In the early 1970s, the gay rights movement adopted the upside-down pink triangle as a symbol of pride. Once the symbol of Nazi hatred of gays and lesbians, the movement reclaimed their imagery.
The triangle was paired with the phrase “Silence Equals Death.” The message? Be open about your sexuality in order to squash ignorance and homophobia.
A decade later, AIDS activists adopted the pink triangle to raise awareness about the HIV epidemic that had begun to ravage the nation, an epidemic also steeped in ignorance.
Today, “Silence Equals Death” could just as easily be applied to other “taboo” public health issues. Experts in the field hope to get Americans talking about issues of sex and sexuality in the context of good health.
“We need to make sex a positive again and eliminate as much as possible these negative connotations,” said Jose Zuniga, president of the International Association of Providers of AIDS Care (IAPAC), in an interview with Healthline. “Interventions are available to allow for HIV-positive and HIV-negative people to enjoy sexuality without having to suffer through the value judgment that many are suffering through now, including in the U.S.”
He acknowledges that a sense of national “prudishness” is a barrier to better public health.
When it comes to what Americans do with their sex partners, we don’t like to talk about it, sex experts agree. At least, we don’t talk about sex in ways that celebrate intercourse, said Dr. Rafael Mazin of the World Health Organization. Instead, most of the discussions we have around sex revolve around how it could hurt you by resulting in a sexually transmitted disease or unplanned pregnancy.
Why Now Is Not the Time for Fear
Messages intended to spur fear about catching a disease stigmatize people with the disease while ignoring the realities of human nature, Zuniga said. “The idea that people should still be able to live with HIV and have a healthy sexual life is a message that has been lost over so many years,” he said.
Using fear to persuade people to remain abstinent or use condoms “or else” doesn’t work, many sex experts agree. In fact, fear shuts down discussions about sex, and that’s what we should really be afraid of, said noted sex expert David Ley. The inability to have healthy discussions about sex can lead people to make decisions that threaten their lives.
Even with new tools, such as Truvada, a pill taken before sex to prevent HIV/AIDS as pre-exposure prophylaxis (PrEP), as well as another medication called post-exposure prophylaxis to be taken after sex to prevent infection, 50,000 people in the United States still contract the virus every year, according to the U.S. Centers for Disease Control and Prevention (CDC). Among some groups, such as young men who have sex with men, the infection rate is going back up after years of decline.
Three decades into the epidemic, it’s clear that past prevention approaches have failed in targeting many groups. If people don’t feel comfortable expressing who they are sexually, public health experts with tailored interventions cannot reach them.
“Look at how we responded to the ‘down low’ phenomenon, bisexual men having secret homosexual sex and potentially infecting their poor, sweet, innocent, unsuspecting partners,” Ley said of the early U.S. response to heterosexual women thought not to be at risk of becoming infected with HIV. “Those were not sophisticated conversations about the reality of sexual desire and how sexual desire affects us and our choices. Those were panics.”
Killer Strains of HPV, Gonorrhea on the Rise
Once again there are fatal sexually transmitted diseases threatening Americans, and they are largely preventable. The human papillomavirus (HPV), for example, can be prevented most of the time with a vaccine given to children and young adults.
In an opinion piece in the New York Times, Dr. Paul Offit of the Children’s Hospital of Philadelphia notes that HPV is the second most deadly STD after HIV. HPV affects 26,000 American men and women per year by causing cancer of the penis, anus, cervix, and throat. On Wednesday, the FDA announced that the HPV vaccine Gardasil 9 has now been proven effective against 90 percent of HPV-caused cervical, vulvar, vaginal, and anal cancers.
Yet less than half of American teens have received the HPV vaccine recommended by the CDC. Some parents have stated that they don’t want their child to have the vaccine because they don’t believe their child is sexually active and at risk. Others have expressed fears that the vaccine will cause their children to become promiscuous.
There is also an emerging, antibiotic-resistant strain of gonorrhea that has U.S. health officials scrambling for a potential epidemic. The CDC has labeled it an “urgent threat” and has ramped up genomic sequencing of the Neisseria gonorrhoeae strain, which can cause infertility.
The U.S. government has acknowledged that its approach to discussing sex in the context of public health needs to evolve. The CDC convened a meeting of experts on sexual health in 2010 and produced this report the following year.
But funding for research into sexual health is limited, Ley said. He noted that our country’s views around sex tend to gravitate toward unhealthy extremes. On one level, we are obsessed with sex in the media, yet when discussed on a medical level, it’s usually in the context of something to be afraid of.
“We’re bipolar as a society as it comes to sex,” Ley said. “On the one hand we’re obsessed with it, manically obsessed with talking about it and using it in marketing. Yet we’re terrified of it and whipsaw people. We dangle the sex carrot in front of people and then we spank them. This is how you make people crazy.”
Psychological Impact: Silent Assault Victims, Curious Teens
America’s stigmatization of sex often keeps victims of sexual assault from reporting crimes, which can have deadly consequences. Numerous studies have linked sexual assault to later life-threatening ills, from smoking to suicide. The White House issued a called to action on the matter earlier this year.
“Rape victims in the U.S. don’t talk about their experiences because of the judgment,” Ley said. “They don’t want to be on the stand and be called a slut.”
He pointed to numerous trials that grip cable news viewers as examples of our appetite for salacious stories about sex. “We watch trials of sexuality and violence as a voyeuristic society with a finger-shaking kind of attitude. It’s no wonder the victims don’t want to talk. It’s terribly unhealthy.”
If we don’t talk about sex early and often with our children, they’ll look elsewhere for answers. And that’s a scary thought too, Ley said.
He said a young person with very little sexual knowledge and a fear of discussing sex with their parents may turn to the Internet for pornography, “which is not supposed to be educational, and they will learn some pretty twisted things. Watching professional football is not the way to learn to play football.”
Having healthy sexual discussions goes beyond just building a foundation to talk about safe sex. It also allows people to set their own boundaries, negotiate sexual experiences, and understand their own desires.
“People have different levels of libido, levels of desire for excitement, or sexual sensation seeking,” Ley said. “If you don’t understand those things about yourself, it’s hard to make judgments and good decisions.”
He said parents need to remember that despite their best intentions, sex happens. They should not be tempted “to control and prevent access to sexuality for other people because we feel they cannot be trusted with it.”
Instead, Ley said sexuality needs to be discussed openly and in ways that foster a rich dialogue. “The more society removes the moral stigma of talking about sexuality, the more people are able to understand themselves, understand each other, and have a dialogue that is not emotionally laden.”
Acknowledging Gay Sex, Sex Work a Healthy First Step
Parents aren’t the only ones to blame for not fostering more healthy discussions about sex. Doctors don’t like to talk about it either.
“When it comes to taking a patient’s sexual history, data indicate a large number of clinicians are not doing so,” Zuniga said. Even among obstetrician-gynecologists, there isn’t much doctor-patient dialogue. A 2012 survey of U.S. OB-GYNs found that only 28 percent confirm a patient’s sexual orientation.
Many people who may be at risk for HIV and are good candidates for PrEP are going undetected by doctors all over the United States. From men who don’t feel comfortable telling their doctors that they have sex with other men (and doctors who don’t ask) to sex workers (who have numerous barriers to health care, including legal ones), hot spots of HIV around the world continue to simmer.
Mayors from around the world gathered in Paris earlier this month and vowed to do what it takes to achieve the UNAIDS 90/90/90 goal for combating HIV. The goal is to reach a point where 90 percent of infected people in the world know they have HIV, 90 percent have obtained treatment, and 90 percent reach viral suppression.
Getting HIV under control in the world’s cities isn’t going to be easy. In many places, it’s going to mean confronting cultural taboos about homosexuality and sex work, Zuniga said.
“If we acknowledge that sexuality and sexual desire has this power over us, and then we pathologize it and treat as taboo right up until the point where we’re there and jump into it,” Ley said, “we’re condemning people to making bad decisions.”