You say po-tay-to, I say pa-tah-to. You, gay history and the Atlanta-based CDC say unprotected sex, we say barebacking. Now a major victory for “condomless sex” and sex-positive messaging proves that words matter.
Incorporating the realities of at-risk groups into prevention messages has been a challenge since the dawn of HIV. Those realities no longer include the stigma and inaccuracy that equates “condomless” with “unprotected.” The CDC now says it will stop using "unprotected sex" to mean "sex without condoms." Instead, the federal health agency switches to "condomless sex," it announced on a Jan. 23 conference call with some 80 HIV service organizations, including advocate Rod McCullom.
“Perhaps once upon a time, all condomless sex was viewed through a lens of heightened risk for HIV,” McCullom said. “That is no longer the case. Men and women are using PrEP and antiretrovviral therapy, for instance, as tools to substantially lower their risk. What if you are on treatment and have an undetectable viral load? That is a new 'protection' that thankfully has become available … proving at least as effective or more effective in preventing transmission than condoms-only messages. The construct of safer sex messaging has lagged behind. Unfortunately, that lag in messaging has also played into the criminalization of HIV.”
Gay Atlanta HIV activist Mark King, who regularly dives into how we talk about gay sex and HIV, agrees that a clarification was long overdue. Sex partners can actually be as much or more “protected” by means other than eliminating barebacking from their repertoire, he says.
"There are now a multitude of strategies that 'protect' people from HIV infection, and I'm thrilled that the CDC is recognizing that," King said. "Their previous definition limiting protected sex to sex with condoms gave a biased view of what's actually happening in the real world," he said, referring to "serosorting, sexual positioning, the precise sex acts involved, PrEP, and successful treatment."
All of them, he said, "qualify as providing various levels of protection [from HIV]. And a couple of them – undetectable viral loads due to successful treatment and the proper use of PrEP – actually provide more protection than condoms."
Does the switch in the language actually shift the conversation in a meaningful way? Does it affect transmission rates, self-shaming, or safer sex practices either way, or is it just semantics? The CDC and a slew of health advocates certainly think it's worth a shot.