Transcript Slide 1

We believe you can have safer sex
if you know how to have good sex
Putting the sexy into safer sex
Based in UK and India with volunteers worldwide
Largely volunteer-run: No full-time paid staff; limited amounts of
project-based funding
Why we started:
• “Insertive probe” and “receptive cavity”: Sex in the public
health world
• Pleasure: one of primary reasons people have sex, yet absent in
public health programming, education, research
• We ‘sell’ everything using sex … why not safer sex?
What we do:
• Advocacy about the importance of pleasure in sexual health
• Training health professionals and educators
• Research to build the evidence base
• Bringing safer sex to erotic media
Advocacy for erotic safer sex
At conferences:
With the media:
– IAC 2004-2008 (Bangkok,
– Washington Post (March
Toronto and Mexico City)
2009) (USA)
– ICAAP 2007 (Colombo)
– the Guardian (UK)
– Women Deliver 2007
– The Times (UK)
(London)
– Sydney Morning Herald
– Microbicides 2008 (Delhi)
(Australia)
– CHAPS gay men’s sexual
– National News (Canada)
health conference 2008
– National Radio
(UK)
(Colombia)
– Terrence Higgins Trust
– American Broadcasting
(UK) Youth Leaders
Co (ABC) (USA)
Conference
– Cosmo (UK)
– Positively Women
– Royal Society of Medicine
magazine (UK)
(London)
www.thepleasureproject.org
Launched in 2004
Usage stats Aug 2008 – Apr 2009 (9-month period)
• 27,000+ visitors, 24,000+ unique visitors
• 89,000 page views
• Avg. 2,500 unique visitors/month, spikes after conference
appearances
• Visitors from 25 countries (top: 31% USA, 8%UK, 4% India & Ireland
…notable: 1.8% China, 1.4% Saudi Arabia, 1.2% UAE)
• Most popular pages: home page (21%), sexy tips main page and
activities (+/-12%)
• Most common file downloads: Global Mapping of Pleasure
(15,000+)
Sexy tips at
www.thepleasureproject.org
Pleasure proficiency training
• CARE Cambodia, 2004: 3-day training of trainers
• IAC Toronto, 2006: How to talk about sex and
pleasure
• ICAAP Colombo, 2007: Sexing up male and
female condoms
• Positively Women, London, 2008: Pleasures of
the Female Condom for HIV positive women
• African HIV Policy Network, London, July 2008:
upcoming
• THT (UK) Youth Leaders Conference
• UK NHS Bristol sexual health training
45 case studies of individuals
and organizations around the
world who aim to empower
people by eroticizing safer sex
and making sex education
sexy.
Designed for everyone who is
tired of hearing the same-old
prevention messages – that
sex is dangerous, something
to be feared, and that safer
sex is un-sexy.
Victorian AIDS Council, Australia
www.protection.org.au
Some topics covered:
•The basics
•Condom use
•Testing
•Unprotected anal sex
•PEP
•State of mind
•Sexual adventurism
•In the heat of the
moment
Images given free
by the only safersex gay porn site in
Australia:
www.hothouse.com
Building the evidence base
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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
- huge burden of disease & need for novel approaches
- Sexual pleasure as key component of sexual health
- examples of eroticising male and female condoms
- future agenda for research (this is important because we highlighted why we need to do
more research in this area so directly led to our literature review)
Qualitative – effectiveness in different social contexts, any possible adverse effects ? Could
promotion of pleasure lead to creation of new norms and stigmas of pleasure ? Are there any
specific groups for who this approach may be less relevant? What lessons can be learnt from
examples of successful marketing ?
Quantitative – how effective is the emphasis of pleasure as opposed to other approaches
and is it cost effective ?
Not only HIV but also reproductive health
Pleasure and Prevention: When Good Sex Is
Safer Sex; Reproductive Health Matters
2006;14(28):23–31 ; Philpott, Knerr and Boydell
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Most sexual health education programmes use fear and risk of disease to
motivate people to practise safer sex
gives the impression that safer sex and pleasurable sex are mutually
exclusive
there are a variety of organisations, including religious and youth groups,
and promoting pleasurable safer sex.
techniques they use include promoting sexual techniques and dialogue
about sex, teaching married couples how to have better sex and putting
images of desire in sexual education materials.
This paper focuses on ways of eroticising female and male condoms as
examples of effective ways of using pleasure in HIV prevention and sexual
health promotion.
Building the evidence base
• Promoting sexual health and rights through pleasure:
A literature review
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Funded by the Pathways of Women’s Empowerment Research Programme Consortium
(pathwaysofempowerment.org)
• Is there evidence that integrating elements of pleasure and
the erotic into HIV prevention interventions can increase safer
sexual practices and empower people, particularly women, to
negotiate safer sex?
• Builds on our preliminary examination published as a
Viewpoint in the Lancet (Dec 2006): "Promoting Protection
and Pleasure: amplifying the effectiveness of barriers against
sexually transmitted infections and pregnancy"
Building the evidence base
• Strong evidence of effectiveness in some settings, but limited
• Need for more research in wider range of settings and
contexts (e.g. high-risk groups, gender and culture
implications)
• Review makes recommendations for capitalizing on the
promising potential of pleasure and erotic approaches to safer
sex promotion
“Pleasure is arguably, if not definitively, the single most powerful
motivating factor for sexual behaviour.”
– World Association for Sexual Health (WAS), 2008
Is there Evidence ?
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A few RCTs examining evidence of effect – positive attitudes to sexuality more likely to
mean practise safer sex (Kyes, Brown and Pollack, 1991, Fisher, et al 1988 ); reading
erotic stories with condoms included had positive effect on mens’ but not women’s
behaviour (Kyes)
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Meta-analysis by Scott-Sheldon and Johnson (2006) examining the effectiveness of
sexual risk-reduction interventions that integrated a safer sex eroticization
– the 21 studies – randomised control trials or had a quasi-experimental design with
a control group
– 19 studies in North America, 1 in New Zealand and 1 Brazil, at universities and
schools, and participants were mostly Caucasian men in their early twenties – 20%
MSM
– a visual erotic component, such as a video, erotic poster or brochure (61%); an
activity, such as creating erotic ways to use condoms or have safer sex or writing a
sexual fantasy (43%); and reading erotic short stories (20%)
• more risk-preventive attitudes, less risky sexual behaviour and an increase in
condom use
• participants did not have more sex overall
• Decrease in numbers of sexual partners
• Increases likelihood that people want to participate
– However not many studies separate out the erotic component from the overall
intervention so the degree of added impact not clear
– Most studies were white US students in low HIV prevalence settings
Psychology, confidence and sexual
decision making
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Many studies have found a link between sexual self-efficacy –and the practice of
safer sexual behaviours
feeling comfortable with and in control of one’s sexuality – and in some cases, feeling
that one is entitled to experience sexual pleasure – can be a key determinant of safer
sex practice.
Boyce et al (2007) state that “HIV prevention is failing, in large part, because of
inadequate approaches to sexuality, premised on rational models of sexual conduct.”
Studies show that there are sometimes high reinforcement values of risky behaviour
– peer pressure or relationship strengthening – which should be addressed in order
to reinforce safer behaviour ( Parsons, et al 2000 Kelly and Kalichman, 1998)
Evidence shows that people make decisions about sex based on the benefits or
perceived benefits of certain sexual practices which provides a basis for interventions
that incorporate desire, pleasure and other perceived benefits of sex
Disciplines such as psychology, anthropology, sexology, communications, sociology
have tended to focus more on positive elements of sexual decision making and
therefore have much to add to public health
Pleasure, safer sex and sexual skill
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Widespread assumption is that sex is something natural and automatic, especially
for men yet evidence shows that safer sex becomes more comfortable and
pleasurable with practice and through learning skills for of eroticization
In Bangladesh Khan (2004) found evidence that, behind the explanation that
‘condoms reduce pleasure’, is a fear of incompetence and lack of skill when using
condoms
One study found that safer sex behaviours were more pleasurable six months after
an intervention than immediately after the intervention (Kelly, St. Lawrence and
Brasfield 1989
Female sex workers in some countries can charge men more money than they do
when having sex without a condom by promoting the female condom as a new sex
toy and allowing clients to insert the female condom into the woman’s vagina as a
pleasurable and intimate act, thereby breaking a major taboo (Philpott, Knerr and
Boyden 2006; Hapugalle 2002)
must also get creative about other modes for delivering information about safer
sex skills – such as through pornography and romance, and by looking to the
‘experts’ who already know how to eroticize safer sex
A Way forward
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Condom promotion needs to move from the discourse of AIDS to a discourse of
pleasure, sexual skill and eroticism in order to harness the positive motivators for
behaviour change
Public Health can gain much about changing behaviour through use of positive
motivators from different disciplines
We found a whole wealth of material that demonstrates the link between
eroticizing safer sex, intention and actual practicing safer sex.
But we would welcome replication of them in contexts of high HIV transmission
risk more research needed in Africa and Asia and high vulnerability/risk groups
The causal links of eroticisation could be tested
More sensitive research needed to inform the settings and groups of people that
would respond most positively to different types erotic safer sex messages i.e. do
evidence shows that women respond less well to erotic films in the US - pleasure
is personal, gendered, contextual and culturally sensitive
Most effective erotic sex education starts by discovering what that group finds
sexy
Assumptions of “rational behaviour” in public health world could benefit from the
sophisticated understandings of self efficacy, reinforcement and context in other
disciplines
Do new products offer potential for introduction as erotic tools ? – microbicides &
circumcision
Microbicides and pleasure
Lube and condoms for slippery and safe sex –
PSI – promotion of lube condoms for enhanced pleasure (in
global mapping)
Recent findings in MDP trial and others
Montgomery and others
Abstract at Delhi MCB conference
“Acceptability studies have shown microbicides are rarely perceived to detract
from sexual pleasure, and in some cases participants stated they enhanced
sexual pleasure. Current trials …could more pro-actively focus on
participants’ views on the product’s effects on their experience of sexual
enjoyment ……especially regarding sexual
pleasure. Post-licensing studies
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could plan to evaluate approaches to microbicide promotion that include
the enhancement of pleasure. “
Why promote sexual health and safer sex through pleasure?
• People have sex for many reasons, but sexual pleasure remains a
• highly significant, if not primary, motivating factor for sexual behaviour
• Since HIV is spread mainly through sexual transmission efforts to prevent
HIV need to consider the role that sexual pleasure and desire play in
sexual behaviour
• Safer sex promotion campaigns and research have been and continue to
be overwhelmingly negative, focusing on fear, risk, disease and the
negative outcomes of sex.
“Rail against it, repress it, and moralize it ad
infinitum; nevertheless, sex will find a way.”
– Abramson and Pinkerton (2002)
www.thepleasureproject.org