Addressing heterosexual men's roles is critical in HIV prevention. New research documents the understanding which inform men's unsafe sex.
Global research on HIV/AIDS has established that gender and sexuality are key factors in explaining patterns of HIV transmission. But heterosexual men’s role in the sexual transmission of HIV has rarely been addressed.
Few studies have focused on men’s involvement in safe and unsafe heterosexual sex, far more research on the heterosexual transmission of HIV centres on women than on men, and very few education campaigns are aimed at straight men. There are good and bad reasons for this. On the one hand, this reflects feminist achievements in identifying AIDS as a women’s issue. On the other hand, men’s absence reflects the status of maleness as normative and invisible and perpetuates the allocation of responsibility for safe sex only to women. Women’s inclusion in AIDS policy and education is a valuable achievement, and there are sound feminist reasons for directing attention also to heterosexual men.
When it comes to HIV/AIDS, men are part of the problem, but they are also part of the solution. Growing recognition of this is reflected in recent international efforts to involve men in HIV prevention, such as the UNAIDS campaign “Men: Make a Difference”. Research too is shifting, and a small body of scholarship focused on heterosexual men’s roles in safe and unsafe sex has emerged. My PhD research (Flood 2000) joined a handful of Australian studies in the area. I conducted in-depth interviews with seventeen men aged between 18 and 26 in Canberra, examining men’s sexual practices and the meanings and sociosexual relations through which these are organised.
WHY MEN DON’T USE CONDOMS
Feminists writing on HIV/AIDS argue that there are constraints to women’s and men’s practice of safe sex at every level of social interaction and social structure, from the broad structuring of heterosexual culture and gender inequalities, to the micro-politics of sexual negotiation in heterosexual relationships, to the organisation of sexual practices. Gender inequality is a key barrier to HIV prevention. Unequal power relations limit the adoption of effective risk-reduction strategies, or produce the adoption of ineffective strategies (Doyal 1994, p. 17). Women’s inferior economic and social status increases their vulnerability to HIV and limits their ability to control their sexual and social lives and protect themselves. At the same time, both women and men’s vulnerability to infection is heightened by common constructions of gender and sexuality.
There has been strong agreement across the literature on AIDS and heterosexual men about which aspects of heterosexual men’s understandings and practices limit their adoption of safe sex. Condom use is seen to run counter to six central aspects of the enactment of masculinity and heterosexual men’s sexuality. I summarise these here, before exploring the results of my own research among heterosexual men.
First, sexual control and knowledge are constructed as male, while condom use involves the man’s agreeing to a woman’s request to change his sexual behaviour (Wilton 1997, p. 34). Masculinity is equated with sexual activity and knowledge, while femininity is equated with passivity and innocence (Foreman 1998, p. 31).
Second, male sexual pleasure is the defining principle of heterosex and is prioritised. Penis-in-vagina intercourse and male intravaginal ejaculation define ‘real sex’, and men’s sexual pleasure is focused on the penis. Condom use involves men deprioritising their own sexual pleasure in the interests of sexual safety, while adopting non-penetrative sex poses an even further risk to masculine identity (Wilton 1997, p. 34). Third, male sexuality is understood to be an uncontrollable or barely controllable force, typically through the notion of “male sex drive” (Kippax, Crawford & Waldby 1994, p. S318). In contrast, condom use involves men demonstrating a degree of control over their sexual behaviour.
Fourth, responsibility for prophylactic (and contraceptive) safety is allocated to women while masculinity is associated with risk-taking. Women rather than men are seen to be the gatekeepers and guardians of sexual safety (Waldby, Kippax & Crawford 1991, p. 40). Safe sex involves men accepting or taking responsibility for their partners’ and their own sexual safety, rather than engaging in risk-taking which is masculine and thus masculinising (Wilton 1997, p. 34).
Heterosexual men’s adoption of safe sex is further limited by their risk perceptions and strategies of risk management and, in particular, their basis in assumptions about women’s sexual histories. Heterosexual men are said to distinguish between two types of women, “clean” and “unclean”, on the basis of their appearance, behaviour and resistance or otherwise to sexual overtures, and men perceive the need to take precautions only with the latter (Waldby, Kippax & Crawford 1993; Wight 1993).
Heterosexual men’s homophobia is a sixth factor limiting their adoption of safe sex. Heterosexual men may feel distant from the epidemic and unconcerned about its effects and they may see themselves as at low risk of contracting or transmitting HIV. Because of homophobic fear, they may try to disassociate themselves from AIDS and thus not respond to safe sex education (Campbell 1995, p. 207).
LUST, TRUST AND LATEX
How do heterosexual men themselves understand safe and unsafe sex? My own research finds that young heterosexual men emphasise five themes in accounting for their non-use of condoms. Some of the configurations of sociosexual meaning and practice documented are at odds with the depictions of masculinity and masculine sexuality in the literature described above. This suggests that a more thorough engagement with heterosexual men’s sexual lives is necessary in order to understand and influence both women’s and men’s roles in the HIV/AIDS epidemic. Greater detail on my study’s results can be found elsewhere (Flood 2000, 2003).
First, men stress the risk of pregnancy rather than the risks of HIV or other sexually transmitted infections, and they deal with the risk of pregnancy by relying on their partners’ use of the Pill. The young heterosexual men in my study spoke of being unwilling to become fathers, especially at this stage in their lives, and some emphasise the financial and emotional burdens of unwanted fatherhood. As one man said, “18 years of paying for a kid, you’d be screwed and getting nowhere in life.”
When heterosexual men use condoms, often they do so to prevent pregnancy rather than the transmission of STIs. However, in long-term or regular relationships, young men (like young women) commonly rely on the contraceptive Pill.
I found three problematic features to young men’s reliance on the Pill. Some men simply assume that women are using the Pill — because they are sexually active, because Pill use is seen to be common, or even because the woman did not ask them to wear a condom. Some men ask or pressure their female partners to go on the Pill. Some men move from condoms to the Pill very early in their sexual involvements, too early to have established that both people were free of diseases. And some men started having intercourse without condoms after they and their partners had decided to use the Pill but before it had become effective.
Second, men emphasise that condoms decrease their penile sensation and are difficult to use. This represents that popular idea that having intercourse with condoms is like ‘taking a shower in a raincoat’. Condoms do have a material effect on men’s sensate experience of intercourse: some men take longer to reach orgasm, and some men lose their erections. However, men’s bodily experience is shaped by cultural meanings, including the widespread idea that condoms are desensitising.
Heterosexual men’s complaints about ‘showers in raincoats’ demonstrate a privileging of the penis as an important site of sexual sensation and erotic pleasure. To the extent that these complaints inform heterosexual men’s reluctance to use condoms, they privilege men’s pleasure over prophylactic and contraceptive safety.
Men also remark that condoms are difficult to use. Some men experience difficulties in unwrapping the condom and putting it on while still erect, and in keeping it on and sustaining an erection throughout the session of intercourse.
I found that three other aspects of heterosexual men’s understandings of sexual practice further hinder safe sex, particularly the option of minimising the risk of HIV transmission (and pregnancy) by avoiding intercourse. For many heterosexual men, penis-in-vagina intercourse is the most important and defining practice constituting ‘sex’. Intercourse often is seen as the inevitable and natural endpoint of a sequence of other sexual practices. And some men in my study emphasise that intercourse represents intimacy and intimacy requires intercourse. This understanding again makes it harder to forego intercourse, but also to use condoms for intercourse because they are seen to block the closeness expressed through the practice.
Third, men emphasise that condoms “kill the moment” and interrupt the “heat of the moment” of sexual episodes. For many of the men in my research, sexual encounters involve a particular ambience or “moment” that is passionate, sexually and emotionally intense, verbally silent, and unable to accommodate calm considerations of prophylaxis or of the possible consequences of the episode. The significance of the “heat of the moment” is particularly in thwarting awareness or reflection about condoms or the prevention of disease transmission.
The “heat of the moment” is ‘hot’ because it is sexy — it involves the literal heat of two bodies in physical contact, and both participants are ‘hot’ in the thrall of sexual passion. Condoms kill this moment: either condoms cannot be incorporated into the episode, or they are unwelcome intrusions which interrupt and spoil the moment.
Several aspects of contemporary Western ideologies of sexuality help sustain heterosexual men’s allegiance to the “heat of the moment”. Sex is seen as a fundamentally irrational and ecstatic domain, such that condoms represent the intrusion of the practical, responsible and mundane into a space that is impractical, irresponsible and ethereal. Sexual relations in general and heterosexual relations in particular are constituted through discourses of the ‘natural’ and the ‘biological’. While the “heat of the moment” and similar notions are not exclusive to heterosexual men, they are underpinned by the construction of heterosexual desire as spontaneous and irresistible.
Fourth, men rely on notions of trust and monogamy to abandon condoms in favour of the Pill (or other contraceptive methods) in regular relationships. Many of the interviewees represent trust, monogamy and closeness as intertwined meanings which rule out condom use in a regular relationship. They quickly define sexual involvements with a particular woman as a “relationship”, and relationships signify trust and monogamy, again rendering condom use redundant. This may show a “gender convergence” in the meanings young men and women give to sex and relationships.
I found that a sense of trust and sexual safety can be established very quickly, even over the course of a single night. Thus the fact of having sex can itself create trust, and trust means sex without condoms.
Fifth, young heterosexual men believe that they are very unlikely to contract HIV because they see their social circles, institutions, the heterosexual community or heterosexual sex per se as safe and free of HIV/AIDS, so there is no need to wear condoms. Such boundaries of imagined safety are constituted by widely available discourses of AIDS as gay and heterosexuality as safe, and by the protection granted by particular institutions’ regimes of HIV-testing and exclusion, but also by the actual low prevalence of HIV and AIDS. As one man said, “in the heterosexual community it’s pretty rare that you’ll catch a disease. […] clean sex, acts, in, just normal circumstances, very low chance of catching something.” It is not merely an imagined ‘heterosexual community’, but the very sexual practices which constitute it, which are rendered AIDS-free in this construction.
Education and prevention efforts directed at the heterosexual transmission of HIV must engage with the sexual cultures of heterosexual men. My study reveals that while there are important understandings and practices among men which constrain condom use, there are also significant resources in men’s lives for safe sex.
Given the small number of men on which the analysis is based, it cannot be claimed that the patterns established can be generalised to all young heterosexual men in Australia, let alone to men in the UK or elsewhere. But the possibility that these configurations of meaning and practice are present in similar forms in the lives of other men deserves further investigation.
Effective approaches to HIV prevention will need to be gender-sensitive. They will need to empower both women and men to challenge unequal power relations and narrow constructions of gender. And they will need to transform the wider gender and sexual relations within which HIV transmission occurs.
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[Citation: Flood, M. (2003) Lads in Latex? Why young heterosexual men don’t use condoms. Impact, London-based journal of the National AIDS Trust, October, No. 4, pp. 10-11.]