In his recent Slate article "Is Unprotected Anal Sex Ever OK?," Mark Joseph Stern argued that unprotected anal sex should be seen as a "perquisite" for monogamous couples. The article was a response to a CDC report noting a rise in rates of unprotected anal sex among men who have sex with men, a report that has led many public-health experts and activists to adopt a harmful tone of finger wagging that completely undercuts what is a central message in health activism: We all have a right to a full life that includes smart, fun, and safe sex. That messaging is harmful—but no more so than Stern’s idea that unprotected anal sex should be a reward for those who invest in a monogamous relationship.
There is no special event or destination that, once reached, allows uninterrupted condomless anal sex. Monogamy is not Camelot. Aside from completely eliding the healthy decisions of those who are polyamorous or nonmonogamous, looking to monogamy as a magical sheath against HIV flies in the face of sound science. One 2009 study of gay men in major U.S. cities showed that as many as 68 percent of new HIV infections come from a person's primary (though not necessarily monogamous) sexual partner. The results of this study show two important, complementary realities: They problematize the idea of a monolithic "monogamy" and they illuminate a glaring blind spot in HIV-prevention agendas—the exclusion of couples as a targeted population in need of prevention outreach.
The problem with treating unprotected anal sex as a reward for monogamy is thatmonogamy is a plastic word, so malleable that it can mean something different to every person who uses it. There is nothing inherent about a dyadic relationship that offers protection from HIV. A verbal agreement between two people is not a risk-reduction strategy. When we talk about monogamy, we're actually talking about a complicated interplay of factors that vary from twosome to twosome—factors that include commitment, trust, satisfaction, communication, intimacy, and power—none of which exist in a vacuum and all of which are completely contingent upon an array of social and structural factors. Power within monogamous relationships varies wildly based on each partner’s age, race, income, education, serostatus, and more.
If we understand our risk for HIV as contingent upon a healthy balance of these factors in all of our relationships—being committed but not obsessed, trusting but not blindly loyal, having a balance of power, and successfully utilizing communication skills—then monogamy itself isn't the gateway to anal sex, but rather an awareness and commitment to fostering healthy relationships. It's a prevention strategy that relies on tools most people have at their disposal. Discussing non-sexy things like communication, loyalty, and trust along with sexual practices may actually be a more effective means of HIV prevention than focusing on sex practices alone.
A model based on fostering healthy relationships opens up anal intercourse for what it actually is: normal and human. Regardless of your relationship status or the type of relationship you are in, you need not be barred from this sexual act. HIV thrives in silence, and the fostering of healthy relationships fights HIV transmission in a way that an updated Facebook relationship status never can: empowerment. Speaking about sex practices in the context of any relationship—whether with a primary, secondary, or casual sex partner—fosters feelings of trust and commitment, allows for feelings of intimacy, and forges a natural balance of power between parties. While condom usage is extremely important to stopping HIV transmission, their distribution is a mostly passive HIV-prevention strategy. Addressing issues of communication, trust, and power can actively fight the feelings of secrecy, shame, guilt, and jealousy that often fuel HIV within relationships, monogamous or otherwise, and can act as an extra layer of protection against HIV.
Prevention messaging that is rooted in fear or finger wagging is based in a faulty power dynamic in which the person or entity delivering the message is inherently more knowledgeable than the recipient of that knowledge. Instead of a model that turns knowledge into something offered, transmitted, or shared—from the "haves" to the "have nots"—prevention should embrace an ethos of personal and communal care that allows people to understand that the tools to fostering healthy relationships and staying HIV-negative are already within them, waiting to be used for the health and prosperity not only of themselves, but those they care about, as well.