Download Promoting sexual health and rights through pleasure

Promoting sexual health and rights through
pleasure:
A literature review
Wendy Knerr, Juliet McEachran and Anne Philpott
August 2008
With funding from the
Pathways of Women’s Empowerment
Research Programme Consortium*
www.pathwaysofempowerment.org
*Pathways is funded by the UK Department for International Development (DFID),
however the views expressed here are not necessarily those of DFID
About The Pleasure Project
Started in 2004, based in UK and India, with volunteers
worldwide
• Training sexual health educators and counsellors to
become more comfortable talking about sex and
pleasure
• Helping NGOs and public health agencies make sex
education materials more sex-positive
• Working with erotic filmmakers to incorporate safer-sex
into porn films
• Research and articles
• Advocacy with media and the public health sector
Context: Where is the pleasure in safer sex?
• People have sex for many reasons: love and affection,
conformity, recognition, power, stress reduction, reproduction, as
part of a social contract (e.g. marriage) or to earn a living.
• Sexual pleasure remains a highly significant, if not primary,
motivating factor for sexual behaviour.
• HIV spread mainly through sexual transmission, so HIV
prevention needs to consider the role of sexual pleasure and
desire in sexual behaviour.
• While use of male condoms has increased since the beginning of
the AIDS epidemic, it’s not as high as it should be.
• Safer sex is considered ‘unsexy’
• ‘Prevention fatigue’ - new approaches needed
Call for more research
‘Promoting Protection and Pleasure: amplifying the
effectiveness of barriers against sexually transmitted
infections and pregnancy’, Philpott, Knerr and Maher;
the Lancet; Vol 368; Dec 2005
‘Pleasure and Prevention: When Good Sex Is Safer
Sex’, Reproductive Health Matters 2006;14(28):23–31 ;
Philpott, Knerr and Boydell
Set out future agenda for research – basis
of literature review
Key questions for Literature Review
• Is there evidence that including
elements of pleasure and the erotic in
safer sex interventions can increase
uptake of safer sex practices?
• In which contexts might a pleasure
approach be more or less effective?
• What role do gender and culture play
in the effectiveness of this approach?
• What future research needs to
happen?
Is there evidence that erotic elements
can increase safer sex?
Yes, but extremely limited in terms of context and
culture.
Two key studies:
1. Gay Men’s Health Crisis (USA) study of 600
gay/bisexual men
– visual – as opposed to verbal and written –
presentation of affirmative, erotically
appealing safer sex material most effective
of four HIV prevention programmes.
– compared to controls, the group that viewed
erotic videos/slides less likely to engage in
risky sex three months after intervention.
Evidence that pleasure/eroticism can
increase safer sex
2. Meta-analysis (Scott-Sheldon and Johnson 2006) examined
effectiveness of 21 sexual risk-reduction interventions that
integrate erotic safer sex component.
• All RCTs/had quasi-experimental design with control group
• Majority low-prevalence settings, mostly Caucasian men in
their early 20s, in US college settings, one-fifth MSM
• Most studies did not separate erotic component from overall
intervention, so difficult to determine causal links
• Findings:
– More risk-preventive attitudes, less risky sexual behaviour
and an increase in condom use
– Decrease in numbers of sexual partners
– Did not lead to more sex overall
– More interest in sex education
How do gender and culture affect safer
sex and pleasure?
• To test erotic interventions crossculturally and in wider contexts, it is
vital to look at implications of gender
and culture
• Sexual activity can:
– be consensual or forced,
pleasurable or not
– serve many needs - procreation,
bonding, work, or obligation (in
the case of prostitution or spousal
duties), recreation or play, etc.
• Sexual pleasure and the erotic are complex, subjective,
varied, shaped by culture and gender
Sexual Pleasure, Gender and Culture
• In most cultures, satisfying sex defined in relation to hetero
male pleasure, thus:
– persistent focus on vaginal penetration in HIV prevention
– condom use as primary
– very little research into women’s pleasure, focus on
‘women as victims’
• Conception that ‘sexual pleasure = orgasm’ equally shortsighted
• Can gender/culture be allies? E.g.: using porn, romance as
modes of communication about safer sex?
• Interventions must be:
– sensitive to gender and culture, including gender roles and
norms and how these affect sex, concepts of pleasure and
ability to practice safer sex (power relations)
– aware of ‘what turns people on’
Pleasure, safer sex and sexual skill
“ … just telling people to use condoms is like telling someone to
use a saddle to ride a horse – there’s a lot more to both safe sex
and horse riding!” – personal testimony of a sex worker in Mongolia, told to The
Pleasure Project by Cheryl Overs, Making Sex Work Safe trainer/educator
• Widespread assumption that sex is something
natural and automatic, especially for men, and
that safer sex is easy or obvious.
• Range of studies indicate that:
– promotion of safer sex can benefit by including
skills education with condoms
– safer sex becomes more comfortable and
pleasurable with practice.
• We need new and more creative modes for
delivering information about safer sex skills, e.g.
looking to the ‘experts’ who already know how to
eroticize safer sex: sex workers, gay men
A way forward
• Condom promotion needs to move from an AIDS/disease
discourse to one of pleasure, sexual skill and eroticism.
• Adapt existing studies – which show link between eroticizing
safer sex and practicing safer sex - for higher risk contexts:
Africa, Asia, Latin American, high vulnerability/risk groups.
• Research must:
– test impact of erotic interventions (e.g. erotic safer sex
education vs non-erotic safer sex education - not just
interventions that include erotic education)
– be gendered, contextual and culturally sensitive, asking:
‘What turns this group on? What influences sex and
pleasure in this culture?’
• Consider the potential of:
– new technologies (e.g. microbicides) as erotic tools
– existing pleasure/desire norms and communication modes
(porn, romance, etc) as routes of safer sex skills education
– skills from disciplines other than public health,
anthropology, psychology, sexology …
Real-world examples of erotic safer
sex interventions:
The Global Mapping of Pleasure:
A directory of organizations,
programmes, media and people
who eroticize safer sex, 2nd
Edition
Read it online:
(www.thepleasureproject.org/section6/)
www.thepleasureproject.org