The Myth of Consensual Sex

If you want to kill a conversation on a first date -- or a second, or forty-second -- mention non-consensual sex.

It's come up for me recently in explaining why I decided to go on pre-exposure prophylaxis, commonly known as PrEP, which is a daily regimen of Truvada proven highly effective against HIV transmission.

The troublesome labeling of PrEP users as "Truvada whores" has been well-documented. And while I don't really care if I'm called a whore for taking care of myself, I do feel the need to tell people why I take it. It's not that I regularly choose to have condomless sex and need alternative protection. It's that I know I might not always get a say in whether or not I have sex, much less if a condom is used.

When I offer that reasoning, I'm met with silence. And usually not a next date.

The Oscars taking on sexual assault earlier this week is notable because our society is generally petrified of discussing the topic of sex and consent. Most people are happy to throw the word "rape" around in the context of a joke or insult, but mention the subject seriously and they go running. Instead we image a world in which 99.99 percent of sex happens with full and free consent, in which a handful of "bad actors" are the ones committing rape, and in which all but a pathetic few are exempted from pain.

I have been sexually engaged without full and free consent a few times in my life, and on two occasions, a condom was not used. The first time, as a recently-out person who knew nothing about HIV, I resigned myself to death if I had had the misfortune of sero-converting after the encounter. The second time, many years later and much better educated, I took things in stride but still had to endure a complicated and humiliating process of acquiring "morning after" treatment for my potential exposure (a treatment known as Post-Exposure Prophylaxis, or PEP). That was a situation I never wanted to be in again, so I began PrEP soon thereafter.

Millions of people experience this type of abuse each year, including shocking numbers here in the U.S. and many more worldwide who lack the healthcare access from which I benefited. Yet it is not something we talk about or have in our minds when we discuss public health. In a recent discussion on HIV prevention at the Harvard School of Public Health, I was surprised to hear some classmates opine that most of the world's population has meaningful choice in every sexual encounter they have -- has a real ability to abstain from sex indefinitely if they want to play it safe -- has an ability to ensure their partner is "faithful" -- has the final say on whether a condom will be used each and every time.

It is absurd to think that most women and sexual minorities live in a world in which they exercise full control over their bodies. Indeed, even those of us fortunate enough to experience such agency most of the time face moments of powerlessness and abuse. By willfully ignoring reality, we allow this culture of violence to persist.

When I speak of a "myth of consensual sex," I do not mean that the concept of consensual sex is itself a thing of fiction. I mean that we as a people collectively ignore non-consensual sex and the influence of coercion in sexual relationships. Indeed, even when one experiences it for oneself, it can be difficult to accept the truth because we are raised in denial. That makes it impossible to get help and to make the best choices about our health and safety.

So when the topic of PrEP comes up, I make a point of mentioning that -- among all forms of HIV prevention -- it offers protection even when one does not have a say as to whether a condom is used. It has the radical potential to enable people all over the world to protect themselves from exposure when they otherwise would lack the power to do so.

Perhaps if we acknowledge the role that PrEP could play in protecting people when they lack the power to say "no," we could begin the much larger task of breaking down the social structures that allow power inequities in sexual relations to persist. There is no vaccine or magic pill coming to cure the world of this disease; it is a condition from which we as a people must save ourselves.