30/01/08

Ask a hooker, not a doctor

The British Medical Journal has been running a little debate on condoms: are they the answer to rising rates of sexually transmitted infections? “Yes but” (we also need other approaches), says one side. “No therefore” (we also need other approaches), says the other. Bald men fighting over a comb. Both sides achieve the almost unachieveable: they make sex crashingly boring. The “no therefore” side (argued by Canadian Steven Genuis) makes sex worse than boring, in fact. Genuis suggests sex is somehow a bad thing. Get this:

“Promoting condoms as ‘the’ answer disregards the complex nature of human sexuality and fails to tackle the underlying social and emotional needs of young people, who are often trapped in high risk sexual behaviour as a consequence of difficult life circumstances. Innumerable adolescents saturated with condom focused sex education fail to have their fundamental human needs met and end up contracting sexually transmitted infections. For some, risky sex is one component of self destructive behaviour that includes substance misuse and delinquency.”

I don’t know how long it is since Stephen Genuis was a young person, or even talked to a young person. But if I remember correctly most young people have sex for the same reason that most old people have it. Because it is really good fun. Oh, and also because their hormones are running rampant, because their mates are doing it, because they fancy the pants off that bloke with the yellow T-shirt, because it will piss off their parents, because did you see her arse when she dances the salsa, because they’re all loved up, because they’ve had a few.

A lot of these things do indeed get in the way of using condoms, as the most sensible commentator in the BMJ debate, Ravindra Gokhale points out. He now works at a clap clinic in Iraq, so he knows a thing or two about young people doing stupid things. But here’s what he says about what he found in Britain:

“When you take a sexual history, the common scenario is boy meets a girl or vice versa, in a club or at a party. Very often he is unable to achieve or maintain an erection under the influence of alcohol and the girl tries to help him by performing oral sex (felacio). Condoms are rarely used for oral sex as most people think it is safe.”

For most of us, the importance of condoms seems to fall as blood alcohol rises. But you can still do a few basic checks that will lower the risk that you’ll get infected. Here’s a tip for the girls that I learned from sex workers in China: if you’re going down on someone (actually, way before you go down on someone) check out his wares. Have a good look, give it a little squeeze, even a little sniff. If there’s anything drippy, or crusty, or smelly. ditch him. Will that reduce your risk to zero? Of course not. But if you’re already that close to his wares and they’re not yet covered by a condom, you’re clearly way beyond the first or second lines of defence. Think of a quick, on-site inspection as part of your “comprehensive approach” to disease prevention.

I’m actually not kidding about this. Most of the (doctors and academics) engaged in the BMJ debate talk as though we should be aiming to eliminate risk. But that isn’t how life works, especially not for teenagers. People (and especially kids) do take risks, and we always will. But we also weigh up those risks. The more information we have, the more able we are to make informed choices. And the more frustrated people who think sex is boring will be when we do “risky” things anyway, because after a Red Bull and vodka or two, a visit to the clap clinic is a small price to pay for a really great night out.

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This post was published on 30/01/08 in Condomania, Good sex and bad, Ideology and HIV, Pisani's picks.

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  1. Comment by elizabeth, 31/01/08, 01:20:

    The following comment sent to me by e-mail. I stand corrected.

    Who told you that the BMJ is open source? No true! Some years ago, those accessing the site from the developing world were allowed free access, but this is no longer allowed. Free access through Hinari only, and that
    doesn’t help the like of me (or you, probably) and helps no-one in Indonesia, which (like Pakistan) is inexplicably excluded from Hinari…

    Just look at http://www.bmj.com/current.dtl for details of the very few parts of BMJ for which access is open…

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