How Can Psychoanalysis Help Safe-Sex Education?

In recent years it has become disturbingly apparent that safe-sex education programs need all the help they can get, simply because they aren't working effectively. After an initial decline in transmission rates during the eighties, the rate of infection has been climbing steadily in the very population group—urban gay men—that pioneered safe-sex education in the first place.1 With the advent of protease inhibitors (a class of new drugs that block an enzyme crucial to viral replication), AIDS may have become—for those lucky few who can afford and tolerate the drugs—a chronic rather than terminal condition, a manageable disease rather than a death sentence. And so as the interval lengthens between HIV infection and the likely onset of illness, gay men's principal deterrent for unprotected sex recedes, with potentially catastrophic implications. In this era of accelerating AIDS science and the resurgence of unsafe sexual practices, I'd like to explain how thinking psychoanalytically about the epidemic can help us grasp both the necessity for maintaining safe sex and some new strategies for doing so.

While it is notoriously difficult to generate accurate statistics about the rate of unsafe sex among gay men, the percentage one third has been repeated as axiomatic since the early 1990s—“one third of gay men are having buttsex without condoms” (Savage 11).2 What makes such estimates so striking is that even those who “know the facts” about HIV transmission continue to become infected with the virus that causes AIDS. Much of the evidence of escalating unsafe sex has been anecdotal, circulating privately, but also publicly in the form of third-person and, more remarkably, first-person accounts in the mainstream—as well as gay—media. When, in 1994, leading gay journalist Michelangelo Signorile and then, in 1995, prominent queer theorist Michael Warner both wrote about their own recent unsafe sexual encounters, these revelations highlighted the extent to which safe-sex educat