Americans have long been told that sex without a condom is "unprotected sex," which leaves you at risk for HIV and a multitude of other sexually transmitted diseases. Now, after pressure from health community advocates, the Center for Disease Control is changing its language and replacing "unprotected sex" with "condomless sex" to reflect the many ways people are sleeping together while minimizing their risks, sans condoms. After all, would you describe two people in a monogamous, long-term relationship who've tested negative for STDs as engaging in "unprotected sex?"
Condoms obviously still play an important role, but there are other ways individuals can protect themselves as well. Many HIV experts, for example, talk about treatment as prevention. Individuals who are on antiretroviral therapy (ART), which suppresses the replication of HIV, often have an undetectable viral load (a measure of the number of copies of HIV in a given blood sample). Though it is possible to transmit HIV even when one’s viral load is very low, it is much less likely.
Much of the conversation is pegged to Truvada, a daily pill, is part of another prevention method called PrEP (shorthand for pre-exposure prophylactics), RH Reality Check reports, which reduces the likelihood of HIV infection if taken routinely and as part of a doctor-supervised regimen, especially among gay or bi men. Technically that counts as some kind of protection, no?
Still, not everyone agrees with this regimen of protection — there are undeniable socioeconomic limitations that may inhibit access to Truvada or the PrEP by those who could benefit from it, young black and Latino men who have sex with men. For example, if they take Truvada but aren’t monitored by a general practitioner because they don't have complete access to healthcare — a situation that overwhelming effects people of color — then the PrEP program might not be as effective.
And then there's serosorting, the practice of identifying partners with a similar HIV or AIDS status to engage in sexual activity — like Ron Woodroof, Matthew McConaughey’s character in Dallas Buyers Club who was HIV positive, has sex with a woman who was also HIV positive. The term seropositioning, meanwhile, identifies folks having condomless anal sex in positions that reflect who is or isn't infected; in this case, the HIV-positive partner is the receptive party during intercourse instead of the insertive party. While this might seem like a logical option if everyone is completely upfront about their status, the CDC isn’t so into serosorting or seropositioning as a "safe sex" option. The CDC says that many gay men don’t know their recent status, might be wrong about their partner’s status and, more plainly, people lie about their HIV status all the time.
Elsewhere, there are others who disagree with the shift from "unprotected" to "condomless" because they think people will discard condoms, opening themselves up to other diseases like chlamydia, gonorrhea, syphilis and more.
Ultimately, this language change to implement "condomless sex" and the varied reaction to it by the health community is a battle between blanket statements and the more complicated, specific realities of "protected" sex. We'll see how this plays out, but for now it looks like the health community is holding us all responsible for our own well-being — but how we choose to achieve that is up to us.
Image via Getty.