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Evidence suggests that volunteerism and activism in GLBT and AIDS organizations and communities are protective against sexual risk and substance use. Yet, the mechanisms by which community involvement is protective are poorly understood, particularly in Latino gay, bisexual, and transgender (GBT) populations. This chapter researches four potential mediators of the association between community involvement and safe sex: self-esteem, social support, safe sex peer norms, and safe sex self-efficacy. Results showed that community involvement in GLBT or HIV/AIDS organizations was positively associated with social support, peer norms, and safer sex self-efficacy (N = 643 Latino GLBT). Involvement in other causes was not associated with these factors. Safe sex was also predicted by peer norms and safe sex self-efficacy. Thus, promoting naturally occurring activities such as volunteerism and activism as prevention strategies may be more effective, sustainable, and less expensive than structured didactic approaches to sexual risk reduction among Latino GBT.

This chapter presents a summary of the preceding discussions. This book began with the speculative question of how to address the history of the condom. How to make sense of safer-sex discourse? In addressing this question it has been argued that what is at stake is not whether it makes sense to refer to the condom in the context of AIDS as making visible or indeed invisible certain sexualities. Rather, the book has shown how the condom concerns the production and regulation of heterosexuality.

In November 2003, Marcus Dwayne Dixon, a high-school-football star, was convicted in Georgia, US, of aggravated child molestation and statutory rape, and was initially charged with raping a classmate, Kristie Brown, in a portable trailer on school property. The case of Dixon v. The State raises many questions regarding adolescence and consent. This chapter focuses on the significance of the condom. Dixon said he used a condom and threw it away. The investigators said ‘they did not look for the condom because they were certain he was not telling the truth’. Why were the investigators certain Dixon was not telling the truth? Why was Dixon perceived as not capable of using a condom? Why was sex with a condom simply not possible for this African American male teenager? If the condom was imagined as an extension of Dixon, would he have been charged with rape? Would the investigators have believed Dixon if he had been a white middle-class adolescent? The chapter explores these questions in greater detail, and does so by paying close attention to the similarities and differences in young men's and women's accounts of safer sex in empirical research on condom use. It begins by addressing the question of consent in the discourse of safer sex.

This chapter analyses the social effects of sex education for adolescents. Focusing on the period post-1986, it examines the impact of AIDS education, and in particular safer-sex education in the classroom. The main point of concern is the framing of sexual knowledge of the condom in public secondary high schools. By comparing and contrasting the provision of sex education in the US, UK and Australia, the chapter draws attention to the differences and similarities in present and past histories of sex education, and in so doing, highlights how the regulation of adolescent sexuality in the era of AIDS concerns the object of the condom. The overall argument is that sex education concerns the regulation of the adolescent's sexual future.

This chapter examines the large-scale promotion of the condom in the US, UK and Australian mass media from the mid- to late 1980s, focusing on AIDS representations on television and in popular advertisements. It pays particular attention to the Australian ‘Grim Reaper’ advertisement, together with audience research studies on this national AIDS awareness campaign, and, in so doing, seeks to highlight the ways in which the condom has come to define national identity, sexual citizenship, and the production and recognition of difference.

This chapter considers the impact of social and cultural theory in the context of AIDS, and does so in relation to theories of pornography from the 1980s and 1990s. Addressing accounts of eroticised images of safer sex, it argues that while there is much debate as to the effects of cultural representations and their relationship to identity construction, many cultural commentators share a number of theoretical assumptions regarding the body, gender and sexuality post-AIDS. This commonality concerns an assumption that the visual field, particularly vis-à-vis eroticised images of safer sex, works to break down and/or transgress a stable heterosexual masculine identity, to the extent that, for many social and cultural theorists, such images have been assumed to incite a crisis of the male body and a crisis of heterosexual masculinity.

While Belgium is more or less accepting of same-sex sexuality, cases of discrimination on the basis of sexual orientation have been documented. Young people still encounter difficulties when coming out. They show higher rates of suicide ideation and attempts than do their heterosexual counterparts. Nonetheless, the situation of gays and lesbians has improved substantially in the past couple of years, thereby potentially opening up opportunities for enhanced prevention programs for gay men with HIV infection. This chapter focuses on gay life in Belgium. In a study conducted by the authors in Belgium, older gay men are more convinced than younger gay men that engaging in sex currently is less safe when compared with the past. Those with a lower educational level were more likely to be optimistic about new HIV treatments. Overall, it was learned that about three out of five gay men were generally practicing safer sex.

By the late 1980s and early 1990s, in the United States, most sexually active men who have sex with men (MSM) involved in relationships outside their regular partner were routinely practicing safer sex most of the time. Gay men had learned to use condoms correctly, had reduced their number of partners, and were engaging in less risky sexual practices. Many had participated in HIV risk reduction workshops targeting the gay community. Others were serving as “buddies” to assist gay men with AIDS through their local AIDS community-based organizations. Today, things have changed. “Barebacking” (anal sex without condoms) has increasingly become acceptable behavior. In 2008, the Centers for Disease Control and Prevention (CDC) reevaluated their data and concluded that the number of new cases of HIV infection per year was not 40,000 as estimated, but rather was closer to 56,300, and it had been at that level for several years. Applied medical anthropologists are in a unique position to understand the dynamics of HIV risk among MSM throughout the world and to contribute to the amelioration of this health crisis.

Many of the risks that people take with their safety and health can be traced to the self. In particular, the desire to be perceived in particular ways by others often promotes risk-taking, leading people to do things that are dangerous to themselves or others. When people drive dangerously, show off with dangerous stunts, or succumb to peer pressure to engage in risky behaviors, they are often engaging in impression management (or self-presentation), trying to convey a particular impression of themselves to others. Similarly, when people engage in excessive suntanning, fail to practice safe sex, or drastically undereat (as in the case of anorexia), their concerns about how they appear to others may result in disease or death. Furthermore, self-reflection is often so aversive that people seek ways to escape it, engaging not only in relatively harmless escapism (such as napping, TV watching, and shopping) but in more extreme and detrimental forms of escape (including alcohol and drug use, masochism, and suicide). None of the dangerous and maladaptive behaviors examined in this chapter would be possible without the self.

The tenuous relationship between duty and pleasure is one that has underwritten HIV/AIDS activism since the early 1980s. Most recently the tensions between duty and pleasure surfaced again in the debates concerning Truvada, an HIV-prevention pill that, if taken daily, can reduce risk of infection by up to 92%. Using the debates over pre-exposure prophylaxis (or PrEP) as a catalyst, the chapter examines the implications this technology has for the civic identities of queer men, their safe-sex practices, and AIDS activism. As HIV has moved from being an epidemic to an endemic, the ways queer men come to understand themselves in relation to this manageable condition is evolving. Members of queer communities now exist, by association, as “chronic citizens.” This rendering of citizenship influences the ways we understand traditional postulates concerning duty and pleasure, looking for ways to avoid sex shaming while thinking through new avenues for queer world making.

This chapter explores how women who become single in midlife approach dating risks and sexual health. Anxiety about finding someone, uncertainty about how to date, and risky behavior are common themes among midlife women after relationship dissolution. Income levels, parental status, and partner availability affect STI/HIV risk as well. Health providers need to be aware that newly single women might be unfamiliar with condom use, uncertain about negotiating safer sex, and unwilling to initiate discussions about safer sex with partners or health providers. Providers should also understand that newly single heterosexual women in midlife usually date older men who resist condom use through force of habit, male prerogative, or fears of impotence. It would be helpful if newly single women were informed that transitional sex is normative and that safer-sex scripts and/or a ready supply of condoms are essential tools for sexual health in the long run.

This chapter examines how ideologies of masculinity and sexual encounters in Zambia lead to the rejection of condom use and the promotion of sexual risk-taking. This study draws upon research designed to explore the manner in which mission-educated men in Zambia constructed their sexuality and sexual practices, in order to investigate how these factors contributed to sexual risk taking and the instability of safer sex practices. The chapter discusses the implications of these ideologies and practices for HIV/AIDS prevention.

This chapter discusses the issues of drugs, alcohol, and safe sex in relation to schizophrenia. Drugs and alcohol, in particular, are known to exacerbate psychotic symptoms in a patient—schizophrenics are particularly susceptible to substance abuse. Certain substances also tend to be incompatible with prescription drugs. Patients struggling with substance abuse have plenty of avenues for treating their addictive behavior, from simply removing themselves from peer groups that support unhealthy lifestyles to joining dual diagnosis programs that can treat both the psychiatric symptoms as well as the symptoms of substance abuse. Finally, patients must also practice safe sex by wearing condoms and using appropriate lubrication in order to reduce chances of further illness and hospitalization. At times, it might even be healthier to simply abstain in the long term.

This chapter describes the work of the National Task Force on AIDS Prevention (NTFAP), an organization that grew out of the work of the National Association of Black and White Men Together, and Reggie Williams, its charismatic leader. NTFAP was funded by the Centers for Disease Control and Prevention in 1988, and produced some of the earliest knowledge about Black gay men’s sexual practices in the age of AIDS through a nationwide survey that it conducted under the auspices of the CDC grant. At the local level, in San Francisco, the NTFAP also forged a multicultural model of AIDS prevention and safer sex education, situating Black gay men within the broader category of “gay men of color.” However, NTFAP’s federal funding also opened it up to public scrutiny, as when the group was targeted by conservative pundits and politicians for its sexually explicit approach to AIDS prevention.

Mark P. Zanna reflects on his most underappreciated work: a study on the link between sexual arousal and intoxication. Applying Claude Steele's “alcohol myopia” theory (the notion that intoxication reduces cognitive capacity so that individuals are influenced primarily by cues that are momentarily salient), Zanna performed a “safe sex” experiment to examine why men who claim to always use condoms do not always do so when intoxicated, and why men who claim they would never engage in date rape might actually do so when intoxicated.

In this chapter, a professor of Christian ethics at a Roman Catholic liberal arts college describes the ways in which her campus community responded to a transgender colleague who had undergone genital reassignment surgery and to a group of students who had advocated for a public event on safer sex practices. Both situations represented opportunities for participants to engage in the “subtle, complex, and poignant interpersonal, institutional, and moral ‘dance’” that characterizes discussions of LGBTQ concerns in Catholic institutions of higher education. Naming this dance prompts a discussion of a series of questions about heterosexual privilege, conscience, institutional identity, and her own identity as a Catholic, heterosexual, feminist scholar.

This chapter describes an HIV/AIDS campaign in Venda, South Africa that employs female peer educators who incorporate and adapt a mix of anti-apartheid, religious, and local musical styles into their public promotion of safer sex. Through the strategic combination of songs from the anti-apartheid struggle, Christian churches and “traditional” repertoires, peer educators attempt a symbolic and material transformation of themselves from unemployed rural women to quasi-social workers. Music is central to this process, not only because it provides an easily accessible and readily understandable medium for the transmission of knowledge, but also because the peer educators claim to “sing about what they cannot talk about.” This campaign, however, has also spurred a musical counter-discourse from a male-dominated solo genre known as zwilombe, which accuses the women’s messages (along with the campaign) as manipulative and exploitative. The chapter highlights the inherent dangers of privileging songs that are rooted in bioscientific worldviews over those which emerge from folk cosmologies of health and/or sickness.