Medicine is good at “shoulds” and “musts” — at prescribing behaviours. But we don’t need any more prescriptions. We need help understanding how and why we take risks and how comfortable we are with the risks that we take. We need help understanding our own emotions.
If most new HIV infections in our community stem from emotional or psychological decisions not to use condoms — rather than ignorance of when to use condoms to reduce transmission risks — then shouldn’t the safer-sex messages focus more on psychology and less on statistical likelihoods of transmission?
We already know when we’re supposed to use condoms.
Granted, the medical profession has done wonders at supporting, treating and educating all of us about HIV. What I know about transmission rates, relative risks and condom use, I know thanks to the information they’ve provided. But the medicalization of safer-sex messaging has run its course.
Transmission risk–based HIV campaigns can and have been useful, but we need help understanding why we make decisions that sometimes put us at uncomfortable risk.
Without the emotional dimension of HIV transmission, we’re still missing a big part of the decision-making picture. And we’re still just fucking in the dark.