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Sex, Pleasure and HIV

The walls of the tents and shacks of sex workers in the Bharatpur region of Rajasthan are adorned with posters of Bollywood Stars. The women in the profession are mostly from the Bedia caste, which traditionally sees its women enter the sex trade at the age of 13-14.A pleasure appraisal of the 2008 International AIDS Conference, Mexico City

Wendy Knerr - 9 October 2008

Until recently, there has been little or no mention of the interrelationship of sex, desire and pleasure with HIV at international AIDS conferences. This is despite the fact that HIV is spread primarily through sex, and that sexual pleasure is a highly significant, if not primary, motivating factor for sexual behaviour.

At the 2003 African AIDS Conference in Kenya and the 2004 AIDS conference in Thailand, Anne Philpott, founder of the The Pleasure Project, broke new ground by discussing pleasure. Since then there have been some indications that sex, pleasure and eroticism – as tools for HIV prevention – are on the radar of more people working in the AIDS and sexual health sectors. Yet these issues are rarely featured as key topics in plenary sessions or in other high-profile ways.

However, at the 2008 International AIDS Conference in Mexico City more sessions touched on the issue than ever before at an AIDS conference. But how broadly was the issue of pleasure covered in relation to HIV and safer sex?

The Pleasure Project has been working with the IDS Sexuality and Development Programme and the IDS-led Pathways of Women’s Empowerment Research Programme Consortium (RPC) to further understanding on the links between sexual health and pleasure. Here, Wendy Knerr from the Pleasure Project reflects on the 'pleasure' content of the Mexico Conference.

Where was the pleasure?

Sexuality and pleasure

Most striking was the mention of the importance of looking at female sexuality in relation – not only to danger – but also to pleasure, by Rapporteur Carlos Caceres in his conference summary.

IRIN PlusNews reported that the conference programme read 'like a “how to” on embracing your sexuality', and that there is growing recognition that people do, indeed, have sex for pleasure.

The Pleasure Project hosted a satellite session on the opening day of the conference, with support from the IDS Sexuality and Development Programme, entitled 'Pleasure, desire and safer sex: can they come together?' They also presented alongside Tsitsi Beatrice Masvawure, from the University of Pretoria in South Africa, who discussed her research project, '”Girls enjoy sex too”: pleasure as a factor in sexual decision-making among female students at a Zimbabwean university'. And they spoke at a skills building session presented by the Indian organisation SAATHI called Safer Sensuous Sexual Pleasure: Using Elements of Sensuousness in Promoting Safer Sex among Men who have sex with Men.

In the Global Village, there was a presentation from a Kenyan group entitled 'I’m Sexy, Too!'; provocative performances on a cat-walk from sex worker groups, who, for example, showed people how to put condoms on a vibrator with the mouth; and the Vaginal Wall Workshop and Exhibition, presented by The Pleasure Project, which highlighted the need for understanding women’s bodies and pleasure in developing female-initiated safer sex technologies.

Pleasure and condoms

At a satellite session on Comprehensive Condom Programming on 7 August, hosted by UNAIDS, UNFPA and a range of partner organisations, presenters mentioned the importance of looking at pleasure in promoting condoms and safer sex. Also, the potential for the female condom to provide pleasure to both women and men was mentioned at a skills building workshop on Expanding Access to Female Condoms through Strategic Partnerships and Informed Advocacy, on 7 August.

Pleasure and circumcision

On the subject of male circumcision, advocates argued that pleasure is not being considered enough in prevention-oriented circumcision programming. Although researchers also presented evidence that circumcision has no detrimental effects on sexual pleasure or function, and may actually lead to more condom use (see article on the Aidsmap website)

What was missing?

Aside from a few sessions and insightful poster presentations, much discussion at the conference focused on the absence of pleasure in programming, and the need for more consideration of pleasure. In the abstract-driven poster presentations, for example, a number of research projects concluded that people do not use condoms because they are not pleasurable. What was missing was the ‘how to’ of bringing safer sex and sexual pleasure together. The Pleasure Project, sex worker groups in the Global Village, SAATHI and a few others discussed (and in some cases, showed) the mechanics of eroticising safer sex, but more of this is needed to turn the discussion of pleasure into action that improves health on a large scale. Recognising the positive aspects of sexual pleasure as potent tools in HIV prevention and how to eroticise safer sex is a key path to empowerment.

Negative messages about pleasure and safer sex

Some negative messages about safer sex and sexual pleasure came out of the conference. The most high profile example came on the opening day, when Swiss researchers announced evidence that people with HIV whose infection is kept at bay by antiretroviral drugs have a very low likelihood of passing the virus during unprotected sex.

Clearly, this was fantastic news for people infected and affected by HIV and AIDS, particularly couples where one partner is HIV positive; although some observers commented that such news could deter people from using condoms.

However, most relevant for work on pleasure were comments picked up in press reports, for example, quoting an advocate as saying that the Swiss research will help people with HIV to 'regain the right to the “uninhibited” experience of sexual pleasure'. Many people associate condoms with a reduction in pleasure (and non-condom sex as more natural and uninhibited), yet it is important to recognise that this belief continues to stymie efforts to promote condoms and other forms of safer sex. It shows that there is still a widespread perception that safer sex and pleasure are mutually exclusive – a belief that The Pleasure Project is working to counter.

To counter this, a more explicit understanding is needed about the mechanics of pleasure and sex – the 'how to' – and that it needs to be accompanied by research and sensitivity into the cultural, gender, biomedical, social and other implications of sex, pleasure and safer sex. The Pleasure Project touched on these issues during their presentation at the conference entitled 'Promoting sexual health and women's empowerment through pleasure: a literature review', which is a project supported by the IDS-led Pathways of Women’s Empowerment RPC, and they hope to further this type of research before the next AIDS conference in Vienna, in 2010.

Wendy Knerr is a member of The Pleasure Project.

Photo: Abbie Traylor-Smith / Panos