Thursday, December 1, 2011

When Condoms Aint Enuf...

via TheBody, by Allen Kwabena Frimpong and Michael Terry Everett

"I also want to mention that we are increasingly becoming better at incorporating conversations about 'harm reduction' into the realms of substance use (needle exchanges, safe injection sites, pill testing, etc.), but we often fail to adequately translate this model when speaking of communicating risk reduction in sex (strategic positioning, sero-sorting, viral load suppression, etc.). My question back to the group then is, how do we more effectively communicate to young people the abstract concept of 'harm reduction' for sex within the context of a sex phobic society?"

This was a question posed by Jamie Forrest of Vancouver, Canada in the North America, Western Europe, and Caribbean CrowdOutAIDS Open Forum on Facebook. CrowdOutAIDS is UNAIDS new collaborative online youth-led project.

He posed this question to the group after people were discussing what they considered to be the main reasons for HIV infection among young people.

Reading the responses on Facebook gave us one of those jolted reactions.

The dominant message about sexual health in relation to HIV prevention has been focusing on condom usage. Jamie's question was one that I saw as challenging; given the propaganda that the HIV/AIDS field has been pushing around what it means to have safer sex.

My colleague at the Harm Reduction Coalition, Michael T. Everett, was also raising this same question especially among young men who have sex with men (YMSM) of color given that their rates of infection have been steadily increasing while rates of infection among injection drug users has been on the decline.

The question for us became what (besides the exchange of needles) was accounting for the decrease in transmission of HIV among injection drug users, and how could we use what works in harm reduction messaging and education when it comes to drug use (if anything) for other high-risk populations greatly affected by the epidemic through sexual transmission.

We considered this in light of the following:
  1. We cannot exchange condoms like we do syringes.
  2. We know people are not using condoms all the time, and the possibilities of HIV and other STI's has not scared enough people into doing so, and so ...
  3. If people have been harboring condom use as the dominant end all be all harm reduction response- well then something is terribly wrong with this picture.
The place to begin the conversation around the idea of prevention of at-risk behaviors like having unprotected sex is a great place to start.

We need to engage an intentional conversation concerning the reality that the message of safe-sex, by way of condom usage, may not resonate with people because it is limited and does not allow one to ponder the spectrum of other possible harm reduction practices.

The point is: we want people to still live a healthy life without causing further harm to themselves and others. The spectrum of harm reduction practices includes everything from prevention to helping those who are most affected by the collateral consequences of their at-risk behavior.

The spectrum does not begin or end with condom usage only.

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