Presentation on theme: "Putting the sexy into safer sex"— Presentation transcript:
1Putting the sexy into safer sex We believe you can have safer sexif you know how to have good sexPutting the sexy into safer sex
2Based in UK and India with volunteers worldwide Largely volunteer-run: No full-time paid staff; limited amounts of project-based fundingWhy we started:“Insertive probe” and “receptive cavity”: Sex in the public health worldPleasure: one of primary reasons people have sex, yet absent in public health programming, education, researchWe ‘sell’ everything using sex … why not safer sex?What we do:Advocacy about the importance of pleasure in sexual healthTraining health professionals and educatorsResearch to build the evidence baseBringing safer sex to erotic mediaout 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
3Advocacy 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 ConferenceRoyal Society of Medicine (London)
4www.thepleasureproject.org Launched in 2004 Usage stats Aug 2008 – Apr 2009 (9-month period)27,000+ visitors, 24,000+ unique visitors89,000 page viewsAvg. 2,500 unique visitors/month, spikes after conference appearancesVisitors 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+)
5Sexy tips at www.thepleasureproject.org Lots of sexy tips out thereTPP site, but not specifically aimed at MSMSites mentioned earlier have lots of great tips for eroticising condomsThis info can be used in publications and in face-to-face counselling or health context5
6Pleasure proficiency training CARE Cambodia, 2004: 3-day training of trainersIAC Toronto, 2006: How to talk about sex and pleasureICAAP Colombo, 2007: Sexing up male and female condomsPositively Women, London, 2008: Pleasures of the Female Condom for HIV positive womenAfrican HIV Policy Network, London, July 2008: upcomingTHT (UK) Youth Leaders ConferenceUK NHS Bristol sexual health training
845 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 healtheducators in Cambodia.Researched and written on a shoestring, in just ten days, yet has been widely referenced in the media and health sectorTo 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 sincethat first edition was published.With support and funding from the Realising Rights Research Programme Consortium, we were able to widen oursearch for organizations that eroticize safer sex, and to produce this updated edition.
10Victorian AIDS Council, Australia www.protection.org.au Some topics covered:The basicsCondom useTestingUnprotected anal sexPEPState of mindSexual adventurismIn the heat of the momentCampaign launched in response to increase in HIV since 2000.Social researchers reported that new cases of HIV were among those:aware of safer sex messageswho knew that condoms prevent HIVolder.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:
20Building the evidence base Promoting Protection and Pleasure: amplifying the effectiveness of barriersagainst sexually transmitted infections and pregnancyPhilpott, 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 approachesand is it cost effective ?
21Not only HIV but also reproductive health Pleasure and Prevention: When Good Sex IsSafer Sex; Reproductive Health Matters2006;14(28):23–31 ; Philpott, Knerr and BoydellMost sexual health education programmes use fear and risk of disease to motivate people to practise safer sexgives the impression that safer sex and pleasurable sex are mutually exclusivethere 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.
22Building the evidence base Promoting sexual health and rights through pleasure: A literature reviewFunded by the Pathways of Women’s Empowerment Research Programme Consortium (pathwaysofempowerment.org)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"
23Building the evidence base Strong evidence of effectiveness in some settings, but limitedNeed 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
24Is 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 eroticizationthe 21 studies – randomised control trials or had a quasi-experimental design with a control group19 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% MSMa 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 useparticipants did not have more sex overallDecrease in numbers of sexual partnersIncreases likelihood that people want to participateHowever not many studies separate out the erotic component from the overall intervention so the degree of added impact not clearMost studies were white US students in low HIV prevalence settings
25Psychology, confidence and sexual decision making Many studies have found a link between sexual self-efficacy –and the practice of safer sexual behavioursfeeling 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 sexDisciplines 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
26Pleasure, 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 eroticizationIn Bangladesh Khan (2004) found evidence that, behind the explanation that ‘condoms reduce pleasure’, is a fear of incompetence and lack of skill when using condomsOne study found that safer sex behaviours were more pleasurable six months after an intervention than immediately after the intervention (Kelly, St. Lawrence and Brasfield 1989Female 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
27A Way forwardCondom 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 changePublic Health can gain much about changing behaviour through use of positive motivators from different disciplinesWe 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 groupsThe causal links of eroticisation could be testedMore 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 sensitiveMost effective erotic sex education starts by discovering what that group finds sexyAssumptions of “rational behaviour” in public health world could benefit from the sophisticated understandings of self efficacy, reinforcement and context in other disciplinesDo new products offer potential for introduction as erotic tools ? – microbicides & circumcision
28Microbicides 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 othersMontgomery and othersAbstract 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 ahighly significant, if not primary, motivating factor for sexual behaviourSince HIV is spread mainly through sexual transmission efforts to prevent HIV need to consider the role that sexual pleasure and desire play in sexual behaviourSafer 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)