Public health officials recommended early in the AIDS epidemic that HIV-prevention education be targeted and explicit, using language and images familiar to those it is intended to reach. Controversy has swirled ever since over what, exactly, is meant by "explicit" prevention education and who should pay for it.
Prevention educators recognized early on the potential of sexually explicit media (also known as porn) to provide instruction in the mechanics of safe sex and, they hoped, increase the use of condoms and practice of safe sex among gay and bisexual men.
In the late 1980s, Boston's AIDS Action Committee attempted to produce a safe sex film featuring porn star Al Parker. Cindy Patton, who today teaches sociology at Simon Fraser University, in Vancouver, worked on the project. Writing about it in her 1996 book Fatal Advice: How Safe Sex Education Went Wrong, Patton explained that the video wasn't intended to "eroticize" safe sex, but rather "to retrieve already and always safe activities" gay men might do together that seemed to have been lost in the shuffle as everyone focused singlemindedly on eliminating unprotected anal sex.
"Porn videos," wrote Patton, "are useful if they suggest positive attitudes about gay male sexuality because that helps create and sustain a social environment in which safe sex is practiced because it is viewed as a positive aspect of gay male sexuality." The group at AIDS Action Committee reasoned that gay men would practice safe sex if they were persuaded to view it as something positive rather than as a kind of punishment for being gay -- as many men seemed to see it.
Although the Centers for Disease Control and Prevention estimates that "men who have sex with men" (MSM) comprise only 2 percent of the American population, we consume as much as 50 percent of the porn produced and sold in this country, annually spending as much as $6.5 billion on it.
University of Minnesota psychologist and sexual health researcher B.R. Simon Rosser and his colleagues note in a January 2012 article in AIDS Behavior that pornography is a major source of sexual information on the "mechanics" of sex, especially anal intercourse. Although it appears to negatively affect some young men's body image -- all those sculpted bodies on the screen can be intimidating as well as stimulating -- porn also seems to play a role in setting behavioral expectations.
For this reason, the researchers recommend that prevention educators consider harnessing the instructional and expectation-setting effects of sexually explicit media "to re-engage, and re-energize MSM in HIV prevention."
Since sex itself is complex, it's not surprising that the reasons men watch porn -- and fast-forward to what for them are the "good" scenes -- are equally complex. In an interview, B.R. Simon Rosser told me that 40 percent of the gay or bi men in his research prefer to watch "bareback" (condomless) sex; 41 percent have no preference; and 17 percent prefer safe-sex porn. "It's a mistake to assume the people who prefer bareback porn are engaging in bareback behavior," he said.
"We've had guys say they prefer bareback porn for good reasons," Rosser told me. "One guy said, 'I'm HIV-positive and the reality is that becoming poz has robbed me of so much. What I love about bareback porn is that I can enjoy it without thinking about HIV.' We have other guys who say, 'I really love bareback porn because there's a piece of having unsafe sex that is really exciting to me. And by doing it in fantasy I don't have to do it in my behavior.'" Rosser added, "Clearly this suggests that if they didn't have this outlet they might go out and do it."
A subject not often discussed is that, although porn movie actors may be skilled at creating sexual fantasies for their viewers, they are still real men at real risk for HIV and other sexually transmitted infections -- just like anyone who engages in unprotected intercourse outside a monogamous relationship between uninfected partners.
At least one industry leader continues to speak against bareback videos and refuses to make them. "After all the gay community has been through, why are we putting people at risk for porn?" asks producer Chi Chi LaRue in a public service announcement on her website safesexishotsex.com.
"You choose what fantasy you want to live and what fantasy you want to watch," says LaRue. "Just remember you are also choosing the reality of thousands of models that work in this industry every year and impacting the gay community for years to come."