In today’s world it is prudent to practice safer sex strategies. Sexually transmitted diseases too often have significant implications for those who contract them. The CDC reports that “studies of sexually transmitted diseases and sexual behaviors suggest a resurgent HIV epidemic among men who have sex with men.”1 The CDC goes on to say that “having anal sex without a condom continues to be a significant threat to the health of men who have sex with men.”2 Unprotected anal sex (barebacking) with casual partners is an increasing concern. There may very well be many unknown reasons for what appears to be an apparent increase in unprotected anal intercourse, but research suggests that optimism about improved HIV treatment, substance use, safer sex fatigue, and seeking sex partners on the Internet are part of the explanation for the trend.3 Although my discussion of safer sex fatigue is placed in the context of men who have sex with men the analysis I am providing can just as readily apply to women who have sex with men and do not consistently adhere to safer sex practices. That is this post applies to risky sexual behavior between all people regardless of their gender, orientation, or identity.
Rational Emotive Behavior Theory hypothesizes that safer sex fatigue is largely but not exclusively the result of low discomfort tolerance and low frustration tolerance beliefs. Humans by nature too easily think that what is good for them to do in the long run and which is likely to be uncomfortable or inconvenient to do in the short run is therefore too uncomfortable or inconvenient to do consistently and perpetually. This philosophy of easily doing what feels good even when it can have very significant long term implications is what we call in REBT short term hedonism. It is completely understandable that humans want to be comfortable and to avoid inconveniences of all degrees of magnitude. However, when humans implicitly hold the belief “I must be comfortable, I must avoid sexual inconvenience, I must have maximal sexual pleasure and gratification even if it may very significantly alter the course of my life and longer term pleasures” this is likely to produce safer sex fatigue. This idea that “it is too hard to keep at and perpetually practice safer sex strategies” will lead to sexual risks which can sadly lead to infection of sexually transmitted diseases.
When working with clients who are experiencing safer sex fatigue I start by fully and unconditionally accepting them with their risky behavior. Without the client perceiving unconditional acceptance there can be no open and honest discussion about the important issue of safer sex fatigue. In REBT we rate what people do but we never, ever rate the person who may act in a shortsighted way. The next step involves raising the client’s awareness that their implicit beliefs about comfort and convenience are likely to be at the core of their risky sexual behavior. There may be other assumptions and beliefs that are associated with their risky sexual behavior but often low discomfort tolerance and low frustration tolerance beliefs are largely responsible for this behavior. If other beliefs are uncovered I certainly will address those as well but often low discomfort tolerance and low inconvenience tolerance is a large part of the clinical picture. With this caveat in mind, I help the client question the adaptiveness, utility, and validity of their beliefs around giving into the urge to avoid the inconvenience of consistently adhering to safer sex strategies. In the context of my unconditional acceptance of them with their risky behavior clients are inclined to see that their belief “It is too hard to continue to regularly use condoms, I absolutely should not have to be so diligent, and I must have the pleasures of condom free sex” is related to their so called safe sex fatigue. Once they acknowledge their rigid demand for maximal sexual pleasure with minimal sexual inconvenience we work on carving out a more self-helping philosophy that leads to safer sex frustration tolerance. Such a philosophy is along the lines “I really wish I could indulge in condom free sex because it is so much more pleasurable and convenient for me to do so but I can stand the discomfort, frustration, inconvenience, and loss of pleasure of consistently using condoms and it is worth doing so.”
Is it easy for humans to think along the lines REBT teaches? No it is not. This is the human condition. It is hard to think in this self-enhancing way about sexual pleasure but it is harder to bear the burden of many sexually transmitted diseases. Fallible humans are encouraged to do what is harder in the moment but which will pay dividends over the long run and lead to more total life pleasure and less total life suffering. This is the message of REBT and it is my role to continue to help and to encourage you to have high discomfort tolerance for safer sex strategies. With work and practice you can do this. The choice is yours.
References:
1 CDC. HIV Incidence Among Young Men Who Have Sex With Men – Seven U.S. Cities, 1994—2000. MMWR, 2001; 50(21):440-444.
2 Mansergh, G, Marks, G, Colfax, GN, et al. “Barebacking” in a diverse sample of men who have sex with men. Journal of the Acquired Immune Deficiency Syndrome 2002; 16:653-659.
3 Wolitski, R. The emergence of barebacking among gay men in the United States: a public health perspective. Journal of Gay and Lesbian Psychotherapy 2005; 9:13-38.