2009 is drawing to a close. As I look back on the work we have done at OUT throughout the year I feel a sense of pride, amazement, and excitement. OUT is rapidly expanding, with work being done in Pretoria, Mamelodi, Johannesburg, Nelspruit and Mafikeng. OUT is professionalizing, with a move towards drawing on the expertise of doctors, nurses, psychologists, social workers, and experts in the field of activism, research, and HIV prevention.
OUT is becoming credible, by providing high quality services (e.g., face-to-face and telephonic counselling, primary health care clinic services, various support groups, and the distribution safer sex packs), conducting outreach (e.g., Play Safe campaign addressing the links between substance use and HIV transmission, and One2One peer education programme promoting sexual health), facilitating group-based activities (e.g., gay and lesbian interest groups and book clubs, P-Flag, Supamoms), providing up-to-date information (e.g., informational material on sexually transmitted infections, hate crimes and substance use, informational workshops for lesbians and gay men, as well as informative websites such as www.men2men.co.za and www.womyn2womyn.co.za), training of service providers (e.g., developing service providers such as clinics, doctors, nurses, psychologists and social workers to become more sensitive to the needs of gay and lesbian people), and advocating on behalf gay and lesbian people in terms of their rights.
These projects and programmes are informed by the needs of gay and lesbian people. When shared on international platforms, it would appear that this work (which you may be surprised to know is carried out by only 15 people) sets a high standard for others working in the health sector. This makes us very proud of the work that we do.
But this is not a fluff piece on how great we are doing. In fact it is quite the opposite. Recent experiences, which I will share with you now, has left me wondering ‘what are we doing?’ and ‘how effective are we in the work that we do?’ At a recent outreach HIV testing event I was alarmed at how much misinformation there is among gay and lesbian people about their risk behaviour, and how many people still don’t know about OUT and the work it does (meaning they had not been exposed to or benefitted from our projects or messaging at any point in their lives).
On another level, it reinforced our growing awareness that our work cannot focus merely on the physical (e.g., the sexual act and associated sexual health) but should rather include the psychology and sociology of individuals (e.g., sense of self worth, sense of agency, the role of peer pressure and the basic need for connection come to mind as worthy examples). The challenge here is how we address these contributing factors on a broad level, as we simply don’t have the human and financial resources to work one-on-one with each and every gay and lesbian person.
At this testing event I heard a few clients mention that they were in a ‘monogamous’ relationship. When questioned how long they had been in this relationship, responses ranged from 2 weeks to 1 month. I probed further and it seemed that on average they had 3 to 4 ‘monogamous’ relationships this year alone. This might not be surprising to many, as the gay and lesbian sub-culture seems largely supportive of physical relationships that develop rapidly and intensely but have a shorter shelf life than a carton of milk. I also found that these clients had taken the decision that condom use was no longer necessary as they were in this ‘monogamous’ relationship, which they trusted and felt safe.
For them, this sense of safety is attributed to the conviction that they were not having sex with multiple partners at the same time. They were correct in part, but seemed to overlook the fact that frequent serial relationships can pose similar risks as multiple concurrent partners. This is especially the true in cases where trust is established rapidly and condom usage becomes a thing of the past in the absence of establishing a sex partner(s) actual current status.
A few of these clients also claimed to be safe as they were only exposed to their partner’s cum and not their blood. For them, as long as there was no sign of blood everything was ok! Furthermore, very few of them seemed aware of the range of sexually transmitted infections (STIs) out there, how these are transmitted, how some of these may manifest or remain invisible, and if left untreated, how this could affect their health and increase their chances on contracting HIV.
A common theme amongst these individuals was the moderate to heavy use of alcohol and/or other recreational or prescription drugs. The connection between substance use and increased risk-taking appeared to be a non-issue. Unless you are driving, substance use appears to be harmless and fun. These revelations, demonstrating high levels of denial of their own risk behaviour and exposure, concerned me a great deal and I immediately felt that I had failed them in my job as a sexual health professional in the field of HIV prevention.
I am all for having fun and experiencing pleasure, expressing oneself as a sexual being, and making meaningful connections with others. But my concern rests on the need or compulsion to place a few moments of pleasure and connection ahead of one’s own self-worth. I am left wondering of all the great projects and programmes we are currently running, what are we missing and how do we address this? At the same time I wonder at what point does our social responsibility end and the client’s responsibility begin?
It seems clear that we need to increase efforts to make people aware of the fact that exposure to cum is just as risky as exposure to blood; that the biological make-up of the anus (which is far less elasticised than a vagina, therefore more likely to tear during the course of penetration, and as a result increase exposure to one’s partner’s cum for a period of time) makes them especially vulnerable to HIV; that cumming in the mouth poses some risk as one cannot be absolutely sure of what is happening exactly in their mouth; that serial monogamy (that is one partner after the other) is possibly just as risky as having multiple concurrent partners (especially when condom usage decreases); and that one cannot be absolutely sure of their or their sex partner(s) current HIV status (unless abstaining for the duration of the window period and then getting an HIV test) and resorting to the dangerous assumption that their partner(s) were safe because they looked healthy and said they had recently been tested!’
As I look forward to 2010 I want to encourage everyone to continue their efforts at developing awareness and insight into their thoughts, feelings and associated (risk) behaviour. I also want to encourage everyone to start communicating; talking about sex, sexual histories, risk practices, risk reduction strategies, needs, fears, and anxieties.
We live in a society where people don’t really talk anymore. We, as individuals and as a collective, need to change this. It is our shared responsibility. If you have any suggestions or comments about the work we do or how we can address the issues raised in this articles, please feel free to share this with us. We are, after all, here to respond to your health needs.