Dr. Dick on Demand: Human Rights, Sexual Rights and World AIDS Day

Last year the research community was all aflutter about ‘conclusive’ evidence linking HIV transmission and uncircumcised males. While I’m certainly not ready to take this data on face value, let’s just say, for the sake of discussion, that the link is conclusive. A massive campaign of circumcision was proposed as the best means of HIV prevention. The medical community would descend on epicenters of the disease, scalpels in hand, ready to eliminate the offending foreskins from every male in sight, young or old.

But wait, there’s a problem. Most HIV/AIDS epicenters are in underdeveloped countries. In these places, access to enough clean water to attend to even the most basic personal hygiene, like daily cleaning under one’s foreskin, remains an enormous chronic crisis. Without first addressing the problem of unfettered access to clean water and adequate sanitation, which according to The United Nations is a basic human right, further disease prevention efforts are doomed.

I mean, what are the chances that surgical intervention would succeed—one that would involve significant and sophisticated aftercare; especially if there’s not even enough clean water for bathing?

These well-meaning medical personnel suggest imposing a strategy that not only works against nature—our foreskins do have a purpose after all: a healthy prepuce is a natural deterrent to infection. But this intervention would also violate long-held cultural and societal norms—circumcision is abhorrent to many of these same cultures. Wouldn’t this proposed prevention effort to stem the tide actually make matters worse?

Other epicenters of the global HIV/AIDS pandemic are associated with indentured sex work. Until the economic and educational opportunities for women throughout the world improve—which is a basic human right according to The United Nations—women will remain chattel. Families in economically depressed areas of the world will continue to be pressured to sell their daughters (and sons) simply to subsist.

Closing brothels and stigmatizing prostitutes as a means of disease prevention overlooks the more pressing human rights concerns at play here. Sex is a commodity because there is a voracious market. Men from developed nations descend on the populations of less developed nations to satisfy sexual proclivities with partners they are prohibited from enjoying in their own country. Young women (and boys) in developing countries are viewed as exploitable and disposable, because they don’t have the same civil protections afforded their peers in the developed world. And runaway population growth in countries that deprive their women and girls access to education and contraception inevitably creates a never-ending supply of hapless replacements.

Addressing the endemic gender inequality in many societies is key. Equal access to education and economic resources must come before, or at least hand in hand with any serious sexually transmitted infection prevention effort.

Finally, people in the developed world enjoy a certain level of affluence and economic stability which allows them to indulge in sex recreationally. Thanks to effective birth control methods we can ignore the procreative aspects of sex and replace it with a means of expressing a myriad of other human needs. Not least among these are status, self-esteem and self-expression.

If we’re trying to prove something to ourselves, or others, by the way we conduct our sexual lives, simple prohibitions against certain sex practices won’t work. If I’m convinced that unprotected sex with multiple partners and sharing bodily fluids is edgy, cool fun, without serious consequence, as it’s portrayed in the media (porn); I will be more likely to express myself the same way. This is especially true for young people who are already feeling invincible.

Case in point: there has been a startling uptick in seroconversions among young people, particularly gay men, which indicates that disease prevention efforts, even in the world’s most affluent societies, are simply not up to the task. It’s not that there is a scarcity of resources, quite the contrary. It is more likely that these efforts are not connected to a fundamental understanding of the role sexuality plays in the gay community (and increasingly among non-gay people). I believe that sexual expression and sexual pleasure are the overarching issues here. These too are fundamental human rights.

Bareback (condomless) porn went from being a pariah genre on the periphery of the gay porn industry just a few years ago, to the hottest, most prolific and biggest moneymaking genre today. It’s no accident or coincidence that this surprising reversal coincided with this the increase of HIV/AIDS infections in certain populations. I hear from people all the time, from those inside as well as outside the porn industry, who tell me that it’s their prerogative to engage in unprotected sex. “I have the right to express myself that way,” I am often told. “If one has the bad luck to seroconvert, it’s just that, bad luck. After all, HIV is now a manageable chronic condition, not unlike diabetes,” or so the reasoning goes. So I should just get over it and mind my own business.

No amount of safer sex proselytizing is going to overcome this kind of resistance. I propose we need to look at why and how we express ourselves sexually. As we unravel this complex jumble of motivations and behaviors, effective prevention strategies will manifest themselves clearly. We must develop a sex-positive message; one that celebrates sexuality, builds self-esteem and counteracts the prevailing media messages of sex with no consequences.

World AIDS Day brings into focus the micro-strategies needed to combat a macro problem. But it also shows that we cannot fight this, or any disease, in a vacuum. It’s imperative that we see how global health and wellbeing is completely dependent on basic human rights, including sexual rights that include gender and reproductive rights, the elimination of sexual exploitation and the freedom of sexual expression.

Human rights that include sexual rights encompass the goals of World AIDS Day—increasing awareness, fighting prejudice and improving education. But applying these principles must cover the full spectrum of human sexuality, gender equality, reproductive health and, dare we say it, pleasure. To repeat the General Assembly declaration; Respect for human rights and human dignity "is the foundation of freedom, justice and peace in the world.”