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The risk matrix

This article in the Independent gives me cause to revisit some old thoughts about the way in which normative behaviour gives rise to new paraphilias. Here’s a definition of paraphilia that I find useful; a sexuoerotic embellishment of, or alternative to the official, ideological norm.

The topic of how something arises as an alternative to the norm first came to mind in this context when I was discussing bareback sex with some friends on an internet forum. As usual, the self righteous tendency within  the swinging community was having a field day, decrying anyone who ever has bareback sex outside of a monogamous relationship as mad, bad or both.

Someone’s claim that he was appalled by the behaviour he heard about whilst observing (in some professional capacity) in a GUM clinic prompted me to observe that there was another pespective. Regularly attending a GUM clinic is a good risk management strategy if you engage in risky sex. Early intervention has transformed HIV from an automatic death sentence to a long term life limiting chronic condition; reading the Independent article I could not help but think that that knowledge may have contributed to a new type of risky behaviour.

What made AIDS so dangerous when it first emerged was the way in which changing medical paradigms in the seventies enabled behaviour that deviated from the ideological norm to be relatively risk free. STIs were treatable, and not life-limiting.  It was even possible to have serial infections with STIs and not suffer unacceptable consequences. That paradigm was shattered by AIDS; safe sex became the new ideological norm. We know now, according to most medical opinion, that there are complexities in the transmission of HIV that mean that previous STI infection may affect the likelihood of HIV transmission; the medical paradigm that STIs were treatable may have made HIV infection more likely for some individuals.

Bareback sex could not have existed before condom use became the official norm, and if I know anything about human sexuality it is that anything that opposes the ideological norm is likely to become  a paraphilia, a desire of those who are attracted to it precisely because it isn’t the norm. Add in the prevalence of the money shot in porn, and you have a powerful set of drivers likely to make bareback sex appear attractive.

There is a hierarchy of risk avoidance strategies for HIV / AIDS; celibacy is one of them, but only as strong as possible  if you combine it with not being a health care worker and not being an intravenous drug user.

Below that there are a number of other risk avoidance strategies; condom use is one. If you look at this set of stats  sorting partners by postcode is another, relatively rational technique. Sorting by postcode, whether they have unprotected sex with men who have sex with men, honesty and regularity of attendance at a GUM clinic is a reasonable strategy with a lot to recommend it.Remove any of those elements and it a much less reasonable strategy; add in condom use for casual sex and it’s a more powerful strategy. One mistake frequently made by people who voice their opinions about this on the internet is to underestimate people’s understanding, at some level, that their behaviour is risky. As I’ve said before, you can’t expect complex risk management to be the norm in a society that has a national lottery but it’s wrong to extend that out to argue that people have no perception of risk at all.

If your particular paraphilia is bareback sex there are ways of minimizing the risk; having a hissy fit about the very mention of bareback sex isn’t one of them. Neither, probably, is reading articles like the one in the Independent, since it describes the behaviour of the men involved as being other, the behaviour of people who are always going to be outside of our lives. When you read Adam Bourne, lecturer in public health at LSHTM, saying  “Gay men have always been prolific drug users, particularly when it comes to ‘club drugs’, but injecting drugs – crystal meth, GHB – is a relatively new phenomenon that we haven’t really observed before…” you have to remember that he’s using ‘gay’ in a very specific sense that is a subset of men who have sex with men, and actually, a subset of men who identify as gay. The risk involved in the search for causation as well as correlation in the article cited is that it might lead individuals to believe that risk is uniquely associated with certain sets of behaviours; that, if I may say so, is somewhere we have been before with the rumours in the 80s that AIDS was caused by poppers. People may do more risk management than we think, but less well than we would wish; othering or stereotyping certain sets of behavious as risky may well obscure other equally risky behaviours.

One comment on “The risk matrix

  1. Pingback: The risk matrix | Sexworker Blogs

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This entry was posted on January 21, 2014 by in Uncategorized and tagged , , , , , .

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