Views & Reviews Personal View

Bareback to basics: how gay porn undermines safe sex campaigns

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b910 (Published 25 March 2009) Cite this as: BMJ 2009;338:b910
  1. Richard Hurley, technical editor, BMJ
  1. rhurley{at}bmj.com

    In the early days of the HIV pandemic in the 1980s, chilling advertisements included a tombstone-like monolith emblazoned with the AIDS acronym, while John Hurt cautioned, “If you ignore AIDS it could be the death of you, so don’t die of ignorance” (www.nationalarchives.gov.uk/films/1979to2006/filmpage_aids.htm).

    Such terrifying safe sex messages seem to have all but dried up, however. At the same time the depiction, indeed celebration, of unprotected anal intercourse in gay pornography has risen massively. The message this sends to young gay men that sex without condoms is OK is putting them at risk of HIV and other sexually transmitted infections.

    The essence of today’s sexual health messages is that, because of advances in testing and treatment, people with HIV live normal and healthy lives. Of course, the reality isn’t so simple, and AIDS has no cure. The government and gay health groups no longer rely on an authoritarian voice to encourage condom use. Instead, campaigns reflect a drive to reduce the stigma associated with being HIV positive.

    This has led some gay men to reach warped conclusions—for example, that it is inevitable that they will contract the virus and that when they do it won’t matter too much because of what they see as the panacea of antiretrovirals. Add to this the misconception that post-exposure prophylaxis provides a “morning after pill” for HIV, and unprotected sex seems even less of a big deal.

    But AIDS is a big deal. Since 2003 the annual number of reported HIV diagnoses in gay men has consistently increased, to exceed the statistics for the 1980s and 1990s. The incidence in the United Kingdom in 2006 was almost 3000 (www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1197637002300).

    A large and growing proportion of gay porn DVDs on sale through sex shops and the gay press are condom free—and are marketed as such. Their titles often contain the words “bareback” or “raw,” and their covers sport icons of crossed-out condoms. With increasing deregulation and competition from the internet, porn studios are exploiting taboos to maintain market share.

    Bareback sex puts porn performers at risk. Last year the BBC’s Newsnight programme reported that HIV infection was diagnosed in four men soon after they took part in a shoot (http://news.bbc.co.uk/1/hi/programmes/newsnight/7277000.stm). Some studios reacted to this exposé by setting up the Gaikiss (gay adult industry keeping its sex safer) campaign (www.gaikiss.org.uk). This collaboration has developed a code of practice, with advice from London’s Charing Cross Hospital (which runs a service for people working in the sex entertainment industry) and the support of Gay Men Fighting AIDS. The code aims to protect performers by recommending that condoms be used for anal sex. It also emphasises the need for studios to insist on seeing certificates to show that performers have recently been tested for sexually transmitted infections. The US director Chi Chi LaRue has taken a public stance against bareback porn and produced a public service film to promote safer sex (www.safesexishotsex.com).

    The condom is a physical barrier between partners in what should be a highly intimate interaction and is often criticised for spoiling the moment. In the post-AIDS mentality, many gay men see bareback sex as more authentic, more pleasurable, and more masculine. If bareback porn does not fetishise risky sex, it at least eroticises it.

    The use of condoms in porn films normalises safer sex and offers practical demonstration. Many films show sex between men under the age of 30. And because most young men learn about sex through pornography, it seems likely that they may mimic their screen heroes in their own sexual practice.

    Doctors should:

    • Remind their young gay male patients to use condoms, especially with new partners

    • Suggest to gay men that they ask about a new partner’s HIV status and that they are honest about their own

    • Recommend that gay men be tested regularly for sexually transmitted infections and that this should always include HIV, and

    • Demand universal antigen or genomic testing rather than antibody testing, which can detect HIV within weeks or days rather than months after infection.

    Notes

    Cite this as: BMJ 2009;338:b910

    Footnotes