To BB or not to BB?
In today’s post-Truvada era, for many queer men sex comes with a burning question: “To bb or not to bb?”. Okay, it may not be quite as Shakespearean, but it is surely one of profound consequences. We’re the first population of adults in which HIV rates are falling, and now that the crippling fear of the AIDS epidemic is finally subsiding, many of us have responded by relaxing about condom use.
The reasons for this are of course PrEP and U=U. But, despite those two being unprecedented medical victories, in many conversations on the subject just a mention of HIV transmission being impossible through condomless sex and it’s never too long before the celebration is cut short by the all-too familiar “you should still always wear a condom”. A well-intentioned collection of words which – despite its simplicity – has proven notoriously difficult to connect with. Its moralistic subtext leaving many feeling unheard, increasingly exasperated, and even bullied.
I’m a sex-worker. Although I use condoms in almost 100% of my work, in private the ratio is a lot closer to 0 than 100. You might think the earth-shattering HIV diagnosis I received in 2013 would change that, or that having to be treated for various STIs over the years would “straighten” me up. But you would be wrong. It’s certainly taken me on a turbulent journey, but if there is anything it didn’t teach me, it’s to like condoms. Why? Why can’t I just take on board a piece of advice so many seem to trust and avidly give out, and just wrap it every time I have sex? “Mental inhibitor”, “physical barrier”, “sensation thief” “AIDS reminder” and “boner killer” are only a few common reasons. When you reduce sex to risk – which is certainly a common trend – they’re all likely to be dismissed without a second thought.
So, instead of justifying condomless sex, I’m going to take you on a little journey where – STI by STI – I’ll examine what happens when you do always wear a condom.
HIV (Human Immunodeficiency Virus)
Let’s start with HIV and, for this part, pretend I’m HIV negative. I’m going for a hookup. Hot vibe. Clothes off. Dicks hard. Condom on. Wooh!
In this scenario, I’m very safe. HIV is almost never transmitted orally, and – for anal sex – condoms are an amazing 85% effective. This used to make them indispensable to me but that was before medicine provided us with PrEP – the blue pill that keeps the virus away – which is 99% effective. That was also before U=U – or Undetectable equals Untransmittable – which means you can’t get HIV from an HIV+U person, even if you don’t use a condom. This has been an approved medical fact for a few years now.
Hepatitis A, B & C
Moving on to hepatitis. Again, hookup, hard-on, condom, bang.
Am I safe from Hep A, B and C? While condoms reduce the risk of contracting any of them, their protection is only high for Hep B, since it’s mostly spread through blood and sexual contact.
A & C are mainly transmitted in two different ways. To get Hep A you need to ingest poo molecules, which may sound improbable but it’s easily done through rimming or any other way your mouth comes into contact with someone’s ass – even by proxy such as fingering, unwashed hands, or ass-to-mouth.
Hep C transmission happens mainly through injecting drugs, and rarely through sex.
This means condoms have questionable application when it comes to Hep A and Hep C.
However, for Hep A and Hep B there’s a vaccine which is a lot more reliable than any condom.
Although there is no known vaccine for Hep C, there is actually a cure. Plus, many people clear the infection without medication.
Herpes (Human Simplex Virus)
Next up: herpes – the star of countless slut-shaming punchlines, and my personal favourite.
For this part let’s imagine I’m 19 years old and don’t have much sex, never out of a relationship. As agreed, I always wrap it up. In fact, I’ve never not used a condom in my life, even with boyfriends.
Now, what if I told you that I already have herpes? Hold up! WTF? How is that even possible, if I’ve always used a condom?
It’s because herpes spreads through skin contact, which renders condoms useless in protecting you against it. But don’t feel bad for me. Although herpes is incurable and may be painful during break-outs, it isn’t actually dangerous and for most people the breakouts are rare.
Most sexually active adults contract HSV-1 (cold sore) or HSV-2 (genital herpes), but because routine sexual health screenings don’t include a herpes test, many people just never find out. Why waste time and resources on something that’s inevitable, negligible and likely to cause unnecessary distress?
You may be thinking – “okay, but cold sores and genital herpes are surely not the same” – and you would be right. Strictly speaking, they’re just cousins. But there’s a twist. Most of the herpes appearing in genital areas (let’s call it #SlutHerpes) is the cold sore virus transferred from non-genital areas. You can get this during sex, but you can also contract it from, say, your mum kissing you on the cheek when you’re a kid or even her giving birth to you (we shall call this #MumHerpes).
What does this mean? It means the only real difference between a cold sore and genital herpes is the stigma. It means, either of the two strains can end up on your genitals and you wouldn’t be able to tell them apart. It means that many of us get herpes long before we become sexually active. And it means that almost all of us have (and have spread) herpes, even without showing any symptoms.
Isn’t it crazy that decades spent harbouring the belief only certain types of people get STIs have all been leading to the realisation that every nasty herpes joke anyone has ever made, they made about their own flesh-and-blood mama. And bother. And wife. And child. Best friend. Favourite teacher. Local priest. The Pope. Quite probably, even the Queen. How LOL is that?
HPV (Human Papilloma Virus)
Moving on to HPV (the wart virus). Transmission wise, pretty much the same story – I’m likely to catch it even if I use a condom. However, unlike herpes, HPV is not something to take lightly – it can cause cancer. The great news is that although condoms are ineffective here, an HPV vaccine does exist.
Chlamydia, Gonorrhoea & Syphilis
And what’s the score for the bacterial infections, like chlamydia, gonorrhoea and syphilis? Well, condoms are very good at preventing anal transmission – particularly when you’re the one getting fucked (bottoming does increase the risk).
But, to avoid bacterial STIs altogether, you’d have to forget about sucking, rimming, heavy petting, and even kissing – unless you use protection for all those at all times – since they can all result in transmission. Some recent studies even show kissing is the number one cause of oral gonorrhoea and chlamydia.
Controversial, huh? And yet it could very well be true. It really looks like, whatever you do, you may not be able to avoid a bacterial infection after all. The good news here, however, is that all three of these are easily treatable, and don’t cause complications – as long as they’re detected early.
So, in addition to their use being impractical and unsustainable, condoms actually seem inferior to most other prevention tools, and the risk reduction they offer is limited enough for you to contract many STIs regardless of whether you use one or not.
I realise that, to some, this conclusion may appear unthinkable and unwelcome, while to others it will be a long awaited relief.
But I’ve not gone to all this effort just to secure my right to bareback. I don’t need approval or permission to do that. I also didn’t write this to put happy condom users off condoms. After all, it’s a personal decision.
What I want is to invite you to engage your capable mind in some more critical thinking around sex and sexual well-being, and to start asking questions.
For example, what is it exactly – because it’s neither science nor common sense – that allows condoms to occupy such an honourable position in our minds, culture, and sexual well-being promotion, while other more effective tools like PrEP are not being made widely available?
Are condoms really just good self-care or are they being employed for other reasons? An easy substitute for education? A fix for the guilt and shame surrounding sex for pleasure. A “cure” for anal? Consequently, ask yourself why so many of us continue to disengage from this trend. Are we all just irresponsible troublemakers? Or are we, perhaps, just building immunity to the fear the narrative of sexual safety has been saturated with?
Throughout history, our sex, our love and indeed our entire queer being, has been systematically misinterpreted, shamed, invalidated, legislated, and criminalised. To add insult to injury, we then got the blame for one of the biggest plagues this world has ever seen – the original name for AIDS was GRID, or Gay Related Immune Deficiency. It wasn’t until it was observed in heterosexual people that the epidemic was finally acknowledged. How do we recover from such desecration of our identity when we continue to be misinterpreted, violated and, all too often, reduced to little more than risk?
That said, though we may be disproportionately affected by this phenomenon, it isn’t just our population to whom sex-negative social attitudes are doing a huge disservice. Shaming, even in the most indirect of forms, serves nothing but oppression and creates barriers to our well-being – including sexual – regardless of sexual identity. It affects all of us.
I don’t know about you, but I sure think it’s about time we set a new standard for this conversation. I genuinely believe that, if anyone wishes to discuss something as personal and delicate as our sexual behaviours – especially if they intend to hand out unsolicited advice on how we ought to govern our bodies and interactions – they should be expected to enter the conversation with nothing short of pioneering insight, and a level of sensitivity and respect our entirely natural, incredibly complex, and fucking beautiful sex deserves.