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Putting the sexy into safer sex

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1 Putting the sexy into safer sex
We believe you can have safer sex if you know how to have good sex Putting the sexy into safer sex

2 Based in UK and India with volunteers worldwide
Largely volunteer-run: No full-time paid staff; limited amounts of project-based funding Why we started: “Insertive probe” and “receptive cavity”: Sex in the public health world Pleasure: one of primary reasons people have sex, yet absent in public health programming, education, research We ‘sell’ everything using sex … why not safer sex? What we do: Advocacy about the importance of pleasure in sexual health Training health professionals and educators Research to build the evidence base Bringing safer sex to erotic media out of frustration that the sexual health/HIV world ignores sex and sexual pleasure … despite the fact that pleasure-seeking is one of key reasons people have sex, including unsafe sex

3 Advocacy for erotic safer sex
With the media: Washington Post (March 2009) (USA) the Guardian (UK) The Times (UK) Sydney Morning Herald (Australia) National News (Canada) National Radio (Colombia) American Broadcasting Co (ABC) (USA) Cosmo (UK) Positively Women magazine (UK) At conferences: IAC (Bangkok, Toronto and Mexico City) ICAAP 2007 (Colombo) Women Deliver 2007 (London) Microbicides 2008 (Delhi) CHAPS gay men’s sexual health conference 2008 (UK) Terrence Higgins Trust (UK) Youth Leaders Conference Royal Society of Medicine (London)

4 Launched in 2004
Usage stats Aug 2008 – Apr 2009 (9-month period) 27,000+ visitors, 24,000+ unique visitors 89,000 page views Avg. 2,500 unique visitors/month, spikes after conference appearances Visitors from 25 countries (top: 31% USA, 8%UK, 4% India & Ireland …notable: 1.8% China, 1.4% Saudi Arabia, 1.2% UAE) Most popular pages: home page (21%), sexy tips main page and activities (+/-12%) Most common file downloads: Global Mapping of Pleasure (15,000+)

5 Sexy tips at
Lots of sexy tips out there TPP site, but not specifically aimed at MSM Sites mentioned earlier have lots of great tips for eroticising condoms This info can be used in publications and in face-to-face counselling or health context 5

6 Pleasure proficiency training
CARE Cambodia, 2004: 3-day training of trainers IAC Toronto, 2006: How to talk about sex and pleasure ICAAP Colombo, 2007: Sexing up male and female condoms Positively Women, London, 2008: Pleasures of the Female Condom for HIV positive women African HIV Policy Network, London, July 2008: upcoming THT (UK) Youth Leaders Conference UK NHS Bristol sexual health training


8 45 case studies of individuals and organizations around the world who aim to empower people by eroticizing safer sex and making sex education sexy. Designed for everyone who is tired of hearing the same-old prevention messages – that sex is dangerous, something to be feared, and that safer sex is un-sexy. first published in 2004, with the support of CARE International/CARE Cambodia, as a training tool for sexual health educators in Cambodia. Researched and written on a shoestring, in just ten days, yet has been widely referenced in the media and health sector To date, it is the only resource available that explores pleasure-focused approaches to safer sex worldwide. We realized the need to update it to include the many pioneering organizations and individuals we have met since that first edition was published. With support and funding from the Realising Rights Research Programme Consortium, we were able to widen our search for organizations that eroticize safer sex, and to produce this updated edition.


10 Victorian AIDS Council, Australia
Some topics covered: The basics Condom use Testing Unprotected anal sex PEP State of mind Sexual adventurism In the heat of the moment Campaign launched in response to increase in HIV since 2000. Social researchers reported that new cases of HIV were among those: aware of safer sex messages who knew that condoms prevent HIV older. VAC decided to do something different -- campaign message: you can have lots of good sex and use condoms. Much easier to do a sexy safer-sex campaign if it is targeted, because sexual pleasure is subjective and diverse. Images given free from the only safer-sex gay porn site, Owner supported campaign as community wanted messages not from the doctor or the ministry but “from someone who was doing it’ Images given free by the only safer-sex gay porn site in Australia:










20 Building the evidence base
Promoting Protection and Pleasure: amplifying the effectiveness of barriers against sexually transmitted infections and pregnancy Philpott, Knerr and Maher; The Lancet; Vol 368; Dec 2005 - huge burden of disease & need for novel approaches - Sexual pleasure as key component of sexual health - examples of eroticising male and female condoms - future agenda for research (this is important because we highlighted why we need to do more research in this area so directly led to our literature review) Qualitative – effectiveness in different social contexts, any possible adverse effects ? Could promotion of pleasure lead to creation of new norms and stigmas of pleasure ? Are there any specific groups for who this approach may be less relevant? What lessons can be learnt from examples of successful marketing ? Quantitative – how effective is the emphasis of pleasure as opposed to other approaches and is it cost effective ?

21 Not only HIV but also reproductive health
Pleasure and Prevention: When Good Sex Is Safer Sex; Reproductive Health Matters 2006;14(28):23–31 ; Philpott, Knerr and Boydell Most sexual health education programmes use fear and risk of disease to motivate people to practise safer sex gives the impression that safer sex and pleasurable sex are mutually exclusive there are a variety of organisations, including religious and youth groups, and promoting pleasurable safer sex. techniques they use include promoting sexual techniques and dialogue about sex, teaching married couples how to have better sex and putting images of desire in sexual education materials. This paper focuses on ways of eroticising female and male condoms as examples of effective ways of using pleasure in HIV prevention and sexual health promotion.

22 Building the evidence base
Promoting sexual health and rights through pleasure: A literature review Funded by the Pathways of Women’s Empowerment Research Programme Consortium ( Is there evidence that integrating elements of pleasure and the erotic into HIV prevention interventions can increase safer sexual practices and empower people, particularly women, to negotiate safer sex? Builds on our preliminary examination published as a Viewpoint in the Lancet (Dec 2006): "Promoting Protection and Pleasure: amplifying the effectiveness of barriers against sexually transmitted infections and pregnancy"

23 Building the evidence base
Strong evidence of effectiveness in some settings, but limited Need for more research in wider range of settings and contexts (e.g. high-risk groups, gender and culture implications) Review makes recommendations for capitalizing on the promising potential of pleasure and erotic approaches to safer sex promotion “Pleasure is arguably, if not definitively, the single most powerful motivating factor for sexual behaviour.” – World Association for Sexual Health (WAS), 2008

24 Is there Evidence ? A few RCTs examining evidence of effect – positive attitudes to sexuality more likely to mean practise safer sex (Kyes, Brown and Pollack, 1991, Fisher, et al 1988 ); reading erotic stories with condoms included had positive effect on mens’ but not women’s behaviour (Kyes) Meta-analysis by Scott-Sheldon and Johnson (2006) examining the effectiveness of sexual risk-reduction interventions that integrated a safer sex eroticization the 21 studies – randomised control trials or had a quasi-experimental design with a control group 19 studies in North America, 1 in New Zealand and 1 Brazil, at universities and schools, and participants were mostly Caucasian men in their early twenties – 20% MSM a visual erotic component, such as a video, erotic poster or brochure (61%); an activity, such as creating erotic ways to use condoms or have safer sex or writing a sexual fantasy (43%); and reading erotic short stories (20%) more risk-preventive attitudes, less risky sexual behaviour and an increase in condom use participants did not have more sex overall Decrease in numbers of sexual partners Increases likelihood that people want to participate However not many studies separate out the erotic component from the overall intervention so the degree of added impact not clear Most studies were white US students in low HIV prevalence settings

25 Psychology, confidence and sexual decision making
Many studies have found a link between sexual self-efficacy –and the practice of safer sexual behaviours feeling comfortable with and in control of one’s sexuality – and in some cases, feeling that one is entitled to experience sexual pleasure – can be a key determinant of safer sex practice. Boyce et al (2007) state that “HIV prevention is failing, in large part, because of inadequate approaches to sexuality, premised on rational models of sexual conduct.” Studies show that there are sometimes high reinforcement values of risky behaviour – peer pressure or relationship strengthening – which should be addressed in order to reinforce safer behaviour ( Parsons, et al 2000 Kelly and Kalichman, 1998) Evidence shows that people make decisions about sex based on the benefits or perceived benefits of certain sexual practices which provides a basis for interventions that incorporate desire, pleasure and other perceived benefits of sex Disciplines such as psychology, anthropology, sexology, communications, sociology have tended to focus more on positive elements of sexual decision making and therefore have much to add to public health

26 Pleasure, safer sex and sexual skill
Widespread assumption is that sex is something natural and automatic, especially for men yet evidence shows that safer sex becomes more comfortable and pleasurable with practice and through learning skills for of eroticization In Bangladesh Khan (2004) found evidence that, behind the explanation that ‘condoms reduce pleasure’, is a fear of incompetence and lack of skill when using condoms One study found that safer sex behaviours were more pleasurable six months after an intervention than immediately after the intervention (Kelly, St. Lawrence and Brasfield 1989 Female sex workers in some countries can charge men more money than they do when having sex without a condom by promoting the female condom as a new sex toy and allowing clients to insert the female condom into the woman’s vagina as a pleasurable and intimate act, thereby breaking a major taboo (Philpott, Knerr and Boyden 2006; Hapugalle 2002) must also get creative about other modes for delivering information about safer sex skills – such as through pornography and romance, and by looking to the ‘experts’ who already know how to eroticize safer sex

27 A Way forward Condom promotion needs to move from the discourse of AIDS to a discourse of pleasure, sexual skill and eroticism in order to harness the positive motivators for behaviour change Public Health can gain much about changing behaviour through use of positive motivators from different disciplines We found a whole wealth of material that demonstrates the link between eroticizing safer sex, intention and actual practicing safer sex. But we would welcome replication of them in contexts of high HIV transmission risk more research needed in Africa and Asia and high vulnerability/risk groups The causal links of eroticisation could be tested More sensitive research needed to inform the settings and groups of people that would respond most positively to different types erotic safer sex messages i.e. do evidence shows that women respond less well to erotic films in the US - pleasure is personal, gendered, contextual and culturally sensitive Most effective erotic sex education starts by discovering what that group finds sexy Assumptions of “rational behaviour” in public health world could benefit from the sophisticated understandings of self efficacy, reinforcement and context in other disciplines Do new products offer potential for introduction as erotic tools ? – microbicides & circumcision

28 Microbicides and pleasure
Lube and condoms for slippery and safe sex – PSI – promotion of lube condoms for enhanced pleasure (in global mapping) Recent findings in MDP trial and others Montgomery and others Abstract at Delhi MCB conference “Acceptability studies have shown microbicides are rarely perceived to detract from sexual pleasure, and in some cases participants stated they enhanced sexual pleasure. Current trials …could more pro-actively focus on participants’ views on the product’s effects on their experience of sexual enjoyment ……especially regarding sexual pleasure. Post-licensing studies could plan to evaluate approaches to microbicide promotion that include the enhancement of pleasure. “

29 – Abramson and Pinkerton (2002)
Why promote sexual health and safer sex through pleasure? People have sex for many reasons, but sexual pleasure remains a highly significant, if not primary, motivating factor for sexual behaviour Since HIV is spread mainly through sexual transmission efforts to prevent HIV need to consider the role that sexual pleasure and desire play in sexual behaviour Safer sex promotion campaigns and research have been and continue to be overwhelmingly negative, focusing on fear, risk, disease and the negative outcomes of sex. “Rail against it, repress it, and moralize it ad infinitum; nevertheless, sex will find a way.” – Abramson and Pinkerton (2002)


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