Safer sex is any sex where you choose behaviours that make it less likely you will get an infection.
Although safer sex may mean protecting yourself and your partner(s) from the exchange of body fluids, it really means any changes you make in your sexual activities to protect each other.
Staying safe from disease is an important part of sexual health.
Problem: As has been well-publicized, there are many far from ideal ways in which people engage in sex, from brutal domination by one partner through various exploitative sexual games — not to mention the implications of prostitution, pornography or what some choose to perceive as perversion. It is questionable how often partners are mutually satisfied by such cooperation. Considerable emphasis is placed on preliminary techniques for arousing interest, on short-term “performance”, on the level of personal “pay-off” (such as the quality and quantity of orgasms), and on avoiding any long-term consequences. “Safe-sex” is advocated to avoid mutual infection and contraception is practiced to avoid the conception of any product from the union — except amongst those without the means to care for such issue. In the unfortunate event of effective conception, considerable means are deployed to ensure abortion or disposal of the issue by other means. Every effort is made by the majority to avoid any tangible consequences of such acts of cooperation — whilst a minority goes to great lengths to rectify infertility — through artifical insemination and the use of surrogates.
Institutions should make an effort towards empowering males who have sex with males toward health seeking behaviors then there needs to be major efforts to:
a. increase access to and usage of appropriate sexual health products and services,
b. reduce STD/HIV infections amongst males who have sex with males and their male and female sexual partners
To ensure that the possible socio-economic impact of AIDS at the personal, familial, community and national level is reduced then the following issues need to be urgently explored.
1. Sexual Behaviour research
Before appropriate strategies can be developed towards STD/HIV control programmes by government and non-government agencies, there needs to be effective research conducted in regard to the full range of sexual practices of individuals, and sexual behaviour patterns of families and communities. For such research to be appropriately used in such a development, then it must be contextualised within socio-cultural-economic frameworks. The problem is that very little of this has been done. No-one really knows what is happening in terms of sexual behaviours and their sociocultural constructions. Sexual behaviour is not the isolated phenomenon of the individual but lies within a context of culture, social and economic conditions.
“…… it would have to focus not only on the incidence of particular attitudes and practices, but on the social and cultural contexts in which sexual activity is shaped and constituted.
Research attention would have to be drawn not merely to the calculation of behavioural frequencies, but to the relations of power and social inequality within which behaviour takes place and to the cultural systems in which it becomes meaningful.
“In relationship to HIV/AIDS, as in relation to gender, inequality and sexual oppression, an understanding of sexuality and sexual activity as socially constructed has thus refocused attention on the inter-subjective nature of sexual meanings – their shared, collective quality, not as the property of atomised individuals, but of social persons integrated within the context of distinct and diverse sexual cultures. This emphasis, on the social organisations of sexual interactions, on the contexts within which sexual practices occur, and on the complex relations between meaning and power in the constitution of sexual experience, has thus increasingly shifted attention from sexual behaviour, in and of itself, to the cultural rules which organise it. Special emphasis has been given to analysing the local or indigenous categories and systems of classification that structure and define sexual experience in different social and cultural contexts.
a. male rape
b. adolescent males as sexual objects of older males
c. high levels of anal sex between males and between males and females
d. very early experiences of sexual activity and sexual abuse amongst males
e. inter-family male to male sex, with sexual partners including brothers, uncles, nephews, cousins, male-in-laws, etc.
f. sexual encounters with servants
g. male to male sex without identity constructions of homosexual/bisexual
h. identity structures around marriage, penetration, age, family, religion, caste and class
i. feminised identities primarily of males who are penetrated
j. Hijras as a socially constructed identity of biological males who are “feminised” through social/sexual interactions in pre-pubescence
k. sexual desire of many males based on discharge and activity not on gender of partner
1. some male to male sexual behaviours based on females being seen as disease vectors
m. gender segregation and limited sexual access to females within a socio-cultural framework of homosociability and homoaffectionalism increasing options for male to male sex
This research is limited by time and available funds, but already it can be clearly seen that what currently exists as HIV prevention strategies amongst males who have sex with males are very limited.
a. who is going to conduct the research
b. how is it going to be conducted
how is information going to be collected and by whom
what questions are going to be asked, how are they asked, and in what language
e. what terminology will be used
f. how will the information be analysed and who will do the analysis how will the data be used in developing appropriate STD/HIV prevention and sexual health services who will develop such services and who will work in them
The need for appropriate information towards developing strategies for sexual health promotion amongst males who have sex with males must be urgently addressed as a priority. This will require developing appropriate behavioural and anthropological models of research that include the subjects of such research, both as subjects and as observers. Such research should also recognise the wide diversity of cultures, languages, terminologies and behaviour of participants, which include those whose primary behaviour is male to male, as well as those whose male to male sexual behaviours are intermittent, secondary and discharge based.
The terms gay/homosexual have very little significance for the vast majority of males who have sex with males, and only seem to have some meaning to those with access to English, and who are primarily middle/upper classes, a small minority in India. Even in their context, marriage becomes a primary focus of identity. Some of those under thirty may well identify with this terminology, but after this age, marriage as a family commitment becomes the primary identity. There may well be those who carry both identities and situate them within specific social contexts, i.e. a “park”/social network identity and a home/business identity.
For the those from the lower-middle/lower income/labour classes, different, more gendered, frameworks exist. Thus the terms, kothi and danga exist as identities of those males who are sexually penetrated and behave in “feminised” ways. These males stated that they ,never penetrate other males, nor have sex amongst themselves. This is considered shameful. Their ejaculation is usually produced through the act of anal penetration by their partner, or through selfmasturbation. However, whilst this is what is usually stated, private one-on-one discussions indicate that some kothis do have sex with each other and do anally penetrate as well.
If we are going to empower individuals, sexual networks, social groups and communities towards an increase in health seeking behaviours, then more research needs to be done to identify as to who, how and why various sexual identities are constructed, there specific meanings, and how they can determine sexual behaviours.
Understanding these constructions enable more effective designs for intervention strategies that enable the promotion of sexual health amongst males who have sex with males.
3. Empowering Behaviour Changes
Why do individuals modify their sexual practices towards safer sex practices? Why should they? Under what circumstances? What forms of persuasion work?
Our evidence from the workshops, research, and direct intervention, indicate that myths, environments, identities, behaviour modalities, socio cultural frameworks, religious ideas, poverty, accessibility to appropriate sexual health products, empowerment, class, economic power, and so on, all play a role in determining whether a shift towards safer sex practices can be maintained over a long period of time.
It is not simply a matter of telling people the risks involved in their behaviours, the possibilities of infection, or the resultant potential death from an AIDS related illness. Fear can be a possible motivation for an individual to change their behaviour, but can this fear be sustained?
Little work appears to have been done as to what effective strategy or strategies would work amongst the differing sexual networks amongst males who have sex with males. What might work amongst one group or class may not work in another. What might work for self-identified gay men may not work for those involved in jiggery dost or discharge sex.
Beyond the actual structures and models of intervention, access to appropriate sexual health products becomes essential. How can one tell an individual to practice safer sex when identity is configured around anal penetration, where the environment is not conducive to safer sex behaviours, where poverty can be one of the dynamics that socially constructs sexual behaviours, and where access to appropriate condoms and lubricants is not possible?
At the same time, sexual health services need to be sensitised to the needs of males who have sex with males. If a clinician does not have the knowledge around anal sex issues, or is too ashamed to discuss these issues, or finds them offensive to deal with, how can such a service deliver an appropriate framework which can be accessed by males who have sex with males?
This is the challenge for South Asian agencies developing sexual health work amongst males who have sex with males.
towards encouraging them to practice safer sex, the levels of knowledge, understanding and acceptance by medical staff and social service agencies regarding males who have sex with males and their sexual practices, and what would work in the differing sexual frameworks and networks of males who have sex with males.
4. Sexual Health Education Resources
This means that males who have sex with males are not able to gain any specific knowledge regarding their sexualities, practices or issues around the risks of STD/HIV infections.
Nor is there any specific information available regarding symptoms of STDS. Many of the workshop participants could not recognise some symptoms as STD related and very often stated that they would not access STD services because of this.
At the same time, those who practice anal sex with females are also not able to access information on the levels of risk of this behaviour.
a. women as disease vectors, arising from many campaigns which target female sex workers as infectors of HIV and therefore to be sexually avoided
b. anal sex is safer than vaginal sex , because no one talks about it
There is an urgent need for a broad range of educational materials reflecting the sexual practices of males who have sex with males, including specifically anal sex, to be made available. Such resources should include that which is part of an ongoing general campaign around raising awareness and knowledge about sexual behaviors, STD/HIV infection symptoms and risks, and condom usage, and those resources specifically targeting behavioural groups specific to the needs of each such group.
5. Sexual Health Products
Figures received by The Naz Foundation indicate that inIndia, only 360 million condoms are sold each year in a population of over 900 million people. These condoms vary in quality and strength, with the higher quality condoms being relatively more expensive.
Condom promotion is usually left to family planning clinics (which are primarily visited by women), some ad-hoc local government poster campaigns (which of course necessitates literacy), STD clinics (if you attend them), and a range of HIV agencies, either through free access or through social marketing principles.
There are no condoms available appropriate for use in anal sex encounters either between males or between males and females. Further, the only water-based lubricant available in the market is Johnson andJohnsonKYjelly sold in tubes by pharmacies and is relatively expensive.
Several points need to be made
1. There are insufficient condoms in the market place to cope with the specific needs for a major reduction of STD/HIV infections through safer sex practices.
2. There is insufficient education to promote correct condom use as a safer sex practice. Condom promotion historically has been seen as an aid to family planning,
3. There is no clear cut strategy to deal with the difference between procreative sex and recreational sex. This issue is clouded with morality, shame and ignorance.
4. Condom quality varies considerably, with the cheaper brand (Nirodh inIndia, and Rija inBangladesh) being seen by potential users as a government condom, aimed for family planning, and of poor quality.
6. Sexual environments, whether indoors or outdoors. are not generally conducive to condom use. A lack of privacy and intimacy in sexual encounters also control condom usage.
7. Sexual taboos against the public discussion of sex, particularly anal sex.
The majority of campaigns regarding condom use are focused on female sex workers and those who access them. What about other females and males who are also sexually accessed?
Condom promotion is seen as targeting “highriskgroups” and not a part of general education campaign.
The methodology of the actual penetrative act increases the risk of condom damage. That is, rapid penetration and thrusts leading to quick ejaculations, and occasional use of oil-based lubricants.
No suitably packaged and priced water-based lubricant in the market.
1. Increased availability and accessibility of good quality condoms at prices every one can afford.
2. Increased usage of condoms through regular and on-going condom promotion campaigning, recognising the high levels of recreational sex including anal sex.
3. Marketing and promotion of appropriate condoms for anal sex.
4. Increased availability of education resources regarding correct condom usage.
Easy availability and promotion of suitably packaged water-based lubricants to be used with condoms.
Destigmatising the public discussion of sexual behaviours through multi-media educational campaigns.
6. Sexual Health Services
that anal sex is not some small minority behavior, but is a significant sexual practice amongst many males of differing ages, socio economic groups, religions, castes, class, and marital status. Anal sex is not only occurring between males, but also between males and females.
…shame is a significant controlling factor with regard to people’s lives and access of services. There are few appropriate sexual health services addressing these concerns.
should receive training on ALL frameworks of sexual behaviors which must include anal sex as a practice both between males and between males and females.
In the 1980s, gay men widely adopted safer sex practices, but the number of … A common perception among communities and institutions is that treatment will take care of an infection. Whereas Religion plays a strong part in perception of HIV risk as it may be a barrier towards … strategies towards women to increase their safer sex negotiation. …
to assess the perception and behaviour of men and women towards …
increase use of condoms by 20%
and increase positive attitudes towards safer sex by. 20%.
In many places it is unacceptable for a woman to negotiate safe sex; … A harm reduction strategy argues that those unable or unwilling to change behaviour …