Talking about HIV is still a challenging task for many within the LGBTQ community. While no longer the terrifying death sentence for parts of the world with access to medications, HIV still conjures up fear and shame for many in discussing it. One of the more difficult conversations to have among men who have sex with men (MSM) is that of condom usage. “Did you use a condom?” is often the first question MSM are asked. Often, admitting to a less than perfect adherence to condom use can be difficult as the failure to do so can invite scorn from others.
Many gay men report hearing derogatory messages about men who do not always use condoms and many HIV positive gay men still struggle with self-blame and guilt over acquiring HIV through unprotected sex. However, the majority of sexually active people (straight, gay, or otherwise) also have imperfect records when it comes to condom use, even when they too know and firmly believe that these barriers work and that they aspire to be more compliant.
The reasons why this is so are less complicated than many imagine. In light of the horrors of the AIDS epidemic, condom use has become synonymous with being strong, responsible, and disciplined. Conversely, condomless sex has been stigmatized as psychologically pathological, self-destructive, and weak. What this fails to take into account is something very basic: desire. As humans, one of our most ingrained natural desires is closeness with others. This need for closeness is both emotional and physical. Our sexuality formed in a world without condoms and it is natural to expect that using them can cause us to feel about condoms what they actually are: barriers.
Whether Good or Bad, Condomless Sex is Common
Using condoms with sex is still an extremely important means of preventing the spread of many STI’s including HIV. However, it is essential that we begin changing the way we talk to people, particularly gay men, about condomless sex. We must stop setting the expectation that if they are good and strong willed people, they will always use condoms perfectly. One major reason for this comes from recent research that shows that Truvada, a drug that can be taken by HIV negative individuals to protect them from being infected with HIV, is extremely effective. In a recent study, of 600 men who used Truvada over 2.5 years and also engaged in condomless sex, not a single person contracted HIV.* If talking about condomless sex is linked to shame and scorn, we make it unsafe to have an honest discussion about what people are actually doing, and if we cannot talk honestly, we miss an invaluable opportunity to help people make responsible decisions about how to protect themselves from HIV.
Reframing the Conversation
When we frame condomless sex as something shameful and aberrant, we deny the reality of our human sexuality. Many of us desire the closeness that can come from condomless sex and even though many times we take care to use condoms for protection, we occasionally get swept up by our most natural urges. Much like knowing that we should not over-eat or drink, we sometimes choose to, despite the risks to our health. When we can talk about striving for condom use while expecting people to be imperfect, we remove the expectation that a back-up measure, like Truvada, may be extremely helpful for sexually active people. We also allow people to talk about their lapses in condom use in honest and shame-free ways that can enable people to have conversations that educate them about the potential benefits of preventive medication. In this way, we help people consider Truvada as a way to remain safe when occasional condomless sex is a part of their lives, and there is no shame in that.
*It is important to note, that other STI’s were transmitted, as Truvada does not protect against these.
IntraSpectrum Counseling is Chicago’s leading psychotherapy practice dedicated to the LGBTQ+ community, and we strive to provide the highest quality mental health care for multicultural, kink, polyamorous, and intersectional issues. For anyone needing affirming and validating support in their healing, please click here or email us at firstname.lastname@example.org.
Dr. Ian Bonner is a staff psychologist at IntraSpectrum Counseling. He specializes in working with the LGBTQ population, addiction, couples counseling, and mood disorders. Ian is a graduate of the Adler School of Professional Psychology in Chicago, and is the former case management coordinator for the Horizons Youth Program at the Center on Halsted.