Much has been going on in the world of HIV, sex and drugs in the last month or so; the US marines recruiting at gay community centers, more mysteriously disappointing study outcomes for PrEP, encouraging news about the effect of microbicide gels against herpes, a new super-easy condom with a brand name that will put off anyone who cares about staying power.

I’ve ignored it all. That’s in part because I’ve discovered a site that really says everything that needs to be said about HIV prevention. Particularly insightful, in this post entitled “usefulness connected realizing hiv indicators”, is this gem:

“For that faculty your body gets very suasible to numerous germ infections and so the indicators are sure not e’er the HIV symptoms. The true unique method to aver that a soul is with HIV is the HIV checking.”

I don’t think I can add to that. Which is my polite way of saying that I’m taking a sabbatical from HIV and epidemiology. I plan to spend the next year or so travelling around Indonesia, eventually writing a book about this wonderful and mad land. Which has it’s own fair share of Bad English, as you can see over at my new blog, Portrait Indonesia.

I’ll be spending a lot of time out of range of wi-fi etc., but will try and post at least weekly. If you’d like to follow my progress, you can sign up here.

For now, on the subject of sex and drugs, it’s over and out. Thanks for taking an interest over the last four years.

It’s not that often that I sit reading the FT on a Tube full of morning communters. Even less often that the Pink Paper (no, boys, not THAT Pink Paper) carries full page ads from the Purveyors of Porn. The ad is pimping a new internet domain ending: .xxx (Slogan: Coming, now!)

The porn industry is positioning itself anew (they don’t excuse the pun, so I wont either) as responsible citizens, protectors of children and the integrity of your credit card details. Re-registering your porn domain with a .xxx extension will make it easier to filter, keeping it away from kids and the easily-offended. Since all .xxx domains will be screened daily by Mcafee, they will be virus-free. The xxx admin folks will also enforce standards of financial transaction probity, apparently. In the meantime, they stand to make an awful lot of money themselves. But here’s my question: what does it say that the ad was placed, as a FULL PAGE, in the world’s most prominent financial organ? Perhaps that purveyors of porn have more to invest than the rest of us?

Certainly, the porn industry could do with brushing up its image after the recent kerfuffle over HIV transmission on porn film sets. Though plenty of people are demanding the introduction or enforcement of condom-only porn shoot rules, I suspect they are on a hiding to nowhere. Isn’t the whole point of porn that is is a bit transgressive? If condoms were sexy, we probably wouldn’t have reached over 60 million HIV infections to date. Goody-two shoes safe sex is rarely enough the stuff of our reality; it is almost never the stuff of our fantasies.

The Salon piece acknowledges this. It fails to stress another important point. Most of the on-set transmission of HIV occurs right after the infected person themselves became infected. This is a time when there is tonnes of virus floating around the body and it is very easily transmitted. It is also a time when antibodies have not yet developed. Since the standard HIV tests are for antibodies rather than the virus itself, they will miss these very new, very dangerous infections. Indeed it was a classic case report from the porn industry that confirmed in life what we suspected from lab work about the dangers of early viral load.

Possible solutions: set a minimum time between shoots of six weeks. That way, if someone gets infected on one shoot, they’ll test positive before the next one. Another solution would be to invest some of the massive profits of the porn industry in testing actors for the HIV virus itself, rather than for antibodies. Both of these solutions seem unlikely, given the profit imperative of porn, but in my mind they are both less improbable than condom-only porn.

One thing that interested me about the .xxx ad was that they are offering, for a small, one-time fee, to BLOCK names from being used with an .xxx extension. Do you think I should sign The Wisdom of Whores up to prevent our good name from being abused?

Apologies if this post looks odd. My first attempt to post from an iPad.

One of DKT’s most successful markets is Brazil, not least because they give away a year’s supply of Prudence condoms to scads of voluntary testers, who twitter and twatter about flavours, shapes, sizes and the rest. They’re not above bonking us over the head with guerilla home videos, either. This one, I think is self explanatory.

“With a year’s supply of free condoms, any place is the right place.” Indeed. Though I could wish I spent more time in the right any place…

Other things I like about DKT: although they work in 16 countries, shift over half a billion condoms and some 75 million other contraceptives a year, they have a head-office staff of just four people, all, I’m guessing, with a sense of humour. Their penchant for fun and puns goes back a while; I’ve hung on for 15 years to a T-shirt promoting their Trust condom brand in Vietnam. It was a time when the Vietnamese currency, the Dong, was suffering a bit, and the government was running a campaign to restore our trust in it. DKT Vietnam turned the government’s “Put your trust in the dong” slogan on its head. Allow me to demonstrate:

Thirty years ago next month, the first reports of the illness that came to be known as AIDS were published. Five cases, all among young gay guys in Los Angeles. Since then, we’ve racked up over 60 million HIV prevention failures worldwide. But new draft guidelines on safe sex advice proposed for the UK suggest we’ve learned almost nothing from three decades of failure.

The guidelines, proposed by the British Association for Sexual Health and HIV are depressing, at very best. They seem to assume that it is the duty of health professionals to protect people from their own bad behaviour, in part by informing them of every possible risk, however marginal. They seem also to assume that the sort of people who take significant risks on a regular basis care about their long term health prospects. We don’t. And that comes from someone who today happens to be wearing a T-shirt embazoned with a slogan picked by algorithm on the basis of answers to 10 behavioural questions. Mine reads: “Runs with scissors”, but it might equally have read “Cycles without a helmet”, “Shags without a condom” or “Rolls her own cigarettes”.

The guidelines available here in pdf form, are open for public comment for another week or so. I would strongly urge people (especially people who’ve ever used a sexual health clinic) to look through them and put in their tuppence worth. The full text of my own comments is available in a doc file here.

In summary, I’m upset that we are still telling people to use condoms every time they have anal, vaginal or oral sex, even though we know perfectly well that that’s no more feasible than never having sex at all, for the same reason: for most of us, consistent condom use in every act of sex involving every orifice with every partner type at every age and level of sobriety is not feasible because it is not desirable.

I’m upset that we don’t give more practical and nuanced advice that people are more likely to act on. Example from my response:

“If you don’t have a condom handy, or don’t want to use one, then oral is your safest bet”. More useful still to a random gay man would be: “Do you have HIV? Yes? Then try always to use a condom if you’re top in anal sex. It would be great if you could use one if you’re bottoming too, but it’s less important, especially if you’re good about taking your meds. Don’t worry too much about oral, though it’s best if you don’t come in some other guy’s mouth. Definitely don’t come in his mouth if he’s just been to the dentist, or looks like he needs to go!”

I’m upset that we’re using evidence selectively. The guidelines imply there’s evidence that condoms work, and no evidence that abstinence works. In fact, condoms work and abstinence works even better, when they are used consistently and correctly. The more important evidence is around whether the promotion of condoms or abstinence lead to their consistent and correct use. Frankly, there’s very little recent evidence from the UK that condom promotion works very well; what worked in an age when HIV meant AIDS and an ugly death does not necessarily work in this post-AIDS age.

And I’m upset that, not content with giving clients information they won’t act on, we’re suggesting things that service providers won’t act on either. Sizing your clients up for condoms using a pasta measurer? Really?

I hate to wish HIV a happy 30th birthday, but I think at this rate it can expect to stay alive and well for several decades to come.

The kerfuffle surrounding the Pope´s comments on condoms continues. As the gender of hookers allowed to use condoms switched in translation, the Pope´s spokesman was asked to clarify. Apparently, HIV-infected people can use condoms to protect their partners:

“Whether it’s a man or woman or a transsexual.”

Of all the men I know who regularly wear dresses, Benedict was the last I expected to be embracing the rights of transgenders to protect themselves and their partners from HIV infection.

Many people have commented that as long as reproduction´s not in the picture, he can say whatever he likes about condom use. I´ve yet to hear of a transgendered woman giving birth, so that might be part of the equation here (though note that women who sell sex to men are also encouraged to “take responsibility”). But I’m in an optimistic mood today, and I think the Vatican could be trying to ease open the door to a more rational existence. Miracles just might happen.

Thanks to Txema, who is always ready to make a girl smile.

Inevitably, the goodie-two-shoes family values mob worries that if boys can get condoms easily, they’ll be more likely to have sex. “Josephine Quintavalle, founder of Comment on Reproductive Ethics, a pressure group, warned: “We are just facilitating and encouraging sexuality without any deeper understanding of the emotional side of relationships” The Times reports. (I don’t know what Josephine’s experience is but I carry condoms all the time and I haven’t noticed that it makes it significantly easier to get laid. The few teenagers I drink with say the same.)

More realistically, some doctors worry that the credit card scheme that goes with the free condoms will put some teenagers off. While condoms will be handed out at football grounds and other places where young guys hang out, they’ll have to show a “condom credit card” to get them. The card shows that they’ve sat dutifully through safe sex training sessions. If they sit through extra “what to do about drippy dicks” sessions, they get stamps on their cards, coffee shop style. The government’s notion that boys will want to collect the stamps as a status symbol seems devised by someone who has little memory of being a teenage boy, and doesn’t even drink with them. As NHS doctor John Crippen says, we shouldn’t be putting any barriers at all in the way of young guys being responsible about contraception and STI prevention if and when they get lucky.

If you’re a teen who’s hoping free condoms will help you pleasure women more often, Durex Play’s here to give you pointers on what you’re aiming for. But to keep in line with Nanny’s guidelines on appropriate viewing, please make sure you only watch this ad after 11 pm.

Thanks to Peter Barnett for pointing me to Dr. John.

Thanks to Paul Canning for pointing me to Patrick’s work. Readers might want to check out Paul’s comments on Iraq’s hideous treatment of gay men, and Britain’s spineless reaction.

I, like many who’ve written to me, am speechless with rage at the Pope’s first direct pronoucement on condoms. (Well, not quite speechless. I had a little vent about it in today’s Times.) To oppose condoms on dogmatic grounds is one thing. That’s the Pope’s job, if he considers it his job to defend Catholic dogma more vigorously than defending the life of young adults.

But the Pope didn’t oppose the use of condoms because Catholic dogma says it’s bad to have sex without making babies. He said we shouldn’t give out condoms in Africa because condom distribution actually makes the HIV epidemic worse. If he’s setting himself up as an epidemiologist, he’s got a bit of work to do. It’s true that in some cases, condom use is highest in communities where HIV is also high. But Rule Number 1 of epidemiology: correlation does not equal causation.

Think of all the miserable sinners who rush (back?) to the bosom of the Catholic Church at the end of a happily dissolute life, just in time for a celibate man in a dress to give extreme unction. In an instant, our sins are absolved, though the pleasure occasioned by all that babyless sex may stand rich in our memory. I haven’t run the numbers on death-bed conversions, but it seems likely that there is a strong correlation between becoming a Catholic and imminent death. By the Pope’s logic, Catholicism kills.

*UPDATE* : The Daily Mash clarifies what the Pope actually meant.
Thanks to Anita Fenton for the enlightening tip.

Thanks to David