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:

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.

Benedict said condoms were not “a real or moral solution” to the AIDS epidemic, adding, “that can really lie only in a humanization of sexuality.” But he also said that “there may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be a first step in the direction of a moralization, a first assumption of responsibility.”

Some are excited that the Pope seems to be opening the door, if only by a hair´s breadth, to a greater acceptance of condoms. Could this be a turning point in HIV prevention? I´ve been asked. I´d say certainly not. Catholics do all sorts of things the Pope forbids, including using contraception extremely liberally, as long as it suits them. The only time they really take any notice of what he says is when it gives them an excuse to do what they would probably rather do anyway, like not use condoms.

I´m much more excited that the Pope has opened the door for discussion of one of the most neglected issues in the sex trade: male prostitution. It´s not clear from his comments if the Pope had any specific gender of client in mind when he said rent boys would be taking a step towards holiness responsibility by using condoms. Since he is a virgin, of course, any suggestions that male sex workers sprung to mind because of personal experience would be thoroughly scurrilous. But I´ll leave the discussion of the potential consequences of the papal embrace of male sex work to those far better qualified to comment than I.

One friend suggested that perhaps the Vatican should start marketing its own brand of condoms, under the brand name “Swiss Guards”. I like it.

For the news that really does have the potential to change the face of the HIV epidemic, watch this space. Tomorrow sees the release of the results of the first large trial of the use of antiretrovirals among uninfected people, to protect against HIV. Expectations are running high.

In passing, let me say that I think the Pope has more to worry about than latex. I went to mass yesterday in a small village church in the foothills of the Sierra Nevada de Santa Marta, in northeastern Colombia. I expected the tiny church to be packed, and, arriving only 10 minutes after the appointed mass time, sat about half way back. By the time mass started 15 minutes later, there was only one other person on my side of the church. The whole congregation totalled fewer than a dozen, including the choir and the two dogs that spent the mass licking my toes. This did not stop the young priest barking at us through a massively over-amplified sound system, reminding us that to sin was to walk naked through the streets.

Really, these Catholic clerics. Each to their own fantasy…

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.

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

According to The Straits Times, the state’s Health Promotion Board asked close to 1,800 Singaporeans how HIV could be prevented. Apparently, almost half of them didn’t know that consistent condom use prevents HIV infection.

We’ll have to take the paper’s word for it, because the survey is not mentioned on the Health Promotion Board’s website. But I’m reluctant to do that, because the paper also gives us this nice graphic:

Does this make you at all suspicious? Leave aside that there’s no mention of drug injection; the numbers don’t add up even for methods of preventing sexual transmission. Over 82% mention being faithful to one partner, hoping, presumably that the partner in question stays faithful too. Next in the ABC list comes abstinence, at 75%. So how is it possible that 80% know at least two of the three ways that Singapore promotes as ways to prevent HIV?

I guess I’m trying to find fault with the study in part because I don’t want to believe that Singaporeans, by far the most educated population in Southeast Asia, can possibly be this clueless. Probably not a comment I should make a few days before I visit the country, but really…

Thanks to David Fox for the pointer.