Exploring Attitudes on the Issues of Sex Positive Therapy and Surrogate Partner Therapy Referral and Execution by Licensed Clinical Mental Health Professionals

Abstract:

This study explores the attitudes and opinions of licensed clinical mental health care professionals when asked about sex-positive therapy and surrogate partner therapy. The sample included 10 mental health care professionals with various advanced education degrees. The participants completed a 15-question questionnaire that provided data regarding demographics, opinions of sex-positive therapy, surrogate partner therapy, ethics, law and the application of the modalities in practice. The findings revealed the majority (80%) of the respondents expressed concern over judgment, lack of knowledge, and stigma and shame surrounding the attitudes of sex therapy and surrogate partner therapy within the United States. The findings also revealed recognition of the need and efficacy of implementing sex-positive therapy and surrogate partner therapy for appropriate clients in need by properly trained clinical mental health care providers.

Damon Holzum Thesis published Attitudes on SPT

Enjoy, Damon

5 Things Gay Men Get Right in Relationships

Five Things Gay Men Get Right in Relationships

I have noticed an odd and frankly negative trend in the sphere of dating and relationships under the heading of “gay men”. We love to pile on and point out the grossness of things. Maybe it’s to point out what some perceive as “wrong” so we don’t make the same mistakes, or maybe it’s a bit of hewing towards the drama and pop culture that social media seems so intent on cultivating. Whatever the reason, I went against the grain (I know, shocking) and wrote a little missive of some things that I feel gay men get right about relationships.

1) Communication: We are men. When the shit hits the fan and we have a moment of mistrust, or miscommunication or misunderstanding, we talk that shit out and conclude it. You feel you are not being listened too or you have been misunderstood? You tell your partner exactly what’s on your mind and then provide space for your partner to vocalize their perspective. It’s really a win-win situation and you may learn some things about your significant other. I call it brutal honesty and it can be uncomfortable, challenging and downright scary, but it’s necessary. And the most awesome thing is: when you’re done talking about it and you reach consensus and understanding, as men, we get to put it to bed. The case is closed and the issue, adequately addressed and resolved, should not rear its ugly head and be brought up again to flavor or instigate a wholly different topic.

2) Sex and Sexuality within a Relationship: The diversity within the gay community and how we define and engage in relationships is at once awesome and intriguing. I can’t tell you how often I get asked, “so, what do you guys do?” With the implicit question, “are you guys open and how does it work?” The beauty of it all is that we can define our relationships and the sex that goes with it any way we choose. Here are five examples of extremely functional, long-term relationships of couples I know and how they handle their sex and relationship;
1) They are best friends and happily married and do not have sex with each other. There is an understanding that they are free to safely engage with others without drama or an inquisition. (15+ years together)
2) They have sex together but probably more often with another individual present as a cycling third, many times under the guise of a mentor situation (absolutely needed in our world and awesome) and they also play in groups. (20+ years together)
3) A is married to B and A has a long term boyfriend C. A and C fuck anything and everything on two legs (preferably with a third leg in the middle). This is not to insinuate this is a hierarchical polyamorous relationship as delineated by the A, B, C labels, it’s just for clarity. The communication, love, sexiness, lack of shame, and non-drama is something to behold, truly lovely. (Husbands 14+ years, Boyfriend 3+ years)
4) They are in a long-term relatively asexual relationship and they are monogamous insomuch as they do not have sex outside the relationship. The love and respect they share is palpable. (19+ years)
5) They encompass a love that is shared deeply and communication that is forthcoming and honest. They have organic, non-drama, sexual guest appearances should they occur, but without seeking it out or needing it to have great sex one-on-one. Out of town rules if one travels for any length of time. Oh, those horny young men. (5+ years)
What’s the common thread? There isn’t one. By defining relationships and the sex within them under the four main tenets of sex-positive ideals (capacity, consent, communication, and safety) then you can create your fulfilling relationship, however you define it, and have your sex however you choose.
I find it important to add that I put this in the context of relationships but single boys and the freedom to explore, engage, and have as many (or as little) sexual partners or explore relationships however defined by you is a valid and encompassing relationship within itself.

3) Freedom: The ability to be who we want to be and explore the things that are important to us without judgment. There is an ebb and flow to every relationship and the individuals within it will grow and change. When my boyfriend (now husband) met me I was a feisty, motorcycle riding, rugby playing escort. Now, I’ve sold my bike and concentrated on classic cars, I hung up my cleats (but still appreciate a rugby ass in a jock) and am months away from my Masters in Social Work in Clinical Therapy where I can help people with my clothes on instead of dick out. But throughout it all, he gave me the freedom to explore, explain, and allow me to be myself and engage in the things I like. And I did the same for him. If you want to see me tune-out post haste, just start playing World of Warcraft or start talking about your WOD (crossfit/cult). But I will be the first one in line to watch him compete (and there’s BBQ) and support his interests. It’s important to have shared visions; be it education, future living arrangements, travel, hobbies, sports, or even socialization, but those shared visions cannot usurp your partner’s individuality and your support for said individuality. That is what initially attracted you to them, let them shine and evolve into someone you like even more, and grow along with them.

4) Friendships: We create and cultivate the most beautiful and strong friendships. Be it a result of challenges within our own family, or bonding over shared escapades, some of the strongest relationships I see are based on created and maintained non-bio families. Gay men can discuss anything and everything and know that one or more of their friends has their back, no matter what. This is not unique to da gays, but it takes on a special level of importance and commitment when it can seem that your childhood acquaintances and even your dad (the ones posting about “Yay, guns!”, “Go, Jeb!”, and “Blessed are we for…”) may be better left under the heading of past acquaintances and your immediate family is relegated to a polite holiday dinner. A truly beautiful thing occurs when we, through our wit and charm, bridge that gap and commingle the facets of loving bio-family, childhood besties, and our current gay friend/loves. The bond that is created through shared experiences, both negative and positive, is something that cannot be underestimated and helps stave off a host of negativistic thoughts and will only make you and your friends better people.

5) Claiming Their Love: We are gay men. And as more rights and “privileges” (that is in quotes because they are not privileges per se but more an evolution of things that should be innate) become realities for us there can be instances of bigotry, homophobia, judgment, slut-shaming, and bullshit that frankly we will not tolerate. By embracing, loving, or having sex with another man, and claiming that truth, and living your life to the best of your ability, you are paving the way for not just acceptance but the big shrug of “this is us.” I hate to “should” on anyone (you should…) but I will say this: you should be claiming your love for your gay partner because it’s awesome. And it’s acceptable. And there is absolutely no reason to not live your truth, now. I recently read an article about a preteen bullied for being gay. His father wrote the post and said, (paraphrasing): “I didn’t see a boy cowed by cowardice. I saw a boy angry and indignant that anyone would dare speak to him or bully him for something that obviously wasn’t wrong.” It’s happening. Being gay “is” and it’s beautiful. Own it.

That’s it. Cultivate your relationships in the positive, be they friendships, love affairs, “scrindr”, or family and treat yourself the best, make yourself a priority, because you’re the most important relationship of all.

Thanks, Damon

Our Old New Future. Forgoing Stigma and Shame in a Condomless World.

Read this: http://www.vice.com/read/director-paul-morris-believes-hiv-should-be-part-of-gay-porn

I love this guy. I mean, before he would start the conversation with the reporter, he had to establish his foreskin status (uncut btw, yay!). The interviewer wanted to delve into the reasons and rationale behind such an interesting porn scenario and the responses were genuine, thought-provoking, and pretty spot on. Should anyone depict and defend a guy taking double digit numbers of HIV+ loads on screen with the premise of bug-chasing? I mean, hell, even as a therapist and sex educator I still thought active bug chasing was largely mythic, like a cheap drink at the Abbey, or at the least, rather antiquated. Is it fetishistic? Is it sexual reality? The topic for this little interview and the topic on everyone’s mind is: what about the HIV? What about PrEP and viral loads and safety and undetectable status and cost and health…and what is too much of a good thing? While many individuals will bristle and kvetch about this man’s stance, he is actually vocalizing a distinct undercurrent to our fight for sexual autonomy. The undercurrent very well may be the fear of a truly debaucherous, free new world without this “god” like moralization and punishment raining down on us in the form of HIV and moral persecution.

For the past 30 years gay men have been living under the specter of fear. HIV is gonna get us. It’s going to end our lives, our relationships, our happiness and our future, and for years it did just that. We fought back with condoms (rather ineffectually), and now we’re fighting back with biomedical interventions such as PrEP, PeP, and TasP, and some of the most shocking reactions have been to shut up, use a condom and continue living as sexual second class citizens.

I remember when my 24-year-old bf came up HIV positive. This was 2004 and how much has changed in a decade has been quite amazing. Gay marriage/repeal of DOMA, out NFL players, bearded ladies winning music competitions, and people openly talking about HIV and viral loads. I remember telling my beautiful boyfriend that I didn’t really want him to go on the meds. That they were really harsh on the body, created resistance, and that until something better came along that he should work on being the healthiest boy he could be before subjecting his body to the poisons of the pill. Only upon an AIDS diagnosis should he explore anti-retrovirals. That same rhetoric was recently uttered by the he-who-shall-not-be-named leader of AHF saying, “if something better than condoms comes along then I’m all for it, but this isn’t it” (regarding PrEP). The statistics don’t lie; the meds work, so use them if they’re appropriate for your sexual proclivities. The key difference in our sentiments regarding efficacy of HIV meds is that after 10 years of evolution and education, I have evolved from a condom only at all times stance to a Pro-PrEP, Pro-Slut (actually I was always pro-slut, no evolution there), condoms if you choose them, above-and-beyond-all-education-is-key stance.

And it really is. But with education often times comes more questions and a sudden, sinking realization that we didn’t know everything we thought we did. We are at a crossroads in the gay community. On one hand we are getting what we thought we always wanted; equality: replete with gay marriage and acceptable relationships that are smiled upon by the masses. And support from the unlikeliest of allies has come pouring in at an unprecedented rate. And on the other hand, we are getting all the trappings that come with equality: expectations of monogamy, bland responsibility of ridiculous levels of political correctness (cis-gender, really?), and a general dumbing down of what makes us sexual, intense, creative, and exciting individuals.

The more we march towards the concept of beige banal equality, the more we have to retain what made us the rainbow of amazing outliers in the first place. Paul Morris, the producer of Viral Loads, referenced that this porn wasn’t for everyone. And he’s right, it may not be something you are personally into, but it absolutely does not give you the right to judge it. These men had capacity to make the decisions, they consented to the filming of the scenes, and they communicated their desires. It becomes a very, very slippery slope: if you judge someone for guzzling loads of poz juice, someone will be only too eager to judge you for having sex with the lights on in the living room. As we fight people who are against PrEP and fight people trying to run headlong into our bedrooms and stop us from loving and fucking or putting asinine limitations on our sex, we also have to accept that some of the things they see when they tear the door off may be unsavory to their palate. And that’s awesome because that means you’re doing something right and they don’t get to say who, or what we do in the bedroom.

The outrage that comes from seeing a supposedly HIV negative man take countless HIV positive loads has been met with shock and awe. But what if there were no positive or negative? What if it was just guys having sex? Without condoms because they wanted to express how truly awesome gay sex is? What if we watched that porn for the hot guys and the sexy scenarios and the fantasy of being the center of a gang-bang? Would it be okay to watch it and jack off to it then? Not only without stigma, but with an absolute absence of judgment, knowing that it was normal. Knowing that having hot ass sex with multiple partners, because that’s what we wanted to do, was absolutely okay. To literally not be able to comprehend a stigmatizing view of sex between consenting adults, however they define that sex.

So long as there is shame being hurled at us from biblically blinded ass-hats and especially from our own brethren, we will not experience equality. And we need to realize, above and beyond anything, that our equality is not a one size fits and all and it does not have to fall under preconceived notions of what “should” be experienced, sexually or otherwise, and especially not based in heteronormative ideals. Whatever works for you and your relationship, you need to embrace it and fight for it. Also, support your fellow man on their journey and realize that it does none of us any good to stymie and stigmatize our glorious gay world and those that passionately partake in its raucous past-times. It is time to embrace our newfound and budding equality with a look to the freewheeling past. Pre-PrEP, pre HIV. I will not say we are post HIV. Far from it. With infection rates rising and the thankfully renewed discussion of best practices I’m hoping we are in the final stages of HIV; the last obnoxious death throes of a dying disease. But we are at a complicated provincial intersection without any stoplights and we all just got our driver’s license to wield mopeds. This is the time to support education, conversation, and above all embrace the power of non-judgment and our passionate past as we pave the wave for a truly remarkable present and new old future.

 

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The iGays are on life support, but I’m Fabulous!

I read with great interest the article blog titled “The iGays Are Way Too Sick: TURN OFF THE LIFE SUPPORT!”
http://stopracismandhomophobiaongrindr.wordpress.com/2012/07/20/the-igays-are-way-too-sick-turn-off-the-life-support/
I too am a 37 year old gay man but I’m going on breathtaking fabulousness. This author brings up an unsettling perspective regarding a perceived younger generation of gay men (I will speak only of gay men, not purporting to live the life of a proud lesbian) that base a great majority of their interaction online. Compartmentalization, hooking up, hunting for sex, social interaction, socialization and some basic human functions have indeed been reduced to a click and a “sup?” However, two major themes struck me. One was the author’s undercurrent of abject failure, rejection, giving up and throwing in the towel because he didn’t look a certain way or wasn’t a certain age and the second was the comments section wherein several commenters sprinted to reinforce and say, “yes, that’s me too!” Now, I’m not in any way invalidating their perspective or experiences, but I’m going to offer a slightly different take on the topic.
The author’s blog makes me sad. What he speaks of doesn’t make me sad because I do believe there is a kernel of truth to his observations. What makes me sad is the focus on the negative aspects of a stunningly amazing gay life. I love a good online hook-up. I find it efficient and I love sex. I love finding what’s behind zipper #1 (and 2 and 3 and 5) and I love group sex and I love sex with guys in a 25-55+ age bracket. Hooking up online to me is quick, efficient, and if I literally just want to get naked and fuck, why should I have to buy you a drink? You can be as socially awkward as you want, we aren’t going to a movie, I just want to sniff you out and have a good time. A picture and a description online tell me a lot about the physical characteristics that I look for and that turn me on. And I love hairy guys, and smooth-ish guys, (as long as they have a hairy crack), and I love guys that are black and white and middle-eastern and Latin and I like guys with a little cushion for the pushin’. I’m not a huge fan of smooth or small of stature but I’ve been there and had a fine time. It’s just the way I’m wired. In this bloggers viewpoint that would probably make me racist, or body-ist or hair-ist or something. I just like what I like and I’m not going to label someone who doesn’t like the same things as me as bad, just different. For every guy that rejects me for being hairy and 37, there is a guy that loves my hair and wants to call me daddy (yes, apparently I’m “there”). I love it.
The compartmentalization of gay men is something I’ve observed for years. This is not a new phenomenon. You could probably track it to the 60’s and 70’s when gay men would flag hanky codes for sexual preference. If I found you hot and you were flagging dark blue left and I was flagging dark blue left, (that’s two “Greek” tops for you uninitiated, aka: let’s fuck, I’m a top) would I go home condemning the whole of gay culture for not being diverse and “versatile?” Nope. Yes, versatility is good, but I love that there are so many bottoms out there too. It just means that a lot of gay men have embraced this role of pleasure. An unapologetic bottom is a glorious thing. To fully embrace something that can be viewed as submissive is truly empowering. In the ‘80’s into the early ‘90’s only shaved and plucked men were ogled over and epitomized (for reference pull up some late 80’s porn). Now it’s scruffy, hirsute gentlemen of a certain vintage. I can feel rejected because I’m not muscly enough and I have been absolutely rejected because I was a white guy going after a black dude. It happens. That does not make me any less valid or any less of a catch. And that’s internal confidence. I did not persecute the guys who weren’t interested in me; I simply changed my focus to someone who was.
I have seen, over the course of the past decade, the same evolution to online interaction that this gentlemen has. But I don’t decry it as the end of civilization. I take it for what it’s worth, one aspect of an exploding option in our gay life. Grindr and Scruff and Craigslist (yes, I’m old school) and adam4adam and manhunt and bigmuscle (2 year boyfriend out of that one) are all completely valid places to meet people. The same way that the gay bars, walking your dog, grocery shopping, social clubs, and rugby teams can be venues to meet interesting people. Or just someone you want to fuck.
While I see a challenge with relying completely on an online presence, there can also be challenges with meeting people in a bar. I’m not a big drinker and find bars rather tedious. If I’m single and going out I largely am on the prowl. I don’t want to make silly small talk just to get my dick wet. If I do walk through those sticky doors and don’t find anyone that piques my interest or vice-versa should I then judge the entire bar scene and say, “how dare you reject me?” No, I take it at face value, socialize with friends when it’s comfortable and do my own thing when it’s not.
It has to do with attitude and perspective. If you leave the house thinking you’re ugly, old, and no one wants you, then guess what? You’re right. If you leave the house (or engage online) with confidence, self-care, self-respect, and a good attitude, you’re more than likely going to get those same qualities in return. If you don’t get that deserved respect, delete or walk away. It’s really that simple. An online presence requires effort to maintain and cultivate; the same way that interacting in a public, physical, social setting does. To throw in the towel because you’re 37 and non-white, or not your perceived ideal body type speaks more about your self-perception that it does about our society in general.
The awesome thing about our gay culture is that we are more visible and accepted than ever in history. As a result there are a ton of choices out there. Simply put: quit playing the victim. The only person who can fix this shit is you. If you don’t like how you’re being treated online, leave. If you don’t like how that guy you like is treating you out and about, exit stage left. Surround yourself with individuals that love you for who you are: your age, your race, your sexual preferences (remember, fuck your species!), your love of creepy figurines, or just because they make you laugh. But I caution you, befriending those that jump on the isolation and negativity bandwagon is a path fraught with disappointment. Misery loves company, but happiness and self-respect is infectious.

Positively PrEP

Positively PrEP

 

I attended the PrEP panel hosted by the Impulse Group in Los Angeles on a truly beautiful Saturday afternoon.  As many of us know, November in Los Angeles can be a lovely time of year, and the 9th was no exception.  Pristine weather, the obligations of a sick puppy dog (a real one) and a grumpy husband almost stopped me from attending.  That and the relatively realistic fear that I would be saddened by the lack of interest, lack of education, or both at such an event.  I was happily surprised at the turnout, the knowledge, and the passion presented by the panelists and the attendees.  PrEP, to the uninitiated, is the use of HIV meds (anti-retrovirals such as Truvada) in a once a day dose by HIV-negative men to reduce the chance of contracting HIV should they be exposed.  Studies show that used in conjunction with condoms, using PrEP results in a 96% reduction in sero-conversion.  It’s controversial on several levels: 1) will men on PrEP stop using condoms? 2) How effective is it really unless adhered to on a strict regimen and close medical supervision and monitoring and 3) Why can’t gay men just stick to condoms instead of taking the pill that they would have to take if they were HIV-positive?  Isn’t it just precluding the event or building resistance should it ever “really” be needed should they convert? 

The Impulse Group is funded in large part by AHF and at first blush runs relatively counter to what AHF is known for: militant condoms only, no excuses, no exceptions education. Knowing several of the participants and volunteers that work with Impulse, I can say that they do work diligently to spread a more reasonable, approachable take on safer sex education.  It is indeed counter to the AHF mantra but it seems that at the minimum the Impulse Group is making inroads into discussions within our community about safer sex education.

Arriving at the event at noon, per the facebook timeline, I watched as the boys of LA slowly trickled in.  They were affable, affluent, diverse, and interested.  The party finally got started around 1pm and the panel consisted of Aaron Laxton, an outspoken HIV-positive youtube speaker, Dr. Hardy, and Dr. Wohlfeiler, both whom specialize in HIV prevention and research, and Michael Weinstein, head of AHF.  A moderator did his best to wrangle the strong, disparate personalities and divert the conversation back to questions that were being posed by the audience via text and email, but right from the start it was a challenge. 

When asked their stance on PrEP, three out of the four individuals said that they think PrEP is beneficial when used in conjunction with condoms and is a safer sex method that’s time has come.  Dr. Hardy started the responses and spun into studies, definition of PrEP, how he prescribes it and so on.  Aaron was undoubtedly pro-PrEP and received a round of applause from the crowd following his eloquent evaluation.  Dr. Wohlfeiler was agreeable, but used a very specific set of circumstances in which he prescribed PrEP.  When later asked another question, he referenced the same scenario and patients, which gave the impression he had a tunnel vision approach to how and who should receive the treatment.  And of course Michael was dead-set against it and appeared antiquated in his contrarian views.  And for good reason.  He cited several studies in which the participants simply didn’t adhere to the regimen of a daily pill, the cost associated with it, and the perceived tendency of those taking PrEP to forgo condom usage altogether.  Michael made some good points, but the reality is: it doesn’t matter.

Why doesn’t it matter?  It doesn’t matter because we are in a new era of HIV prevention, and like abstinence only education, not talking about it doesn’t stop them from doing it.  And by them I mean men fucking other men and foregoing condoms on a regular basis.  I did a quick qualitative analysis study for a class last semester where I asked 10 friends and strangers about their perception of safer sex, HIV, and how condoms are being used today.  It turns out, they aren’t.  We, MSM, are a victim of our own success.  HIV is no big deal.  You get HIV, you take a pill, you qualify for steroids because of “wasting” and you look better than when you were negative.  Oh, and don’t forget the bonus of being able to now do the kinkiest, funnest, barebacking-est sex you ever dreamed of.  Positive guys simply do not use condoms today.  And many negative guys don’t either because they don’t see their friends and fellow gays affected by HIV.  The concept of “undetectable” has rendered HIV mentally innocuous. 

 I am on the cusp of generation X/Y.  I was raised that if you fuck someone, or get fucked, you put on a condom and that is just how it is.  AIDS education and the condoms only for everything messages were everywhere.  If you didn’t use condoms, you caught the HIV and you got sick.  You might not die, but it would suck, and you would have a hard time dating, and your insurance would go up, and the pills would cause lipodystrophy, and one good cold could spell the end.  I was borne of the era and mentality that putting on a condom makes sex better because I don’t freak out about catching something.  I still get the chills waiting for my result regardless of how safe I’ve been, but unfortunately that mentality is virtually non-existent now within the Millennial generation.  And that’s okay, if men choose to fuck without condoms, it’s not my job to shame them, or guilt them, or tell them they’re bad people.  It is my job to provide them with education and options, like PrEP. 

Will gay men go on PrEP and stop using condoms?  Most likely.  Why not?  They’re not using them now, so why would they put on a condom when they have a biological barrier in their body?  Will gay men have “riskier” sex while on PrEP?  Well, not to tangent, but risky versus kinky are not interchangeable.  I can fist someone and be safer than someone barebacking.  I can go to the Slammer every night and make a BDSM daddy blush and walk away HIV negative.  What someone is really saying when they pose this question is: will someone make choices putting them at higher risk for HIV infection by being on PrEP?  That equates to, “will guys bareback more” and again, most likely yes.  But if they’re already doing it (and the increase in HIV infection rates bear that out) then it doesn’t really matter.  Michael made it very clear that the studies he read showed that MSM simply did not adhere to the protocol’s set up to effectively gauge if PrEP was effective.  Meaning: they said they used condoms, but their blood tests showed a small percentage of the drug in the bloodstream: they weren’t taking the meds.  So if they weren’t taking the meds, then one may surmise they weren’t telling the truth about their high rate of condom usage either.   Double trouble. 

Weinstein and Hardy saw their own interpretation of the study; I saw two vastly different takes on social norms and cultural awareness.  Dr. Hardy realized that gay men were going to take these risks and wanted to provide another tool in the toolbox to supplement an already relaxed baseline of condom usage.  The difference lies in political spin versus empirical evidence.  Empirically, PrEP works and has been approved by the FDA and is ready and able to be prescribed by those that have it to those that want it.  In my personal opinion, one key component in the fight against HIV and the inclusion of PrEP in our arsenal, is that if someone willingly, consciously, and with education asks for PrEP, they are more likely to adhere to the protocols and requirements needed to render it as effective as it can be.  In short: just because some guys in a study didn’t use it properly 100% of the time, does not give one man the ammunition to throw out the entire argument based on a perceived lack of efficacy.  Frankly, what I heard Michael say was, “Gay men can’t handle the responsibility and rigors of PrEP, and so condoms are the only logical choice for HIV prevention.” 

One of the most important things that I felt was missing, or not really articulated throughout this ongoing discussion of PrEP is the specter of “choice”.  If a person wants PrEP, that is their choice.  It is no one’s sole responsibility to inhibit the access to a potentially life-saving device.  The discussion on Saturday, sponsored by Impulse with a shadow of AHF behind the curtains, really illustrated the passionate responses to a prevention method in its infancy.  We, as gay men, must nurture, respect, and raise this new prevention method carefully.  We must provide it with education and grow along with it, like a good parent.  And we must respect it and the other families affected by our choices.  With that being said, it is ultimately up to the individual choosing to utilize PrEP whose opinion matters.  I don’t get to say if it works for you.  I only get to cite empirical evidence, encourage you to do your own research, and make the best choices you can.  PrEP certainly has its flaws, as do the men that will take it, but PrEP is yet another tool in our toolbox and should be treated as such.  Exploring it should be encouraged, studying it further should be encouraged, and using it to inhibit the negatives of becoming positive should be encouraged.

I f*ck with education

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As a sex educator I get asked a lot of fun questions.  Many of these questions center around sex, sexuality, and how or what to do with the infinite combinations presented to us as sexual beings.  But for every question asked, there is an undercurrent of what really wants to be asked – what really is being felt by the person and even our community.

Recently I’ve had three distinct conversations with individuals, which really gave me a lot to think about.  I had to think about how I answered these questions and how I address our community and the current challenges facing it.  The first question came from a good friend of mine who inquired about the “real” risk of barebacking as a top.  The second conversation was an affirmation in that my opinions were validated by someone else’s similar observations regarding the challenges of HIV education and the current opinion of the “crisis”.  That friend asked me if I had observed a shift in our safer sex practices and even more so the attitude towards safer sex.  We both have.  And the final encounter was at a sex club with yet another friend where as I mentioned observing some barebacking he responded with, “Well, that’s kinda what this is all about…”

The trifecta of interactions were at once wholly independent of each other, but also completely interrelated and amazingly apropos to our current gay men’s health crisis.  The first question posed to me, “What is the “real” risk of barebacking?” ties into gay men’s inherent desire to have awesome, intimate, unprotected sex and look for the escape hatch.  I have fielded this same question for years.  The cognitive dissonance of wanting to do something they know is inherently risky, but hoping to find evidence that means it’s okay anyway.  Quite commonly the undercurrent is someone asking for permission to bareback, or looking for salvation after having barebacked.  The question is being asked quite typically under the auspice of a new mentality within the gay community.  Quite simply, gay men don’t want to wear condoms and feel that the current iterations of medication and treatment options are negating the need to play safely.  The most common opinions I see right now regarding HIV are the: “It’s no big deal” or “The meds mean I’ll be fine if I get it” or “It feels better.”

The second observation, regarding the shift in safer sex mentality was truly fantastic.  It affirmed my long-held belief that we are seeing such a concrete and fundamental shift in safer sex ideology that sex educators, health officials, outreach centers, and – above all – gay men, simply must change how they view safer sex and the rhetoric attached.  Gone are the days of “put a condom on it” (if that has even really been working for the past decade) hopefully to be replaced with “I f*ck with education.”  The tag line I’ve used for a few years now is coming into its own, but it usually needs a bit of an explanation.  I’ve been pilloried by both camps; on the one hand I’ve been accused of promoting condom-less sex, and on the other hand of promoting rigid safer sex practices sacrificing choice and independence.  It may be a fine line to walk, but it can be done, and I’m living proof.  I’m a sexually adventurous, sexually intimate, HIV-negative man, who above and beyond anything respects myself and my fellow play-partners with communication and intelligently based choices.  I use condoms as the first line of defense for fucking, and I know whom I am playing with.  I ask HIV status; I ask if someone positive is on meds; and I ask what they’re into – allowing me to make conscious decisions about who I’m going to play with and how I’m going to do it. 

Today we are seeing a truly astounding backlash and lack of education when it comes to HIV education and the choices being made to practice safer sex.  Well, it’s astounding to me who had it drilled into me (no pun intended) from about 15 years old that if you touch a guy, you put on a condom.  A generation of men is gone and a new generation of boys with a blatant disregard for the idea of safer sex interactions and HIV awareness has replaced them.  This is further compounded by an older generation of men who are HIV-positive and feel persecuted, judged, and ostracized for being HIV positive.  This can lead to many of them being at odds with their negative brethren; embracing condom-less sex without proper communication, and becoming quite indignant when questioned about their choices.  And it’s understandable that they feel this way.  There is such a wealth of conflicting information that we are seeing, it should come as no surprise that these are the actions we have wrought. 

Right now, there is a belief system gaining steam that going on medication and/or playing with positive guys on meds is an effective way to combat the spread of HIV.  Simply playing with someone who is undetectable will slow the spread of HIV and ostensibly the negative partners will remain that way.  However, gay men make up 61% of all new HIV infections (http://www.sfaf.org/hiv-info/statistics/).  This tells me that the best efforts to go condomless and justify it by undetectable-sorting are failing in comparison to the days of a condoms only mentality.  Now, it gets tricky because I am not saying that one does not have the choice (or the right) to go without condoms, but I am saying that in order to do so, some substantial education, information, and protocols must be in place, and these are daunting obstacles in the heat of the moment.  This is where the f*ck with education becomes a mantra. 

When the recent survey was published showing that just under half of all users of mobile-based hook-up sites (Grindr, Scruff, etc.) bareback (http://www.queerty.com/study-50-percent-gay-men-using-hook-up-apps-have-unprotected-sex-20130122/) there was a gay gasp of astonishment with our collective consciousness.  My first shocked reaction was to the reaction.  I was shocked that people found this surprising.  It had nothing to do with the venue or method of hooking up and everything to do with the changing mentality of gay sex in the post-AZT generation.  As HIV has been reimagined as something to not worry about, there has been a foundational shift in how gay men are choosing to have sex.  Whatever the reasons gay men are citing as justification to go condom-less, it is happening.  Many say it’s because they choose to be more intimate sans condoms.  Others say that they felt comfortable with their choice.  Some instances may be accidental or affected by drug or alcohol use.  Whatever the reason, there is a pervasive mentality today that HIV is no big deal due to medications prolonging life, and the visibility of men who are long term (or recently converted) HIV-positive and are doing fine. 

The mentality of undetectable-sorting to reduce or at the least control HIV is potentially great in theory, but it is not being realized in the statistics.  Unfortunately HIV rates are rising and have been for some time.  In just two years, the HIV rates among men ages 13 to 24 have increased 22% (http://www.cdc.gov/hiv/risk/gender/msm/facts/index.html).  Despite the rationale of a new era of PrEP (http://www.cdc.gov/hiv/prevention/research/prep/) or PEP (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm) reducing the need for condoms, it’s simply not working.  If gay men were truly communicating their status and taking their education (play partner(s) status, top versus bottom, condoms or no, testing regimens) and applying it accurately, our community may see a decline in rates.  But right now we are seeing the exact opposite.  For the individuals who see HIV as “no big deal” and choose to have condom-less sex, the argument that they are still being “safe” is simply inaccurate.  The root of the problem may be that gay men simply don’t care anymore.  This is not a judgment, this is an observation based on the numerous conversations I have about HIV and gay sex on a daily basis.  This is about the giant shrug I get from gay men when they speak about HIV and their risks.  Either it can’t happen to them or it’s no big deal if it does.  Case closed.  The evolution in HIV-care has rendered the threat of HIV moot.  Meds equal freedom to engage, contract, and forget.

I’m calling for a fundamental shift in the mentality of our gay men’s sex-based culture.  I’m calling for a hybrid mentality of still revering condoms first and foremost as a necessity for playtime in conjunction with regular testing and even more frequent communication.  We must not be afraid to be HIV-negative and wear it proudly.  We must not be afraid to be HIV-positive and wear it proudly.  By wearing our statuses on our sleeves, and truly owning our sex and sexuality, only then can we make better choices to protect ourselves against the spread of HIV.  I feel we are on the cusp of losing the battle with HIV.  When my sex club cohort made the comment that barebacking was what the space was about, I shuddered.  Yes, I love barebacking as much as the next guy, but not at the sake of my own long term health.  It does not have to be a given assumption that it will happen to you, or that it doesn’t matter if it does.  One of the hardest things I do as an HIV-negative, empathetic sex educator is respecting and loving my HIV-positive family.  Conversely I have to respect and love my HIV-negative family as well.  They are two very different sides to the same coin.  HIV-negative does not mean that one cannot embrace all aspects of sex and sexuality, from the mundane to the extreme.  And being HIV-positive does not mean that you are broken in any way.  With that being said, there should be no sides to the coin at all as it takes both parties f*cking with education to see a reduction in HIV transmission rates and a better, safer, more inclusive community. 

Damon