By the late 1980s, most Western governments had belatedly acquired a grasp of the urgent need for intervention, partly triggered by the rising numbers of heterosexual infections. The intensity of policy efforts varied across countries, however. Most Western countries introduced Aids-prevention measures in the form of poster and television campaigns and various forms of sex education from the late 1980s, and have repeated these since at varying intervals every few years. Switzerland had, in the mid-1980s and early 1990s, the highest level of HIV infection in Europe, partly due to relatively high levels of intravenous drug use. It is now recognized as the most proactive European country in publicizing Aids prevention, having introduced yearly nationwide Aids-prevention campaigns as well as a complete overhaul of its policies towards drug users, which have switched
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8. An example of an Aids-prevention poster campaign
from an emphasis on police repression to medicalization, including free supply of sterilized needles; the result has been a dramatic decrease in new cases of infection.
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Debates continue, however, about which prevention policies to promote, and have been the arena for major intervention from religious models of sexuality. Controversies have centred in particular on the promotion of condom use. Recognized by medical experts to be the most effective protection against Aids short of sexual abstinence, condoms continue to arouse great opposition from fundamentalist groups and the Catholic Church, who reject their interference with procreation and claim that they encourage sexual promiscuity. The US and American-funded
programmes operating in developing countries currently privilege the ABC approach to Aids prevention, emphasizing ‘Abstinence, Being faithful, and Condom use’. In the US and elsewhere, ‘Just Say No!’ campaigns promote sexual abstinence, while unmarried young people with a sexual past are encouraged to become ‘born-again virgins’ through a pledge to refrain from further sexual activity until marriage. However, such programmes have generally been unsuccessful in radically changing sexual behaviour or in reducing rates of HIV/Aids transmission, as health evaluations have demonstrated.
The emerging recognition that the majority of infections occur through unprotected heterosexual intercourse led to what has been described as a ‘de-gaying’ of Aids in the 1990s. Its results were received with ambivalence by gay activists. On the one hand, it was welcomed for decreasing the stigma associated with homosexuality. On the other hand, it meant that public funding, which had already been little forthcoming in the early years, was now not allocated with priority to gay support organizations, although gay men were still disproportionately affected by Aids. Some activists have consequently called for the ‘re-gaying’ of Aids.
The issue of heterosexual infections with Aids also triggered further feminist critiques of sexuality. Building on the argument that Aids risk was not attached to certain types of people, as the focus on ‘risk groups’ had implicitly assumed, but to certain types of (unprotected) sexual practices, such as anal sex, feminist research such as the series of studies carried out in the early 1990s by Janet Holland and others explored the consequences of male sexual domination for risk-taking sexual behaviour. The research revealed that both heterosexual men and women tend to define and experience sexuality in relation to the primacy of male sexual ‘needs’. Most partners adopt a biological understanding of male sexuality as the expression of natural, uncontrollable drives which should not be interrupted; a view which puts obvious constraints
on women’s possibilities for negotiating safer sex. Furthermore, normative female identity creates the dilemma for women that, on the one hand, contraception and Aids protection are seen as female responsibilities, while, on the other hand, women feel they should refrain from asking for anything that might spoil their partners’ sexual pleasure. Interrupting the sexual performance of the male partner and being assertive about safety can run counter to being feminine, as Holland’s team pointed out. The non-adoption of safer sex practices such as condom use does not, however, result from an external imposition of male power (at least not within the consensual relationships that were the focus of this study). As Holland’s study demonstrates, male preferences are instead interiorized and actively reproduced by women, a mechanism the team describes as ‘the male in the head’.
Various feminist analyses emerging from the area of Aids risk and prevention have thus been concerned with issues of women’s power and powerlessness in heterosexual interactions, usually stressing the relative lack of power of women in sexual encounters with men. The reasons given for this powerlessness vary, however: different socialization for UK sociologist Janet Holland, economic dependency on men for Australian social psychologist Susan Kippax, or wider dominant definitions of heterosexuality for US anthropologist Carole Vance. Despite such divergent diagnostics, feminist research demonstrates the need to take gender identity into account when conceptualizing risk in sexual practices. Normative gender identities and gendered relations of power have clear implications for people’s ability to prevent the sexual transmission of Aids; implications that government policies have in recent years attempted to try to build into their preventative strategies.
The health emergency created by Aids has constituted a major area for state intervention in citizens’ sex lives, with sex education campaigns spelling out to them, in sometimes graphic detail, how they can avoid risk of infection with HIV. Initial government
campaigns focused primarily on providing information as to how to prevent HIV infection, implicitly assuming that citizens were rational individuals who would abandon their risk-taking practices once they had been informed of their dangers. However, continuing new infections rapidly demonstrated that the provision of information, while crucial, did not suffice. Indeed, sexual interactions do not constitute the most rational area of most individuals’ lives. In addition, we generally do not engage in sex as individuals, but in interactions with others, which again underlines issues of power and communication. The Aids crisis has thus demonstrated the importance for government prevention campaigns to take into account the emotional and irrational aspects of sex.