Avoid death and destruction! STI prevention can be so grim. But it doesn’t have to be. Talking about STIs doesn’t need to fill people with dread. Bringing prevention information out of the dark ages is part of the Sex Talk interview with sexual health activists Damon L. Jacobs and Rodney McCoy, Jr. They illustrate the need to allow the idea of fun and pleasure into the conversation.
DAMON JACOBS: We’ve been asked to interview each other on the topic of pleasure and fun in sexual health. I got stuck on fun, not because I don’t like it, but let’s be honest. The words sex and pleasure until recently weren’t applied to HIV prevention.
RODNEY MCCOY, JR.: I have been working or volunteering in this field, on one level or another, since 1991. And I don’t think the topic of fun has been integrated into that until relatively recently—I’d say the last 10 years. Fun for me is just a general sense of something that brings me a sense of being alive.
So that can be sexual pleasure. Or it can be playing board games. It can be exercise. It can be whatever gives somebody a sense of feeling alive in their body. Something you just do because you enjoy doing it.
I started in HIV prevention when I was 18, at Oberlin College. The sexual information center had a need for educators in the dorms. And there was this thing called HIV. Well, at the time, it was GRID [gay-related immunodeficiency]. People were trying to figure out what exactly it was. And I think because of the seriousness of AIDS, because people were dying, and people who look like me, and then returning to New York, where there was ACT UP—there was all this anger and rage because you had governments at the federal and at the local level that not only did not know what to do, but were not invested in doing anything. We’re willing to let people die and families be torn apart because of their own sense of morality. Let’s call it what it was. So the idea of fun really did not enter into our head, certainly not mine. It was all very serious business.
I would say that in the past maybe four years now, we’re talking about sex and pleasure as important, integral parts of HIV prevention. I looked up fun for this talk and found something that brings joy, something that brings pleasure, something that brings delight. And I’ve been thinking, how is that necessary for HIV prevention?
When a person comes for services, they may be dealing with a whole lot of life stuff. It could be stigma, it could be racism, homophobia, sexism, misogyny, assault, homelessness—all those things. If the care encounter, the testing, the diagnosis, the treatment really doesn’t take care of the person, if it reinforces feeling bad, how can I support you in feeling good?
I often think that because of the work you do as a therapist, that it would be easier for you to help your clients start thinking about the sex that they want to have.
DAMON: Yeah, it’s this idea that fun is important. Fun is a relevant, meaningful part of life. It’s not ancillary to all the services that you were talking about. Meanwhile, we’ve got other stuff to attend to here, because we have boxes to check and we have grant writers and we have testing to do and pills for you to take, and we leave out the fun. Organizations are like, Well, that’s secondary. For me, mental health and sexual health are one and the same. They’re highly correlated. And when we help people find the mechanisms by which they can effectively seek out that fun, to say yes to their yes and no to their no and maybe to their maybe, then we get to participate in the process of someone experiencing extended amounts of fun, extended amounts of pleasure and consequently, extended amounts of good mental health.
ROD: POSITIVELY AWARE asked us to also integrate kink into this. Kink is anything that gives pleasure, that causes sexual and erotic arousal, to the point of orgasm or not, that is outside of the missionary sex position. I think that there is a stigma around kink, and one of the things I like doing with my kink workshops, whether it’s the Beyond the Red Ribbon training or a play workshop specific for the kink and leather communities, is break down that stigma. For those of you who are uncomfortable around kink, let’s have an honest, grown folk conversation. Are we all grown folks in the room? And people are quick to say, Yeah, we’re grown. Okay, so let’s go there. If we have sex, do you like getting your ass spanked, or do you like slapping some ass while you’re having sex? Do you like having your hair pulled? Do you like having your nipples teased? Do you like dirty talk? Do you like someone holding you down where you can’t move, or restraining a part of your body, if not your full body, while you’re having sex? And you can see the eyes light up. You can see the lightness and the understanding going across people’s faces. I’ll say, Congratulations. You just crossed into the realm of kink. I tell my colleagues, why wouldn't you want to bring that light to the testing room?
Looking back in the almost 40 years I’ve been in this, HIV prevention has been so serious, so doom and gloom, because there was a lot around HIV we didn’t understand. So our default when we don’t understand something is to be afraid of it.
Fun for me is just a general sense of something that brings me a sense of being alive.
When we understand it, that helps us relax. It empowers us to take control, to take ownership. I prefer the word ownership: to take ownership of our sexuality, of our sexual health. When I demystify kink, when I demystify sex and talking about it, we see that it doesn’t have to be accompanied by giggles. It becomes something that yes, as grown folks, this is what we can and need to be okay with talking about. Okay, so how can we keep you being sexually active and reduce your worry around HIV or gonorrhea or chlamydia or whatever you’re in this space for. People are more willing to have those conversations.
I did a presentation at a high school in Virginia, and one brilliant young man brought up stigma, and he asked, Do you think people see HIV as a scary monster, so that they don’t want to talk about it or make jokes about it, so it seems less scary? And that made me stop and think. That’s what stigma is. This young man, at 15, understood stigma, that that’s how it works. That people have these defenses against it because it’s so scary.
That’s why for me, in talking about kink and about sex, we really empower people. We don’t scare them away from prevention, but we help move them toward it. To say, I can take control. I can take ownership of my own body, of my own sexual desires, of my own health.
DAMON: When you walk into an HIV testing site and you’re sitting there, that tester can have a lot of power. Emotionally, that person has the power to shame and condemn.
I want you to tell more about your story, not just your thoughts.
ROD: I know what led you to your PrEP work, and why you are so passionate for PrEP, and I would like for you to share that first.
DAMON: I have always wanted to be a therapist. I’ve always wanted to be a healer. And I was coming of age at a time when HIV and AIDS in the Bay Area of California was ravaging the community. My training academically was clinical, meaning you kind of sit in your office. Patients come in and they tell you about their past, and then you try to help them feel better. But that wasn’t reflecting the reality of the times that we were living in. It wasn’t about the past. It was the immediate here and now, grief and trauma that was happening that was devastating our community, physically and spiritually and emotionally. For me, it meant that if I was going to be serious as a healer in the ’90s, it’s not about just sitting on your ass in a clinic all day. It means being active, doing something, anything, to fight HIV and AIDS. So I was getting involved in volunteering in HIV prevention and talking about condoms and harm reduction. When I learned about PrEP in 2010, it was a time when my primary relationship was coming to an end, and I was turning 40 and really thinking about HIV as an inevitability for me, meaning that we weren’t going to see a vaccine or a cure anytime in the near future. I’m like, How much of my life has to be consumed by fear of HIV? I’m so sick of this. I’m so tired of all of my sexual fun being dominated by the fear of what might happen, I might as well get it over with. I’m probably not going to die of HIV at this point [if I acquire it]. So my mind was registering that HIV was a when, not an if.
Then I learned about PrEP, and this new science, and this new study called iPrEX, showing that if you take Truvada—at the time, they were saying every day—that you would have 99% protection from HIV. And I thought, Oh, so I could take a pill and then have the kind of sex I want to have, and I don’t have to worry about condoms, and I don’t have to get HIV. And suddenly it was like, Yeah, this is for me. So I started using PrEP July 19, 2011.
And then, because I wasn’t feeling empowered to talk about that openly, but I talked to a person who talked to a person who talked to a person, eventually that led to an opportunity to go on Huffington Post Live to talk about this with Alicia Melendez, who is now on MSNBC. And I thought, Okay, God doesn’t make mistakes. If I’m being given an opportunity to do this in such a public way, that means that I’m meant to have it. It also means I’ve got to ditch this whole traditional model of ‘professional self here, slutty self there.’ It’s time to integrate that, because if I don’t, if I don’t talk openly and honestly about PrEP and the celebration of sex, I’m going to be shortchanging this opportunity to help other people learn about it.
I felt like my impact in the HIV prevention community took on a different level, making space for other people to be able to be transparent and think about PrEP and sex as something that is jubilant, that we celebrate, not cower away from in shame. We really start to take back the power and the energy and the fun around that, and how different it feels when we do that together.
ROD: I’m feeling a lot right now, because I think there is a parallel intersection in our stories. The pivotal time for me was when I was first diagnosed, and
I remember feeling a lot of shame about having HIV.
DAMON: Can we talk about that?
ROD: Yeah, so I was diagnosed January 29, 2002. At that point, I had been in HIV prevention for 16 years. I was in a relationship with someone. We were monogamous. I had been tested a few months prior. He said that he had been tested, so we made the decision to not use condoms. So when I did find out I was HIV-positive, there was a lot of shock. There was a lot of anger. There was also a lot of shame. A good part of that shame was, here I am in HIV prevention, telling other people what to do.
I went to my bishop at the time, Bishop Zachary Glenn Jones—I’m going to give him his props—and saying this is what happened. Among the things he said was, If you decide to stay in this field, what do we need to do to make sure the messages of prevention click? And sitting with that, the first thing that kept coming to me was, Tell the truth. Yes, sometimes I used condoms, even as I told other people to use condoms all the time. And if someone had the nerve, the audacity, to even suggest that they didn’t like condoms, I was like, No, you’ve got to use them every single time. I was so hip to toeing the party line, saying the message that was expected of me, I did not allow space for anyone else, including myself, to tell the truth. I didn’t always like using condoms my own self, especially when I was topping. And when I was dating monogamously, I was like, Okay, I don’t need to use condoms, or just, I trust you.
DAMON: Why weren’t you honest?
ROD: Because I worked in an industry that was not. That’s why PrEP was such a game changer, because it finally felt safe and necessary to tell the truth. And dare to finally say, I don’t like using condoms; here’s an alternative. By the time PrEP came out in 2012, to be honest with you, as happy as I was, I also resented it because I already had HIV. It was not an option given to me. I was already 10 years into HIV living with me.
That’s why, for me, doxy-PEP is another game changer. [SEE “Briefly.”] It means a lot to me because I’m going back to the resentment I felt around PrEP. So I do get emotional sometimes when I think about it, that I could now be part of the conversation around something other than condoms that would protect me as someone who is HIV-positive. Doxy-PEP is one of the few things in this industry that is truly status neutral [a healthcare standard referring to care for people both living with HIV or HIV-negative]. By the way, I don’t believe in status neutral. I do believe in status inclusive.
Also, doxy-PEP takes away probably one of the biggest barriers from providers who are against PrEP. Well, PrEP doesn’t protect against STIs. Well, bitch, now here’s something that does, that you can use in conjunction with PrEP.
You know this, that [care providers are] still resistant to doxy-PEP, and it really is a sexual pleasure resistance. Because when people say to me, Oh, well, we don’t know how much doxy-PEP is going to hurt people who take it in this way, I’m like, Don’t play me for a fool. We use doxycycline to treat syphilis. We use doxycycline to treat acne. We use doxycycline in larger doses for longer periods of time to treat other conditions with not a bat of an eye. But the moment we talk about using doxycycline to treat and prevent STIs so that people can enjoy sex the way that they want to, and reduce their worry around STIs, particularly bacterial infections, now there’s an issue? Don’t blow smoke up my ass and tell me that’s the problem. No, this is still about sex negativity, particularly homo sex negativity, because that’s the context in which we talk about doxycycline.
I love talking to women, trans folks and straight men about doxy-PEP. People are like, What? Oh, I’m interested. Can I learn some more? PrEP is only for people who are HIV-negative and treatment as prevention [also known as U = U] is for people like myself who are HIV-positive and who by staying on our medications can be undetectable and therefore not pass on HIV and can still enjoy the sex that we like. Anyone can use doxy-PEP.
I’m so excited for it, even as I see some of the trends that we saw 12 years ago in terms of the rhetoric against PrEP. We didn’t learn our lesson, but that’s why you’ve got old heads like me and like you to say, Oh, didn’t we have similar conversations about PrEP 12 years ago, and whatever happened to the mass drug resistance that we were so concerned about around PrEP? The superbug? Gurl, where’s the superbug? What happened?
DAMON: Growing up in the 70s, not even understanding what sex was about, I would see the hairy chests of guys on TV and knew I wanted to do something with them. I didn’t know what, but I also knew I couldn’t—that I shouldn’t. There was something wrong with that, something bad. Then I was about 10 years old when the AIDS crisis started being reported. So I was coming of age and starting to understand my desires for men in a time when I knew that if you were to do something about that, you could die. Everything in my mind has been embedded to associate sex with fear, to associate pleasure with fear. The thing that began to shift that for me was PrEP.
However, just because I started using PrEP didn’t mean the fear went away. There was still the fear of, What if? Because it was a habit. What about gonorrhea? What about syphilis? What about all these things that everyone was telling me I should be afraid of? And then when doxy-PEP came around, it was like I can be proactive, responsible and empowered about my pleasure and protection in this way. And what a liberating experience this continues to unfold for me in my 50s, to say I don’t have to associate sex and pleasure with something traumatic or devastating or deadly.
ROD: There are cultural things that we need to keep in mind. As African Americans, we have a different history where our sexuality was actually abused and used against us. Rape, forced labor, separation of families, a basement where wives were raped in front of their husbands, just to name a few. That has had an impact on how we as African Americans talk about sex, definitely in terms of how we talk about kink.
So by virtue of the fact that we’re male or gay, or by the color of our skin, we may not be the one to talk to. We as an industry have to be okay with that, to say different people may have different needs and may have different languages and different experiences. I’m not always so quick to talk with women, for example, about sex and sexuality, or at least I’m careful.
There is a truth that if you keep doing the same thing over and over again, but expecting different results, it is insanity. As an industry, we have been talking about risk and death and disease as motivators for people to make behavior change. Honey, it doesn’t work. Talking about sex and pleasure is our opportunity to stop being insane and to do something different.
This is too much of an issue for us to hide behind cultural fears of we can’t talk about that. We can talk about that, and we need to.
DAMON: CDC data tell us that more than 50% of new HIV diagnoses are coming from nine states in the South. Do you think that this message of pleasure and fun and kink and celebration—does that translate to the communities that are most impacted by HIV today?
ROD: Yes. The South has traditionally been a more conservative part of the country. That doesn’t mean that people don’t want to talk about sex. It doesn’t mean that people don’t want to talk about fun. It doesn’t mean that people don’t want HIV prevention. Now, there may be a generation of folks who still feel it’s wrong, bad or not necessary. But I think that’s changing. So once upon a time, it would have been Oh, hell no. I think right now it’s, Oh, hell yeah. The numbers don’t lie.
Damon L. Jacobs is a family therapist and founder of the PrEPFacts Facebook page. He is the author of Absolutely Should-Less: The Secret to Living the Stress-Free Life You Deserve.
Rodney (Rod) McCoy, Jr. is a research assistant at Us Helping Us in Washington, D.C. He created a sex positivity training for public health professionals called Beyond the Red Ribbon in collaboration with Louis Shackelford of the HIV Vaccine Trials Network.