Why do people continue to engage in unsafe sex?

Great Debates
81

Actually, no. When I said, above, that “education has little to do with it”, I guess I just meant that even people who are very well educated about STI’s and the risk of unsafe sex (eg, me) make irrational, risky decisions sometimes - especially when alcohol is involved. I did not mean that education is unimportant in helping people make smart decisions about safe sex. I believe very strongly that kids need good, thorough sex education, presented in a way that they can relate to. My bad for not phrasing this better.

The Shill, I’m involved in a volunteer programme educating high school kids about safe sex, drugs, etc. To make sex with condoms more pleasurable, we recommend lots of foreplay, and plenty of water-based lube. I’m told that putting a blob of lube (roughly pea-sized) on the head of the penis before putting the condom on can increase pleasure for the guy.

Even if it’s not as good, it gets pretty near (from my end, anyway). And on a balanced, rational risk assessment, I’d always, always use a condom with a guy for the first couple of months - until I trusted him enough to have “the talk”. I’ve had unprotected sex with a new partner once only, and I consider it one of the stupider things I’ve ever done (I was on the pill at the time, so there was no risk of pregnancy). I hope I never repeat the mistake.

And, SJSB, the morning after pill (or the contraceptive pill) is not the answer to all your problems. It’ll keep you from getting pregnant, but it won’t protect you from HIV/AIDS, chlamydia, gonorrhoea, or a host of other nasties. Condoms are the most reliable way to do that.

Sing with me, everyone [sub]I’m sure I’ve posted this before, but it was a while ago now[/sub]

Now, syphillis isn’t nice
And neither is gonorrhoea
So use a condom, it’s good advice
And don’t mix sex with beer.

Itchy, scratchy, yucky you
The burning burns for days
And when you’re going to the loo
It’s like you’re pissing razor blades
(OUCH!)

82

Well, that seems to be more ideal then practice.

Back in the middle ages, it was not uncommon for monks to have mistresses, even though they were not supposed to.

I’m not sure there’s ever been a time when a great majority of christians were celibate until marriage(I mean really celibate, not “I messed up last night but I went to church, asked forgiveness and It won’t happen again”)

83

They are either uneducated or just plain stupid!

84

amazingly, christians I know are celibate, no sexual contact.

My friend isa 25 and her fiancee is 24.
They’ve been engaged for a few months.
They are getting married in early 2005.
Yep, theyre waiting.
They will live and not go psychotic.

Most of us think its a sin, for me; its also just a lousy idea.

Weren’t the Lachey’s chaste until marriage?(Jessica SImpson and Nick Lachey)

85

No shit, Sherlock. Strawman. I never said that being buggered by someone who didn’t have the virus carried the slightest risk, and no-one who knows a stuff about the subject would have assumed I implied such.

Not a silly idea. My argument hinges on whether or not anal tearing and consequent exposure of blood to infected bodily fluids is a high-risk activity. This is, as I said, either a true statement or it is not.

You’re the one who’s trying to massage this into “he said anal sex is a high-risk activity --> he is a racist and/or homophobe”. Incidentally, you have to be really stretching to get from a question about heterosexual practices to homophobia. If either of us is putting the cart before the horse, my friend, it’s the one who’s insisting that sodomy must not be claimed to be a high-risk activity because to make such a claim is tantamount to homophobia.

As for my likings - don’t make insulting presumptions.

86

You’re right. That was fallacious reasoning on my part. I’m sorry for the mistake, and I’m glad you called me on it. It was a very poor example to set in a thread that’s saturated with fallacy already.

I applied the adjective “silly” to your hypothesis that AIDS is more common in Africa among straight people than gays because heterosexuals there appreciate anal sex more than their Western counterparts do:

(1) You have offered no facts to support the statement that “hetero anal intercourse is much more cultural in sub-Saharan Africa than it is in US/Europe.” Beyond whatever the word “cultural” is supposed to mean in this context you’re suggesting a causal relationship between anal sex and the AIDS pandemic.

(2) You have offered no facts to support the statement that anal sex is “a much higher-risk activity than vaginal,” let alone how that could account for the African situation even if you could prove that conjecture to be true.

The simplest explanation as to why AIDS is epidemic among Western homosexuals and African heterosexuals is that both groups are promiscuous and both groups are members of societies in which HIV infection is prevalent. That’s really all it takes, so what does anal sex have to do with it? Do you suppose that if we cauterized people’s assholes shut the epidemic would suddenly dissipate?

That’s your point to prove, but if you intend to mold your argument until it fits the conclusion you’ve already chosen for it, what difference does the answer make?

Transmission is a binary phenomenon; it occurs or it doesn’t, and the nature of probability is such that you can sometimes escape harm even when your risk of infection is 100 percent. Whether anal sex is less risky than oral or more risky than vaginal (and why stop with rectal abrasions? let’s assume they’re Haitian, hemophiliac and intravenous drug users as well) the sex act itself is almost insignificant compared to the fact that one of the partners is infected.

Now, you’ve already decided anal sex to be the key factor in the epidemic equation so you’re free to ignore or reject any information that doesn’t support that hypothesis. That’s your prerogative and I have no complaint with it. What I take umbrage of is someone else to come along and suggest that your hypothesis is in any way empirically valid.

You think that AIDS is ravaging a continent because buggery is an aspect of its heterosexual culture and you’re accusing me of making insulting presumptions?

87

I’m a HIV- with an HIV+ partner.

I spent college during the early '80’s, when images of the infected and all the horror stories to go with it were on the news. I’ve also had extended periods of time when I was celibate, when I chose to forgo sex rather than put myself at possible risk. There were friends of mine who thought I was overly cautious, that I didn’t need to worry as much as I did.

• Once, before I met my partner, I went out with someone who I got very drunk with. I hadn’t had this much to drink since my college days, but he was a lot of fun, and our date was going great. We had drinks before dinner, a bottle of wine with dinner, then went back to his place. We had unsafe sex that night, and somewhere in the middle of my alcohol fog I felt a twinge of guilt. The next morning, fully sober, I felt fearful and angry. I had always thought men who did things like this were inexcusably stupid, yet I had joined their ranks.

Many safe-sex information outlets discuss making bad decisions while altered on drink or drugs. It only takes one stupid time, but nobody should cast stones unless they’ve never made any mistakes of their own. You can’t see the “bullet,” so you never know if you’ve dodged it. My partner and I have discussed our sexual pasts, and we’ve never tried to judge each other; there are too many in the world who will.
• Why do some people play extreme sports, break the law, cheat on their spouses? Maybe they think they can handle the outcome, or that whatever happens is their own mess to deal with.

I think that’s another reason why some younger men decided to gamble; sex can be so life-affirming and it’s more pleasant to think about than waiting in a clinic office for your case number to be called. I’ve had friends that I know think they can just go on the regimen if they get infected. They don’t know what my partner has had to deal with. The newer prevention literature shows the wrongness of that line of thinking.

88

Assorted quotes from KoalaBear and my answers to them. Life’s too short to get all the quote tags looking pretty:

“Cultural” in this context means that the population in question consider hetero anal intercourse a mainstream activity rather than a fringe one. True, I have offered no facts to support the statement. I don’t know for a fact that this is so, which is why I asked if anyone could shed any light on it. A causal relationship is a reasonable assumption if it’s the case that HIV is transmitted much more readily by anal than vaginal intercourse. I can’t speak for the AIDS pandemic, but my original comment was in the context of the much higher incidence of the disease in sub-Saharan African heterosexuals than in Western ones.

As to facts, you provided some yourself: the risk factor associated with receptive anal is eight times higher than the vaginal risk factor. The AIDS risk associated with anal has been publicised for many years, and not by homophobic bigots alone. As to how that could account for the African situ, let’s take it slowly:

  1. Two populations begin with a small number of infected persons.
  2. Population A does not engage in high-risk activity X to the extent that population B does.
  3. Consequently, the infection spreads more slowly in population A, and more quickly in population B.
  4. After time T, the incidence of the infection in population B is much higher than in population A.

I apologise for not fully stating this argument before, but I thought it was obvious. Btw, if you’re keen on mathematics, an eight-times-higher risk equates to a rapid explosion in terms of exponential growth.

Well, OK, but how then do you account for the much greater incidence of AIDS in African heteros than in Western heteros? Simple explanations are good things, but they do need to account for all the facts. Do Africans really fuck around that much more than Westerners?

Also, I see what you’re saying, that a high incidence of promiscuity in a population with a high incidence of HIV infection carries a high risk of encountering the virus, but this doesn’t account for how the infection got to be so prevalent in the first place.

Asked and answered already.

:smiley: Well, yes, because they’d all be dead of terminal constipation, supposing the procedure did no other harm, but the cure does achieve the difficult feat of being worse than the disease.

That’s a big if. I said I was open to correction as to the facts concerning the sexual life of the sub-Saharan African. I’m even open to correction as to the facts concerning the efficacy of anal intercourse as a means of transmitting the HIV virus (but a warning here, saying “Even suggesting that this is so is homophobic!” doesn’t cut it). Saying “You’re wrong, but you’re just not going to listen to the explanation” is the kind of line my ex-girlfriend used to try on me. It didn’t work then, either.

/me sighs patiently. If you’re comparing two populations (here heterosexuals from the West and from sSA) and want to explain a difference in the incidence of a disease then the logical thing to do is to examine the differences between those two populations. Unless one group contains a significantly higher proportion of Haitians, haemophiliacs and drug-injectors than the other, the influence of such can be ignored. OTOH, if the behaviour of the two groups differs significantly then this is worth looking into. The fact that one of the partners must already be infected is a given, as I thought we’d already established given your earlier apology.

Re: probability, you’ve got it arse-backwards. If you escape infection then the probability of transmission is conclusively less than 100%!

A possibly key factor, but I had, and have, no intention of ignoring or rejecting evidence. I’ll feel free to ignore your rhetoric, however, since that’s not evidence.

Personally I would take umbrage at anyone mistaking your rhetoric for rational argument, but all I can do is put up the best rebuttal I can and let the reader judge between us. And if someone else thinks my hypothesis may have some merit, possibly you need to re-evaluate it.

Yes, I am accusing you of making insulting presumptions, because you spoke of me arranging the facts to fit my “likings”, which is near enough to an accusation of racism and homophobia that I think I should challenge you to back it up or withdraw it, given the extent to which that kind of tar sticks around here. Since I don’t view a predilection for heterosexual buggery as a barometer of moral bankruptcy, why in the world should it be an insulting presumption for me to enquire whether there is any truth in the rumour that the predilection does in fact exist?

89

Wow, I haven’t checked this board all weekend because I was engrossed with Star Wars: Knights of the Old Republic and unfortunately forgot about time and space for a while, but now I am even more confused. Ok, let’s try to do this right (hopefully, and I’m not trying to be snarky, here, just want to make sure I get my point across properly).

KoalaBear:

Anal sex is riskier, and the facts you cited prove it. However, for further edification, look further up the paragraph you got those numbers from. More numbers that prove it. Just to make sure, here are the cites for those numbers, and some other cites to add to it:

**DeGruttola V, Seage GR III, Mayer KH, Horsburgh CR. Infectiousness of HIV between male homosexual partners. J Clin Epidemiol 1989; 42(9): 849-856.

Jacquez JA, Koopman JS Simon CP, Longini IM Jr. Role of the primary infection in epidemics of HIV infection in gay cohorts. J Acquir Immun Deific Syndr 1994; 7(11):1169-1184.

Mastro TD, de Vincenzi I. Probabilities of sexual HIV-1 transmission. AIDS 1996; 10(Suppl A):S75-S82.

Vittinghoff E, Douglas J, Judson F, McKirnan D, MacQueen K, Buchbinder SP. *Per-contact risk of human immunodeficiency virus transmission between male sexual partners[/]. Am J Epidemiol 1999; 150(3):306-11.

Royce RA, Sena A, Cates W Jr, Cohen MS. * Sexual transmission of HIV*.
N Engl J Med. 1997 Apr 10;336(15):1072-8.

Younai FS. * Oral HIV transmission*. J Calif Dent Assoc. 2001 Feb;29(2):142-8.**

In the references section for each article are literally hundreds of others which I do not have the time to list (but they are easily checked in the reference sections). These articles are available in the journals provided, but you’ll have to get them yourself, because I cannot reprint them here.

As for Africans (sub-Saharan, anyway) and HIV transmission, these articles will hopefully give a better idea of what Malacandra and I meant regarding anal sex there and what I mentioned about STDs facilitating the spread of the disease:

**Leutscher PD, Behets F, Rousset D, Ramarokoto CE, Siddiqi O, Ravaoalimalala EV, Christensen NO, Migliani R. Sexual behavior and sexually transmitted infections in men living in rural Madagascar: implications for HIV transmission. Sex Transm Dis. 2003 Mar;30(3):262-5

Kamali A, Quigley M, Nakiyingi J, Kinsman J, Kengeya-Kayondo J, Gopal R, Ojwiya A, Hughes P, Carpenter LM, Whitworth J. Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial. Lancet. 2003 Feb 22;361(9358):645-52.

Brody S, Potterat JJ. * Assessing the role of anal intercourse in the epidemiology of AIDS in Africa*. Int J STD AIDS. 2003 Jul;14(7):431-6.

Halperin DT. Heterosexual anal intercourse: prevalence, cultural factors, and HIV infection and other health risks, Part I. AIDS Patient Care STDS. 1999 Dec;13(12):717-30.**

Also, check out the Vanguard website for some decent information.

Ok, now for reasons for not wearing condoms, or engaging in unsafe sex. Here are a few studies:

**Tharao E, Massaquoi N, Brown M. The silent voices of the HIV/AIDS epidemic: African and Caribbean women. Can J Infect Dis. 2003;14(Supplement A):58A.

Adam BA, Husbands W, Murray J, Maxwell J. Negotiating safety or slipping out of condoms? Processes whereby gay male couples stop practising protected sex. Can J Infect Dis. 2003;14(Supplement A):58A.

Wiggers LC, de Wit JB, Gras MJ, Coutinho RA, van den Hoek A. Risk behavior and social-cognitive determinants of condom use among ethnic minority communities in Amsterdam. AIDS Educ Prev. 2003 Oct;15(5):430-47.**

3 from the same journal issue:

*Greig FE, Koopman C. * Multilevel analysis of women’s empowerment and HIV prevention: quantitative survey Results from a preliminary study in Botswana. AIDS Behav. 2003 Jun;7(2):195-208.

Sterk CE, Klein H, Elifson KW. * Perceived condom use self-efficacy among at-risk women*. AIDS Behav. 2003 Jun;7(2):175-82.

Salabarria-Pena Y, Lee JW, Montgomery SB, Hopp HW, Muralles AA. * Determinants of female and male condom use among immigrant women of Central American descent*. AIDS Behav. 2003 Jun;7(2):163-74.**

And more:

*Cabral RJ, Posner SF, Macaluso M, Artz LM, Johnson C, Pulley L. * Do main partner conflict, power dynamics, and control over use of male condoms predict subsequent use of the female condom? Women Health. 2003;38(1):37-52.

Wolfe WA. * Overlooked role of African-American males’ hypermasculinity in the epidemic of unintended pregnancies and HIV/AIDS cases with young African-American women*. J Natl Med Assoc. 2003 Sep;95(9):846-52.

Norman LR. * Predictors of consistent condom use: a hierarchical analysis of adults from Kenya, Tanzania and Trinidad*. Int J STD AIDS. 2003 Sep;14(9):584-90.**

These are just recent studies from 2003 that I’ve looked at, there are hundreds and hundreds more going further back in time.

As for the rectum being a more efficient barrier, well, I’ll call your bluff and use the same tactic on you as you have on me: prove it. Every instance of transmission research I’ve read has put anal sex as riskier, because the rectum is less suited for penetration, has fewer natural mucosae to protect it, and tears more easily, resulting in blood leakage (the best route for HIV to get inside the body). So show me the proof of your suspicion.

Now, as for comparing the vaginal and anal percentages: the vaginal percentage given in the paragraph pertains to both insertive and receptive vaginal intercourse. The phrasing “penile-vaginal” in the paragraph of the Epi Update is meant to indicate contact between the two. The probability given came from an analysis of several other studies by Mastro et al (cited above). So my assertion stands, that even averaging anal insertive and receptive intercourse leaves a higher risk rate than vaginal insertive and receptive. That said, Mastro list some studies with just receptive vaginal, and the probabilities range from 0.0005 to 0.002, still lower than receptive anal.

Ok. As for me mentioning that I wrote most of the Update, it was more in a “Wow, someone actually read that outside of the small group of researchers who are interested in this sort of thing, and that’s cool because it means our work is not totally ignored” context, and so a small little boost for me. I was not trying to brag, or sound officious, and if I did, my apologies.

I will address your further point to Malacandra, by simply saying that of course you can’t get HIV from someone who doesn’t have it, no one is disputing that. The point he (I assume) and I were trying to make is that not having total knowledge of your partner’s history (which, let’s be frank, isn’t always available) means that there is a chance someone can have it. From a prevention point of view, this means that if you want people to minimize their risk, you need to tell them what behaviours are risky and of those, which are the riskiest. You can call it homophobia, or whatever, but the truth hurts, sometimes, and it would be a disservice to people to ignore the evidence.

Also, there are a substantial number of people who have the virus but are unaware. Check out those same Epi Updates you first looked at for more info on the estimates (I didn’t write that one). Even if you think you’re clean (not you specifically, anyone), there is a chance, so better to be safe than sorry, and get tested.

So if this helps, I’m glad. If not, then I do not know what I can say or do to show you.

90

IIRC there are chemical reactions during sex which suppress the “fight or flight” instinct and as a result a human would keep banging away even if they noticed impending danger they would normally flee from. I would be suprised if this is an instant changeover instead of a gradual process. I’d guess that by the time someone makes the “glove or no glove” decision that the survival instinct which normally makes this an easy decision is already somewhat depressed.

Enjoy,
Steven