Alex Garner: ‘We need to look beyond HIV’

23 January 2019

We need to appreciate gay men’s right to pleasure and to decide what to do with their own bodies, says Hornet’s Alex Garner

Alex Garner being interviewed

We caught up with Alex Garner, Senior Health Innovation Strategist at Hornet, to chat about sex, condoms and the conversations we’re not having when it comes to gay men’s sexual health. He believes if we want to improve HIV prevention we need to expand our conversations about sexuality and appreciate that everyone has the right to decide what to do with their own bodies.

According to Garner we have become stuck, framing gay sex solely in terms of disease prevention, overlooking the importance of pleasure and intimacy.

He argues that we need to move away from the condom-centred notion of prevention and really challenge ourselves to expand our conversation about sexuality – so it’s not just about sexual health and prevention, but it really becomes a question of ‘Do you enjoy the sex that you are having?’, ‘Do you have questions about how to make it better?’

If we are to do this, public health and HIV prevention need to change. “It’s about giving gay men as much information as possible so that they can make their own decisions about their sexuality,” he says. “And that’s it. That’s when we have to cut the cord. That’s when we have to stop being paternalistic.”

We need to ”create a community which prioritises sexuality, de-stigmatizes sex ... and challenges itself to say: ‘we’re going to let you do what you want to do and we’re still going to be here to support you whatever happens.’”

Unfortunately, as it stands Garner says we haven’t been able to do that. Some of the more aggressive public health messaging, particularly around condoms, has helped to create a culture where there’s still plenty of stigma, blame and castigation around testing positive. The stigma, he explains, has become “wrapped around sex and the choices that you make in the context of this disease”, because ultimately “we are still attached to the idea of assigning blame when HIV happens”. 

As a result, he says, “almost every person I have ever talked to who has tested positive says their first reaction has been one of shame and guilt, and we haven’t done anything to fix that in 37 years… Others often ask how you could have been ‘stupid enough, or reckless enough to let this happen’”.

“We need to get to the point where we understand that HIV is going to happen. It’s a reality of the world in which we live, because the idea that you are somehow to blame for getting HIV, in a world where your risk can be as high as 1 in 2 (for many black men in the USA) is ridiculously absurd.”

Part of the problem, says Garner, is that we have pathologized risk in gay men. The idea of straight-people taking risks for love and sex is seen as completely normal and has even been the basis of heteronormative literature for the past 2,000 years. And yet when gay men do the same it’s seen as pathologically reckless.

“This ignores the fact that gay men have been taking substantial risks for sex long before HIV came into the picture. We would risk physical violence, we would risk arrest, we would risk ostracisation from our community, from our family, loss of jobs, potentially even death from violence. We would risk all of that because the sex was so important and fundamental to who we were: to our experience and our ability to connect to one another.”

So, a lot of this stigma comes from a lack of understanding of gay male sexuality in general; what sex means to gay men; and in particular what sex without a condom means to gay men. “But we can put it right,” says Garner. “We’re now in a position, because of a better understanding of what undetectable means and because of PrEP, to really engage in thoughtful conversations about gay sex including what it means to have sex without condoms.”

The benefits of opening up these conversations go beyond the physical. Garner uses the example of PrEP to explain: “I think the question we are not asking is ‘Who wants PrEP?’. There are probably scores of gay men who use condoms all the time, but who don’t want to, and if they knew they had an option not to and that PrEP gave them that option – that could change something for them. But we haven’t framed it in that context. We have only asked ‘who is most at risk?’ So we have to be able to ask people what they want rather than just tell them what they need.”

Ultimately Garner feels it’s about being able to look further than HIV, and ask: what’s next? “Is our goal simply to teach gay men how to prevent a disease during sex? Or is it to provide gay men with the skills to have the enjoyable, fulfilling sex that they want to have?”

“That should be our long-term goal… a community or culture which prioritises sexuality, examines what sex means, and challenges itself to de-stigmatize sex and have open conversations about it.

“It seems radical even today – but it can have a tremendous impact in terms of our quality of life, our relationships with one another, and of course in terms of our physical and mental health.”

Written by Francesca Harrington-Edmans

Content Editor