Bill Weintraub

Negative Counseling and Unsafe Sex -- or, why David McQuarrie was right

6-25-2004

Negative Counseling Warning of STD Risk Increases Safer Sex

[Reuters]

In motivating HIV-infected patients to reduce risky sexual behaviors, brief counseling about the negative consequences of "unsafe" sex is more effective than discussing the positive outcomes of "safer" sex, according to a new study.

The findings, which appear in the medical journal AIDS, are based on a study of 585 sexually active subjects who attended clinics emphasizing either of these risk reduction approaches or to clinics that only stressed the importance of taking anti-HIV drugs.

The counseling sessions, which lasted 3 to 5 minutes, either emphasized engaging in "safer" sex or avoiding "unsafe" sex. With the positive consequence approach, the subjects were told "safer sex protects you from other STDs and from other strains of HIV." By comparison, subjects in the negative consequence group were told "unsafe sex may expose you to other STDs and other strains of HIV."

Among subjects with at least two sex partners, the negative consequence approach reduced the rate of self-reported "unsafe" sex by 38 percent. In contrast, the positive consequence approach produced no change in sex practices.

Compared with the drug emphasis group, the negative consequence group was 58 percent less likely to report "unprotected" intercourse at follow-up, lead author Dr. Jean L. Richardson, from the University of Southern California at Los Angeles, and colleagues report. The negative consequence approach had no effect on subjects with only one partner or one main partner at the start of the study.

"Additional research is needed to find ways to counsel those with one partner and, among those who are not currently sexually active, to maintain abstinence or safer sexual behavior in the future," the authors conclude.

[AIDS, 5/21/04; Reuters Health, 6/15/04]

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Bill Weintraub:

Why is this story significant?

Because for years the AIDS Service Organizations (ASOs) and "safer-sex" educators have maintained that fear is not a useful motivator, that gay men and people in general tune out negatives, and that "AIDS Kills" is therefore not an acceptable message.

For that reason, the international AIDS community was particularly dismissive of Uganda's prevention programs, which used posters like this one:

Yet, Uganda, using this approach and others, such as encouraging wives to leave husbands who were unfaithful, has reduced HIV prevalence for 12 consecutive years.

Something the US, with the mightiest collection of ASOs and AIDS experts on the planet, has not succeeded in doing.

There are actually more people in America "living with HIV" now than there were in 1995, when my lover died.

Further, we know from our own experience of the world that people do all sorts of things out of fear of a fatal or very negative consequence:

They don't eat potentially poisonous food, they don't run red lights, they don't murder -- out of fear of the consequences.

Which is why many "men who have sex with men" have, since the advent of AIDS, changed the way they have sex.

Not because a "safer-sex educator" told them to, but because they didn't want to die.

Fear then is a motivator, and it's reasonable to talk of "negative consequences" when those consequences are real -- as they are with HIV and other anally-vectored STIs.

About two years ago -- which is about a year before the data from Uganda appeared -- Warrior and Frotonian Brother David McQuarrie startled me by going around the web and posting the message: Anal Sex: IT KILLS!

At first, good student of the ASOs that I'd been, I thought he was being too extreme.

Then I realized he was right, and that his message is right on target.

As is this one:

Bill Weintraub

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