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28 Jul 2009

Why a 'Just Use Condoms (and Now Shut Up)' strategy won't work (for everyone)

Fridae's Men’s Sexual Health columnist Jan Wijngaarden says simplistic slogans about condom usage and nothing else are not sufficient; gay men need to understand how HIV transmission works - in all its detail. 

Frankly, I have been quite amused by the fierce reactions to my previous columns that dealt with sexual risk reduction for gay men. I learned there are a huge number of intolerant queens out there, who not only loudly oppose views that differ from their own - which is fine with me - but who do so by trying to undermine the credibility of the person airing these views - me, that is - using rather nasty (also quite funny sometimes) personal attacks. Many of these people tend to see sex as something harmful, dirty and risky. It should be stated here - there is no inherent harm in gay sex - but there is harm in HIV.  

Many of the people responding to the columns seemed upset that I was discussing details of risk reduction strategies - making risk reduction more complex and varied, trying to make people think about different options for reducing risks for HIV in incremental steps, rather than promoting 'One Message / One Strategy Fits All'. 

Instead, they want me to stick to their own view on HIV prevention, which is: JUST USE CONDOMS ALWAYS (AND NOW SHUT UP). I decided to honour these people, bestowing them the title of Condom Queens.

Many Condom Queens think that talking about incremental HIV risk reduction strategies makes HIV prevention more complicated, and that it can lead to confusion. Implicitly, they are suggesting that most gay men are not smart enough to base their behaviour on a more complex set of knowledge, suggestions and ideas. Therefore we should stick to one clear and simple message. I will repeat it here: Just Use Condoms (and Now Shut Up).

Didn't that also work well for smoking? (Oops... No, it didn't).

Your Majesties, allow me to address you here in my humble column. You can no longer ignore the reality of how HIV affects gay communities in Asian cities. The HIV epidemic is enormous and growing day by day. Your message (Just Use Condoms (and Now Shut Up) may be working well for you - although sometimes those shouting loudest about condoms may be the ones who in fact use condoms the least. However your message is definitely not working for a large group of gay men. 

While your message is short and simple, you should realise that the transmission of HIV is not a simple issue. It links to taboo topics such as sex, submission / domination, power, drugs, passion, lust - things that are difficult to discuss or rationalise for many people. A recent study in Australia and data from Bangkok suggest that the occurrence of unsafe sex is related to socio-psychological and emotional problems that gay men face, including depression, fear of rejection, loneliness, alcohol and drug abuse, suicidal thoughts, fear for getting older - to mention a few. Therefore, if we want to change the parameters of unsafe sex, just giving knowledge can never be more than just one tiny component. 

'Don't be silly, put that condom on your Willie', is what we said in the 1980-1990s. Right. That sounds easy! 'No condom, no sex.' A-ha. Everybody knows that. So why are so many people not doing just that? It is because the problem is not a lack of knowledge. It is more than that. We want love, we want to be loved. What we know is one thing, what we feel and what we (think we) need is quite something else. We need to discuss these feelings and needs in relation to our sexual behaviour. Only then can we make these behaviours safer. 

Two decades after Silly Willie (and their Thai, Cambodian, Chinese and Vietnamese equivalents) 31 percent of gay men in Bangkok are infected with HIV. Incidence of HIV is highest in those under 22 years old. Infections in Singapore, Hong Kong, Beijing, Shang Hai, Guangzhou, Mumbai, Manila, Kuala Lumpur, Chiang Mai, Phnom Penh, Hanoi and other cities are all on the rise. 

Instead of suggesting that HIV prevention activists, donors, Ministries of Health take a moment to ask ourselves whether what we are doing is right, or whether we might need to do something more or something different, the Condom Queens say: Just Use Condoms (and Now Shut Up).

My column of two weeks ago can basically be reduced to just one sentence, which is: "oral sex (yes, also without condoms) is safer than anal sex, so let's promote more oral sex and less anal sex". And look what happened! I was close to receiving death threats for saying it out loud. Shame on him! Pull a Condom Over His Head and may he Suffocate in Hell & be Doomed to 19 hours of Condomless Oral Sex Per Day Forevermore. Amen. (Where do I sign up??)

But seriously - we have known for ages that oral sex is much, much safer than anal sex. Why all the fuss? Well - many people I meet in my environment do NOT know this. Because they do not understand the ins and outs, the details of HIV and how it is transmitted. Based on the 'No Condom No Sex' - message, they think oral sex and anal sex are the same in terms of HIV risk. Since they often do not use condoms in oral sex, they may think that since they are at risk anyway, they may as well not use condoms in anal sex either. Telling them the truth, I am convinced, will lead to less people using condoms in oral sex and more people using condoms in anal sex. 

The 'No Condom No Sex' message also implies that 'sex' equals 'penetration'. Is mutual masturbation, thigh sex or mutual licking or erotic massage / stimulation no sex? I think it is. Why don't we promote that as vigorously, or more vigorously, than using condoms? Why don't we promote solo masturbation, the safest technique of all? "Two Jerk-Offs Per Day Keeps HIV At Bay". Or something like that - I have never seen that one before. All these sexual techniques are perfectly safe. Fun too, especially in the shower. Why all the fuzz about condoms? Fuckers. I mean that literally.

The term 'Safer Sex: Needs Discussion' which I see on Gayromeo and Gaydar website profiles used to make me angry. Are the people who put this on their profile irresponsible? Or are they perhaps more responsible than the Condom Queens - who flatly deny the need for allowing discussion of additional ways to reduce risk?

"No Brain, No HIV Prevention". 

What I am saying is: We should stop using these simplistic slogans to advise gay men on how they can reduce their risk of HIV transmission. We have to make them understand how HIV transmission works - in all its detail. We have to help them understand what makes them vulnerable,for example by linking HIV risk to socio-emotional well-being or states of mind. Doing so will provide them options on how they can reduce - or even eliminate - risk. 

Yes, Your Majesties, reducing risk also includes condoms. But not exclusively. 

In our communities, safer sex needs discussion - and urgently so. In that sense I am happy and grateful for the response my columns have sollicited. Thank you for your attention and for your views.

Jan Wijngaarden has worked, in different functions and roles, on promoting HIV prevention, care and support for men who have sex with men (MSM) since 1994. He is also the moderator of MSM-Asia, an information network on MSM, HIV and human rights, with nearly 600 members from across the region. If you want to become a member of MSM-Asia, or for information requests or comments, pls contact him at jwdlvw@gmail.com

Reader's Comments

1. 2009-07-28 20:02  
Fantastic to see a more nuanced and realistic approach to this topic finally getting through. I have not yet quite worked out how, exactly, but I am certain that this issue is inextricably linked to the terrible fear and self-loathing that I have found is so closely linked to sex and sexuality here in China: a repetition of the repressive fear that pervaded the UK in my formative years. People are incredibly complicated - gays more than most - and this issue cannot be reduced to soundbites and easy-sounding solutions.
Comment #2 was deleted by its author
3. 2009-07-28 20:33  
Very well put, Jan. Thanks for all the useful information you are putting out to the community. And telling it like it is.
Comment #4 was deleted by its author
5. 2009-07-28 20:40  
Thank you for being clearer this time round. In all honesty I was rather appalled with the ambiguity of tone in your previous article. On one hand you seemed to want to raise a new perspective to the whole HIV issue, on the other you also seemed to come across as being not serious enough. I guess many of those "condom queens" could have misunderstood your point as a result of this ambiguity.
All these misunderstandings wouldn't have occured if the points of clarification in today's article had been expressively conveyed in the previous one.
Just a point of consideration though. Seeing that you've extensively been working with the asian gay community on HIV issues since 1994, wouldn't you already have encountered or realised that there are many of these so called "condom queens"?
Which brings me back to my first part, that it would've been assumable that you should know of the common existence of "condom queens". Hence, you could have tackled the previous article with more clarity and seriousness to prevent the outrage (which shouldn't come as a surprise if you knew of "condom queens") that happened.

PS: To enforce your articles with more credibility, it would be good to provide links to other scientific articles or statistics. After all, like you mention, most gay men should be smart enough to think for themselves and base their behaviour on a more complex set of knowledge, suggestions and ideas.
6. 2009-07-28 23:25  
Thanks a lot for the so much enlightening article, do keep posting further useful information about HIV prevention on a website like this!
It is evident that the blokes who tend not to wear condoms during anal sex have already been infected with HIV. Or they have simply no educational background as such. Pls take care of yourselves and be responsible for our vulnerable community. Strong health and good life to everyone!
7. 2009-07-28 23:51  
Bottomline: We need to be educated, and to educate others. A book left unopened ain't serving its purpose.
8. 2009-07-29 00:35  
"A recent study in Australia and data from Bangkok suggest that the occurrence of unsafe sex is related to socio-psychological and emotional problems that gay men face, including depression, fear of rejection, loneliness, alcohol and drug abuse, suicidal thoughts, fear for getting older - to mention a few. Therefore, if we want to change the parameters of unsafe sex, just giving knowledge can never be more than just one tiny component. "

Well, you have just moved from the realm of preventing physical virus transmission into the murky waters of the psychological etiologies of unsafe behaviors. Good luck with that can of worms. Community mental health has an even lower priority than physical health even in first world countries.

"NO GLOVE, NO LOVE!" Call me what you want....
9. 2009-07-29 01:29  
As others have said the change of tone is welcome (except for the sarcasm), but I still have the same objection:

You discuss having sex in terms of strategies. Many people don't like condoms. Anal sex without condoms is dangerous, oral sex without condoms is far less dangerous. Therefore, why don't they choose oral sex?

Except that it doesn't work like that. Some people need their anal sex and won't be content with oral sex just because of dangerousness. (Some also don't like anal sex at all.) This is libido, not smart shopping!
Comment edited on 2009-07-29 01:31:35
10. 2009-07-29 01:51  
Hear! Hear!
11. 2009-07-29 04:41  
Drelin (comment #9) I'm afraid your comment shows that you haven't read Jan's article thoroughly enough, as is so often the case here. People seem to read too fast and then react even faster. The result is more like ping pong than serious debate and on a topic like this, it's regrettable.

Jan never says or even implies that when you're having sex you are thinking in terms of strategy. If anything, he says quite the opposite and is obviously very much aware of the fact that most of our behaviour, where sex is concerned, is irrational and light years away from ANY kind of strategy.

What he's saying is that by INFORMING people more thoroughly, by providing them with more precise, nuanced and reliable information, their brain is likely to process that information and then, in turn, influence their sexual behaviour in a positive (ie safer) sense.

It's like so many other things that we do without actually deciding to do them. Additional information will not necessarily bring us to act deliberately and in full awareness the next time, but it will most probably affect the WAY we act.
12. 2009-07-29 07:03  
Knowledge is power...great article
13. 2009-07-29 09:43  
It is very sad that some people living and educated in Sg are still not practising safe sex. Some weeks ago, I had fun with a 27-year-old top from China. He had been educated in Sg for many years. Yet, he tried to enter my anus raw. Had I not insist that he used a condom, he would have had his way in the midst of his passion. Sigh!
14. 2009-07-29 10:31  
Couldn,t agree more Jan.

You have touched on a couple of the most endearing aspects of the asian (gay) male... "The first is, When in doubt resort to personal insults" But anyone with self confidence can learn to live with that.

The really serious issue is the need by asian men to want simplistic answers to everything. Then they'll accept anything and certainly dont want any in depth discussion on 'sensitive' issues

This attitude is a by-product of their repressive upbringing where they are given the most simplistic answers ( if they dare to ask a question).. and then told to SHUT UP!!

The answer to HIV ,and so many other issues relating to being gay, is knowledge and understanding. And the obligation and responsibility is on every gay man to know "his trade" and all the issues associated with it

There are many sources of reliable information... use them.

But that brings up another issue ... That asian men have been spoon fed for so long that they are largely incapable of doing anything for themselves

15. 2009-07-29 11:04  
Re Denseaus's post (no 14),

I can't see how you can agree with Jan when he was not referring specifically to Asian males who :"want simplistic answers to everything. Then they'll accept anything and certainly dont want any in depth discussion on 'sensitive' issues" as you have written.

To write that "Asian men have been spoon fed for so long that they are largely incapable of doing anything for themselves" is quite unnecessary and racist.
Comment #16 was deleted by its author
17. 2009-07-29 11:33  
Just my 2 cents worth of thoughts...
HIV is real...and it relates to the community and each and everyone of us in one way or another. Fridae has given us this opportunity to share ideas and information on various matters relating to the GLB community.
In the age of the internet, informations are abundent. Some are good..others maybe not. Readers should exercise caution and reasonable judgement when digesting these informations. When in doubt, always go to reliable sources (eg, doctors, health professionals). There's no cure for HIV, better to be safe than sorry.
Comment #18 was deleted by an administrator on 2009-07-29 11:50
Comment #19 was deleted by its author on 2009-07-29 12:17
20. 2009-07-29 13:38  
Ethics wise i think it aint right for a writer/ columnist to give names to readers, be it the ignorant ones, or not. So much for condom queens, so shld they jus give up on their committment to condoms and go au naturale? :)

While typing this i saw this note above the comment box, stay on topic, an be polite; does this implies to the writer to? :)

Still the latter part of the article is rather informative (doh am still having a hard time comprehending the incoherent write-up), as compared to the earlier half which i saw alot of effort put to refuking all the comments (which you think was crap and unnecessary) you have been slapped with.

nonetheless, keep the work up :) you are doing better and better!
21. 2009-07-29 13:38  
Is it really necessary to use derogatory language to get your point across? Where I come from the term queen is a derogatory word. I think that on fridae everyone has the right to put their views across and indeed many people have put their views across without the use of derogatory language. Therefore why the need to do so in reply? If we cannot make comments without having derogatory words used against us then why does fridae make a comment box?

Whilst I agree with 85% of what you say most of the time. I do not agree with the use of derogatory wording.
22. 2009-07-29 13:54  
think the author is kinda figuring it out how to write better but still, is very bitchy about critics. the whole simple safe sex thingy is just got entangled more and more complex... for what
23. 2009-07-29 15:26  
let your light and words of wisdom and experience shine, let science shine and laguna bro will help u keep the queens at bay, keep telling the truth and don't ever apologize again for it, men need to spend more time learning how to be men, whether gay or straight, then just chasing a piece of ass

you will save a lot of lives here so don't stop and hesitate for one minute man
24. 2009-07-29 23:13  
Thanks for your views Jan! I'm glad to see the beginnings of a healthy discussion on this and hopefully more appropriate action from here onwards.
25. 2009-07-30 00:20  
When I first read Jan's past articles I kept questioning myself why a person of his position would adopt such a controversial approach in writing. Perhaps it's a ploy to get attention. I guess there's some positive outcome in creating active discussion and reflection.
26. 2009-07-30 22:07  
I believe Dr. Wijingaarden will bring us more and more sound knowledge and viable solutions regarding our health in the future.
27. 2009-07-31 00:18  
How widespread is the ongoing phenomenon?... the strategy of "Let's get tested 2GETHER B4 we have sex, for A VARIETY of STDs." Do sexual health checkups reduce ambiguity and can they be like anything else POTENTIAL sex partners do together?...
bloglinks at
http://notb4weknow.blogspot.com
http://continuedat.blogspot.com
Comment edited on 2009-07-31 00:19:48
28. 2009-07-31 02:31  
Its good to see this discussion. For those who are willing and able to use condoms everytime they have sex, they can be fairly sure to stay HIV negative, and that option should be fully encouraged. For those who occassionally or frequently engage in anal sex without condoms (for any number of reasons), it makes sense to educate them to the many approaches for harm reduction.

There are multiple ways to reduce risk of sero-conversion in addition to condom use (well beyond what was discussed in these articles). They are clearly less perfect than condom use or abstinence, but taken as a whole they can have an impact. If everyone who was having anal sex without condoms, took multiple imperfect steps to reduce their risk, sero-conversion rates would decline on a community basis.
29. 2009-08-02 15:06  
Terrific article, Jan - great response to the rebuttal you've been getting these past couple of months. Keep it up!! (and the sarcasm!! :P)
30. 2009-08-03 02:28  
Whether or not I agree or disagree with the stance of the writer is almost irrelevant - I must commend him on presenting such a balanced view on what is a very sensitive subject. If only more of us would talk about HIV transmission so openly.
31. 2009-08-03 16:23  
I've always noted that sarcasm is proof of wit. So congratulations to Jan on a well written and obviously witty reply.
32. 2009-08-10 00:27  
I agree with your assessment. Simple answers to complex problems are not likey to work over time. Education is our strongest too and I am glad that there is starting to see some additional educaton resources being made available online. www.vir.us was recently featured in a Fridae article. It is an online resource with interactive vides and social media components. The success of this resource literally depends on word of mouth. So want a new approach -- spread the word. www.vir.us

Doug

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