A complicated relationship with condoms

The moral dilemmas of gay men.

Image by Matheus Ferrero on Unsplash

We recently conducted a survey about porn — we asked 341 gay men a lot of personal questions.

It was a survey, not a scientific study, but it did give us lots of interesting insights and things to think about and explore.

One of the key themes that seemed to emerge from the men that we spoke with, was some differing points of view regarding the use of condoms in gay porn.

A lot of the porn that we see now doesn’t involve condoms, and some porn deliberately celebrates that — using the terms ‘bareback’ or ‘raw’ to promote that they are condom-free. Our survey indicated that a lot of guys want that, they don’t want to see condoms in porn, and that good porn is bareback porn. However there was a definite percentage of our respondents who felt that not using condoms in porn was irresponsible, that it sent ‘harmful’ messages about safer sex, and undermined health campaigns about condoms preventing the transmission of HIV and other STIs.

I caught up with health specialist Matthew Hodson of NAM Aidsmap to try and understand what the survey results might be telling us about gay men and condoms.

Why do you think condoms are such a big deal when it comes to porn?

Porn is fantasy sex. It’s not surprising that many people don’t want to grapple with the realities of sexual health in their fantasies.

Fairly early on in the HIV epidemic, most of the porn industry adopted condoms as standard, not least to protect the actors. Often the condom use was not commented upon, with the condoms magically appearing mid-scene. Some of the major porn producers reissued old movies as ‘pre-condom classics’ to meet the demand for condom-less movies. Increasing access to porn online changed viewing habits and helped pave the way for a massive rise in the consumption of bareback porn. Some of the new titles not only portrayed condom-less sex, but actively celebrated the potential for transmission, selling the fantasy of ‘breeding’ and ‘seeding’ — often irrespective of the actual HIV status of the performers.

It’s impossible to say with certainty what the relationship between bareback porn and rising rates of bareback sex was exactly. Gay men certainly didn’t need bareback porn to inform them of the possibility of bareback sex. A GMFA porn survey did find that a lot of gay men felt that watching porn influenced their own sexual behaviour, including the sexual risks that they were taking.

With HIV medication making guys with HIV undetectable, and the availability and effectiveness of PrEP, are condoms now superfluous for gay men?

The idea that safer sex begins and ends with using condoms is out of date. Someone who is HIV-positive and undetectable on treatment doesn’t pose any transmission risk to sexual partners. PrEP, when used correctly, is almost 100 percent effective, and certainly offers greater protection against HIV than condom use alone. Condoms still play a role in safer-sex. Condoms also prevent the transmission of other STIs, and for some men they’re preferable to the prospect of taking drugs to prevent acquiring HIV.

Are some gay men not hearing the information that’s currently available regarding PrEP and Undetectable=Untransmittable?

It can be difficult for some gay men, who lost friends and lovers during the worst days of the epidemic, to accept that the safer sex message has evolved. PrEP, when taken as prescribed, is almost 100 percent effective. There are no recorded cases of someone with an undetectable viral load passing the virus on sexually. Both offer greater protection against HIV acquisition than condoms do.

Before effective treatment came along, when we had lost thousands of lives to AIDS, I’m sure the idea of a pill that could prevent infection would have been hailed as little short of a miraculous gift. Now, with a greatly reduced death toll, just such a treatment has been tested and found to be effective. PrEP should be embraced and celebrated.

Different safer sex strategies will suit different people. The important thing is that individuals are supported to adopt a strategy that they can keep to and that will be effective for them.

Is it accurate to suggest that some gay men are struggling with moral judgements regarding sex and condom use?

For many gay and bisexual men, condom use has become intertwined with morality and notions of being a good gay man. That notion has caused harm. Telling someone that they’re wrong or disordered because they prefer to have sex without condoms, only serves to alienate them from sexual health messaging. Condoms are good for gay and bi men because they prevent transmission of infections — but that doesn’t make condom use morally superior to other methods of preventing HIV acquisition.

What role does porn play in conveying sexual health messages to gay men?

Some performers have actively used the platform that porn has given them to promote sexual health. Jason Domino has made promotion of PrEP central to his work and also has been helping to share the message that people who are undetectable on HIV treatment can’t pass the virus on to sexual partners. Kayden Gray is very open about living with HIV, and has also spoken out about sexual exploitation, chemsex, and issues relating to consent.

Our survey indicates that gay men are watching a lot of porn. Is porn a good way for younger gay guys to learn about sex?

There are a number of ways that you can argue that porn can give people a distorted image of what sex is like. Not least among porn’s problems, as a guide to sex for the inexperienced, is the high level of racial stereotyping or the virtual exclusion of some ethnic groups from porn, the additional pressure it puts on people to conform to particular body-types, the expectation that all men have large cocks which can be easily accommodated, or the commonplace absence of any discussion about HIV status or sexual safety.

But it would be naive to think that it’s porn’s role to educate. The ease of accessing porn makes it all the more vital that LGBT-inclusive sex and relationships education is taught in schools, to counter some of the myths and misinformation that porn fantasy might support.

If you were talking to a young gay guy about sex, how would you explain how to try and protect yourself against STIs?

Even though biomedical HIV prevention methods, such as PrEP, doesn’t stop STIs, it doesn’t mean that their use is going to increase STIs. People who get their PrEP use monitored will also get regular STI screens. In one major London clinic they’ve seen a 24 percent decline in cases of gonorrhoea among their PrEP users because more gay men are getting screened regularly and, if they’re found to have the infection, they get treated and cured before they pass it on.

Getting people into clinics is vital. It’s easy to have infectious gonorrhoea, particularly in the throat or arse, without any symptoms. This is why it’s so important that PrEP is available, free of charge, through our NHS services.

You can be vaccinated against HPV, hepatitis A, and hepatitis B. You can reduce your risk of acquiring STIs by using condoms, by avoiding penetrative sex or by having fewer partners. If you’re sexually active, you should get a full sexual health screen at least once a year, more often if you have had several sexual partners. The more regularly people are screened for STIs, the earlier that they’re diagnosed and cured, and the less opportunity there is for them to pass on the infection.

Read more from Gareth Johnson