Safer sex guidelines and bibliography

by Jan Grover

from Jump Cut, no. 33, Feb. 1988, pp. 118-123
copyright Jump Cut: A Review of Contemporary Media, 1988, 2006

On Tuesday, October 14,1987, two days after the National Lesbian and Gay March on Washington, U.S. Senator Jesse Helms (R-NQ waved a Gay Men's Health Crisis "safer sex" comic book around the Senate floor, denouncing its contents as "so obscene, so revolting," that he was too embarrassed to discuss it:

"I believe that if the American people saw these books, they would be on the verge of revolt."[1][open notes in new window]

To fight this gay menace, Helms submitted an amendment to the FY 1988 omnibus appropriations bill. Amendment No. 956 would prohibit the federal Centers for Disease Control from making funds available to provide AIDS education, information , or prevention materials and activities that promote, encourage, or condone homosexual sexual activities.

Under Helms' proposed amendment,

"Education, information, and prevention activities and materials paid for with funds appropriated under this Act shall emphasize—(1) abstinence from homosexual sexual activities."[2]

After very little debate, Helms' amendment passed on a roll-call vote, 94-2.

Helms had set the stage for his amendment weeks before introducing it by sending photocopies of a GMHC (Gay Men's Health Crisis, NYC) safer sex comic books to "about 15 or 20 Senators … in a brown envelope marked 'Personal and Confidential, for Senator's Eyes Only'." He also brought a copy of the comic book to the White House to show to Reagan, who, according to Helms,

"opened the book, looked at a couple of pages, closed it up, and shook his head, and hit his desk with his fist."[3]

The upshot of this manly display of restraint in the face of GMHC's "pretense of AIDS education" was Helms' proposal to prevent federal CDC funds from being used for any form of safer sex or IV drug-use information to slow or prevent the passage of HIV (the human immunodeficiency virus) among populations that gave offence to Mr. Helms and Mr. Reagan.[4]

I bring up this episode because JUMP CUT has decided to publish a set of safer-sex guidelines in this issue, not least because the actions of a Jesse Helms in the U.S. and a Mary White House in Britain, along with the recent FCC regulations restricting "obscene" material on radio, threaten to make explicitly safe-sex guidelines tailored to specific populations impossible to circulate.[5]

We are also reprinting here one of the GMBC safer-sex comics that so offended two national leaders — the most-requested safer-sex material developed by any AIDS service organization in the world.[6] If the Administration has its way (pace Edwin Meese), such information will become increasingly more difficult to obtain.

There is already an increasing public confusion over what safe-sex guidelines might mean. For at least five years (1981-86), the concept of safe or safer sex was defined primarily by those who practiced it — gay and bisexual men who evolved a set of guidelines in cooperation with sympathetic members of the medical community experienced in treating gay men and people with AIDS.

Since the mainstream media "discovered" AIDS as a threat to the general population,[7] however, the usual range of self-appointed experts have emerged: pop figures like Art Ulene, M.D., Today show's resident OB/GYN, who has written Safe Sex in a Dangerous World: Understanding and Coping with the Threat of AIDS; sexologists like Helen Singer Kaplan, M.D., Ph.D., author of The Real Truth about Women and AIDS: How to Eliminate the Risks Without Giving up Love and Sex; journalists like Cris Norwood, author of Advice for Life: A Woman's Guide to AIDS Risks and Prevention; and, of course, politicians like Jesse Helms.[8]

Along the way, safer sex as theory and practice has become highly politicized, a field for argument for sexual puritans and adventurers, civil rights advocates of many stripes, anti- and pro-sex education groups. Fundamental to the contestations over safe/safer sex[9] is the fact that much about the HIV's transmission is still a matter of speculation rather than solid knowledge. What has been made of the comparative absence of grounded evidence, moreover, spits fairly evenly between the very pragmatic responses within gay communities, where safer sex carries with it the axiomatic assumptions that each person must behave sexually as if he/she were infected with HIV and the absolutist yearnings of conservative, heterosexual safer-sex advocates like Ulene, Kaplan and Norwood, who want above all to return to the certainties of a pre-AIDS world, when people could assume/act as if they were not infected.

The safer-sex guidelines developed within the gay communities, which are the ones I will outline below, begin with personal responsibility to prevent any possible transmission of HIV from oneself and to oneself from a (possibly or actually) infected partner. Practices based on this concept of responsibility entail the scarey if realistic assumption that one might indeed be infected. If followed, such practices render the need for "testing" for HIV antibody unnecessary, except insofar as it might affect one's medical treatment.

In contrast, the safer-sex guidelines developed by mainstream media/political AIDS experts are grounded in a search for a totally safe partner with who one can do "anything" (everything one's used to doing). Books and advice columns representing this position devote a lot of space to "estimat[ing] the likelihood that [a partner] is free of the AIDS virus."[10] As part of their conservative, black-and-white view of sex in the age of AIDS, they may also make eloquent cases for abstinence in the absence of certainty:

"Truly 'safe sex' is an all-or-nothing thing. Sex is either 100% safe or it's not, even when it's 'almost safe.' If you can't find a safe partner, don't kid yourself into believing that there is a perfectly safe alternative — other than abstinence … But no one talks about abstinence today. Judging from my mail, it was a somewhat surprised — but approving — Today show audience who heard me suggest that abstinence is a reasonable alternative in these dangerous times … a choice that deserves serious consideration in the age of AIDS."[11]

When the quest for that rare, 10-years-monogamous-but-free-to-be-yours partner has failed, when abstinence cannot be enjoined, the conservatives call for HIV antibody testing — invariably characterized as the AIDS test — as the only reasonable solution to prevent getting or giving the virus. Chris Norwood, in Advice for Life, even rallies enthusiasm for the prospect of antibody testing, seeing it as an opportunity to prove one's fidelity to a sexual partner/ prospect:

"The bottom line, again, is that testing will relieve most people of a brutal worry, while giving them a good opportunity to be counseled about avoiding Aids risks in the future. Why not go with him and get an HIV test yourself?"[12]

What is conspicuously lacking in the zeal these writers summon for antibody testing is any discussion of what effects such testing may have in altering one's own or other people's behavior: it's as if the very idea of testing were somehow a sufficient anodyne to current cares. Helms, Kaplan and Ulene, for example see widespread testing as both imminent and desirable, but they're much vaguer about what should be done with those found antibody-positive. It's as if those people might disappear from the social and sexual landscape, leaving the playing fields to the general population, the heterosexual and uninfected, who could then return to the joys of an eros untroubled by mortality.

Believing that personal responsibility begins not in undergoing an antibody test,[13] but in altering one's sexual behavior to render it safe, JUMP CUT offers these guidelines:


Though conservative safer-sex guidelines neglect to make this important connection, let me emphasize that there is no significant distinction between the sexual practices of gay men, lesbians, and heterosexual men and women. It is
not any practice per se that causes transmission of the HIV; it is the infectious status of one or more of the partners. Therefore, the goal of safer-sex is to eliminate transmission, no matter what the practice.

Realistically, however, some sexual practices are more difficult to perform without risking the possibility of the virus being inoculated into one's partner. This is where the concept of "high-risk practices" comes in (NOT "high-risk partners" — our goal is to think of all of us as this). Unprotected fisting or anal-receptive intercourse, for example, provide the HIV, if present, with abundant opportunity to reach the T-4 leukocytes for which the virus has an affinity. If, however, anal intercourse is performed with a condom, if fisting is done with a calf-birthing glove, then the practices move from "high-risk" to "low-risk." Note, however, that they still carry some risk.


Rather than balkanizing sexual practices as if there were distinctly safe and unsafe practices — there are several excellent texts that take this approach[14] — I intend listing them continuously, together with the risks currently thought to be associated with them and the modifications that are thought to make them safer. Completely "dry" sex (i.e., abstention, Mary five-fingers, massage, hugging, dry kissing), as most people have heard by now, do not offer much of a likelihood for HIV transmission — but neither do they stimulate widespread enthusiasm. Throughout these guidelines, our assumption is that all partners are presuming that they are infected with HIV and/or are responsible enough to behave as if they are.

ANAL DOUCHING Do it all you want, but use your own equipment exclusively. Never share hoses or tips with partners. Any anal sex (intercourse, fisting) following douching must include barrier protection.

ANAL INTERCOURSE The incidence of HIV antibody among men having only receptive anal intercourse is magnitudes higher than it is among men only having insertive anal intercourse, according to those studies where distinctions could be made about men who performed anal sex exclusively one way or the other (studies of women who perform exclusively anal-receptive sex have not been done). Unprotected anal intercourse is a very high-risk activity. The risk is reduced if the partner who inserts wears a condom properly, but it is not risk-free unless both partners are uninfected. For conservative safe sex advocates, this is sufficient reason to never perform it — but this attitude is also colored in many cases by the "unnaturalness" they attribute to sodomy.

CUNNILINGUS/GOING DOWN (on a woman) The genital and cervical secretions of infected women may contain HIV, so theoretically, it is possible to transmit the virus by going down on an infected female partner. However, the amount of virus in a given quantity of these secretions is many orders smaller than in blood, so, unless blood from menstruation or other cause is present, the risk is thought to be low. Given the many if's, however — presence of blood, presence of undetected sores in the mouth or on the lips of the other partner — the lowest risk is presented by putting a barrier between the genitals and the partner's mouth. Dental dams are thin pieces of latex, thicker than condoms, that can be used as such a bather. They can be sewn into crotchless underpants or held in place by either partner during oral sex. Dental dams can be purchased at dental-supply stores and, in larger cities, in drug stores.

FELLATIO/SUCKING/GOING DOWN (on a man) Again, the studies that have been done of men whose sexual practice is confined to sucking conclude that this is a far less-risky activity than, e.g., anal-receptive sex. However, the possibility of undetected sores or cuts on either the penis of one or the mouth and lips of the other partner make it important for the inserter to wear a condom, withdraw carefully when he comes, and not re-use the condom.

FISTING (anus or vagina) Any part of you that goes inside a partner should be protected before it heads home. In the case of anal fisting, latex or rubber calf-birthing gloves, which cover the arm to the elbows, provide the necessary barrier. These can be purchased at veterinary supply stores and should be lavishly lubed with a water-soluble lubricant like KY. In the case of vaginal fisting, latex examination gloves (medical supply stores and some drug stores) should be used, again with sufficient lubricant to prevent trauma to the vaginal walls. Fisting without barriers is high-risk sex because of the possibility of breaks in the skin surface of the fistee's hand and arm and in the mucous membrane surfaces of his or her partner through which the HIV could penetrate.

FRENCH KISSING/DEEP KISSING The HIV is present in low concentrations in the saliva of some infected people, so deep kissing carries some risk. The risk is clearly magnified if either partner has sores or cuts on the lips or in the mouth. If you're not going to give up deep kissing completely, the best solution here is to get to know your own mouth — feel around it, look inside it, smell your own breath, know whether or not you're likely to have broken areas in your mouth through which the virus could be transmitted.

PIERCING/KNIVES Do not share needles, scalpels, or knives with your partners.

RIMMING Oral/anal contact, for all the reasons that anal intercourse is high-risk, is also high-risk. It's also a great source for other STD infections like herpes, genital warts, amebas, so there are a number of good reasons to protect yourself with a barrier when performing it. The trusty dental dam comes into play here — stretch it across the anus before rimming.

SCAT The HIV has been found in shit, so if you play around with it, you'll need to keep it out of your orifices — mouth, eyes, ears, etc. — and know your body's condition well enough to be sure that there are no other points of entry. Intact skin is a highly effective barrier against the HIV, but if you have open cuts, dermatitis (acne, eczema), or sores, be sure to cover them with bandaids or other barriers before scatting.

SEX TOYS Don't share dildos, cock rings, ass plugs, benwa balls, whips, or other sex toys that come into contact with your own blood, genital, or anal secretions.

VAGINAL INTERCOURSE Women can become infected through vaginal intercourse, and men can become infected by an infected woman. Women should use nonoxynol spermicide in their vaginas in addition to demanding that their male partners use latex condoms. There is no laboratory evidence that the HIV can penetrate natural (membrane) condoms, which many men prefer because of their thinness, but hepatitis B virus can penetrate natural condoms in laboratory tests, so it's better to use latex as a broader protection.

WATER SPORTS The HIV has been found in the urine of some infected people, so use the same precautions you would with SCAT (see above).


1. But that's not all: "Oh, boy," said Mr. Helms. "No wonder we have such a stupendous Federal debt." (GMHC received $674,679 over a two-year period.)

2. Congressional Record, October 14, 1987, p. S14211.

3. Helms, ibid, p. S14203.

4. Helms, ibid. p. S14204: "We have got to call a spade a spade and a perverted human being a perverted human being … Every AIDS case can be traced back to a homosexual act"

5. In Britain, the 1984 passage of the bill popularly know as the "Video Nasties" bill resulted in Thatcher's administration establishing a censorship board answerable to no one but the Home Secretary (an appointee) to scrutinize all videos offered for consumer/home sale or rental in Britain. This board publishes no guidelines and unlike the national film boards of the U.S. and Britain does not suggest or accept cuts in order to make offending videos acceptable. Part of the fallout of the Video Recording Bill is that safe-sex videos like Gay Men's Health Crisis' CHANCE OF A LIFETIME (1985) cannot be imported into Britain legally, nor could similarly sexually explicit videotapes be made for distribution in Britain. Cf. Martin Barker, ed., The Video Nasties: Freedom and Censorship in the Media (London: Pluto Press, 1984).

Simon Watney, author of Policing Desire: Pornography, AIDS, and the Media (London and Minneapolis: Methuen and the U. of Minnesota Press, 1987), notes that passage of the Video Recording Bill produced the paradox of a Parliamentary committee having to get a copy of CHANCE OF A LIFETIME smuggled into Britain in a diplomatic pouch in order to the committee to view it.

6. Information provided by Joey Leonte, Director of GMHC Publications, in conversation with the author, April, 1986. The "erotic comic books," as Leonte describes them, were devised for a specific use: they were and are handed out in bars by "bar fairies" — GMHC volunteers who go to gay bars to make safer-sex information available. Based on heterosexual porn comics of the 1920s and 1930s, the 8-page books are designed to make safer sex both hot and funny. Their small size encourages bar-goers to stick them in their back pockets. According to Leonte, in a discussion of the comics on GMHC's Manhattan cable program Outreach in 1985, all of the artwork was donated by well-known gay artists.

Jesse Helms, of course, based his October 14, 1987, Senate tirade on the contention that such materials were perhaps developed with federal funds, although in the course of his monologue, he conceded that GMHC's safer-sex comics were not produced with federal dollars. But that simple fact is largely irrelevant to his long-range goal — to see that all approaches to AIDS education and prevention that offend his sensibility are simply written out of history, much as his allies in the current Southern Baptist Conference are determined to see pluralism excluded from their faith.

7. See my "AIDS: Keywords," in the forthcoming October (Winter, 1987-88), where I identify a number of terms whose meaning has shifted to accommodate the realities and fictions surrounding AIDS.

8. I single out Ulene's, Kaplan's, and Norwood's books because they were all published in 1987, purport to be guides to prevention, and are products of major U.S. publishers — Vintage/Random House, Fireside/Simon & Schuster, and Pantheon/Random House, respectively.

9. The term "safe sex" was coined while the HIV was still believed to be found only in blood and semen. Now that the HIV has been isolated from a far wider variety of human fluids — e.g., saliva, joint fluid, tears, urine, milk — it has become more realistic to speak of "safer sex," since the exchange of any fluids seems to carry some possibility of HIV transmission where one or more partners is infected.

10. Art Ulene, Safe Sex in a Dangerous World (NY: Vintage, 1987), p. 33. See especially the "questions you should ask to help determine just how risky your partner is for the AIDS virus" (pp. 34-5), hypothetical cases to test your assessing savvy (pp. 39-53), and table for "Estimating A Sex Partner's Risk for AIDS," (pp. 64-5). Similar sentiments appear in Helen Singer Kaplan's The Real Truth about Women and AIDS.

11. Ulene, pp. 31-2. It goes without saying that this is also the position taken by, variously, Jesse Helms, Ronald Reagan, William Bennett, and other newly-coined Administration experts on the importance of sexual repression to battling AIDS.

12. Norwood, Advice for Life (NY: Pantheon Books, 1987), p. 58. Norwood also suggests that one couch one's queries to a potential (male) lover in a "non-threatening way" — which includes verbal assurances that any homosexual activities on the partner's part must have been someone else's fault. "Most people," she advises women to state, "don't fully understand the risks. They think you just have to be gay or an addict. But even a guy who shot up drugs a few times or got seduced by some guy when he was a teenager might have a small risk"(p. 57).

13. Norwood: "…there are already signs … that more and more people consider testing a personal responsibility" (p. 58). The "signs" of personal responsibility that Norwood reads are legislative proposals (like Helms'? Like California State Senator Doolittle's draconian proposals?) and increased demand at test sites.

14. See, for example, Cindy Patton's excellent Making It: A Woman's Guide to Sex in the Age of AIDS (Ithaca: Firebrand Books, 1987), and Diane Richardson's equally fine British reader, Women and the AIDS Crisis (London: Pandora Press, 1987).


Safer sex suggested reading

by Jan Grover

Many of the most recently published AIDS titles provide a deeply conservative sort of advice and social/political content. If you want to see how AIDS education can be constructed to ignore gays and IV drug users and to emphasize pie-in-the-sky celibacy or monogamy — a return to "time-proven values," start with the texts we have quoted above. You won't find these or similar texts listed below.

If, however, you want to see safe-sex guidelines embedded in a political analysis of AIDS and studies focusing on the politics of AIDS per se, then we suggest the following as good places to begin:

Michael Callen, ed. Surviving and Thriving with AIDS: Hints for the Newly Diagnosed. New York. People with AIDS Coalition, 1987. (Available through National AIDS Network, 1012 14th Street, NW #601, Washington, DC 20005). A 146-page anthology of pieces by people with AIDS covering medical, social, sexual, political, and spiritual aspects of living with AIDS. The photographs challenge the media's conventional depictions of "victims"-staring-out-the-window-at-life-going-by. $425.

CHANCE OF A LIFETIME (42 mm, video, Gay Men's Health Crisis/Publications, Box 274, 132 W. 24th St., NYC 10011. (212) 807-7517), is a sexually explicit video depicting "different couple[s] involved in realistic socio-sexual situations which focus on safer sex thinking or practices. The video presents a variety of sexual possibilities and preferences from intimacy between two lovers to group sex." Sex-positive and framed from within and to gay communities.

Nancy Krieger and Rose Appleman. The Politics of AIDS. Oakland. Frontline Pamphlets, 1986 (P.O. Box 2729, Oakland, CA, 94602). A brief (60 pp), perceptive analysis of public-health, legislative, and social responses to AIDS in the U.S. at the nation al and local levels. Puts government studies and data to progressive use and includes safe sex and "clean works" guidelines. $4.00.

BettyClare [sic] Moffatt, Judith Spiegel, Steve Parrish, Michael Helmquist, eds. AIDS: A Self Care Manual. Los Angeles. AIDS Project LA/BIS Press, 1987. A slick, comprehensive manual on living with AIDS. $12.95.

Cindy Patton, Sex and Germs: The Politics of AIDS. Boston. South End Press, 1985. Anecdotal material that is a bit dated now, but remains the best analysis of the politics of AIDS in the U.S. $9.00.

Cindy Patton and Janis Kelly. Making it: A Woman's Guide to Sex in the Age of AIDS. Illustrations by Alison Bechdel. Ithaca. Firebrand Books, 1987. Succinct, exhaustive, smart safe-sex manual in English and Spanish. $3.95.

"Facing AIDS," a special issue of Radical America, 20:6 (1987). Includes articles on medical models of AIDS and the biases built into them; the economics of the AIDS crisis; Latinas and AIDS; antibody testing in black communities; and other important AIDS issues. $3.95.

Diane Richardson. Women and the AIDS Crisis. London. Pandora Press, 1987 (soon to be released by Methuen). A politically and culturally savvy analysis of the many roles women are playing in the AIDS crisis — as people living with the syndrome, as lovers, parents, and care-providers of people with AIDS, and as people distinctively positioned amid the politics of AIDS — e.g., lesbians, Central Africans, IV drug users. Includes safe-sex guidelines.

Simon Watney. Policing Desire: Pornography, AIDS, and the Media. London/Minneapolis. Methuen/University of Minn. Press, 1987. Shrewd analysis from a gay perspective of the depiction and consequences of AIDS in media, legislation, and censorship, primarily in Britain, though some discussion of the U.S. $9.95.

Jeffrey Weeks. Sexuality and Its Discontents: Meaning, Myths and Modern Sexualities. London. Routledge & Kegan Paul, 1985. British gay cultural historian's analysis of the roles of sexology, sexologists, New Right, and others in defining historical sexualities; contemporary sexualities and the positioning of the AIDS crisis within them.