Redefining "Unprotected" Sex

The Centers for Disease Control and Prevention has agreed to stop using the term “unprotected sex” to describe sex without condoms in future publications discussing the HIV epidemic.

The reason? CDC official Scott Bryan told the Bay Area Reporter the changes have been under consideration for some time because as “HIV prevention strategies evolve, the terminology needs to evolve as well.” The agency will instead use “condomless sex.”

“This is a critical victory for prevention and treatment advocates,” says Rod McCullom, who has reported extensively on HIV and AIDS issues for The Atlantic, Ebony, the Los Angeles Times, and other publications. “The change in language is long overdue. The new language reflects current advances in biomedical, treatment as intervention, viral suppression, and more. Perhaps once upon a time, all condomless sex was viewed through a lens of heightened risk for HIV. That is no longer the case. Men and women are using PrEP and antiretroviral therapy, for instance, as tools to substantially lower their risk.”

As McCullom notes, the science behind what constitutes risk reduction has been evolving. Preventing HIV infection is not just about using a condom; with pre-exposure prophylaxis, treatment as prevention, and a host of behavioral strategies proving at least as effective in preventing transmission as condoms. The definition of safer sex is changing, but the condoms-only messaging so far isn’t.

Unfortunately, that lag in messaging has played into the criminalization of HIV, compounded by the mistaken belief that HIV is somehow more infectious than other, similar viruses.

That belief is reflected in many state laws related to HIV, where “unprotected” is used as code for “transmission.” If you are HIV-positive and you have sex without a condom, the thinking goes, then you must have been intent on—and actually succeeded in—transmitting HIV. Yet this is usually not the reality.

In an extensive investigation on HIV criminalization published at BuzzFeed and ProPublica in December, Sergio Hernandez studied cases alleging criminal transmission of HIV and found that of 60 cases with “extensive documentation,” only four involved a complainant who had actually been infected.

While opponents of HIV criminalization praised the CDC’s move, at least one is also calling for more precise language from the media when discussing HIV.

“While I welcome the clarification and greater precision in CDC terminology, we also need a campaign to educate the media about the language they use in reporting on HIV-related issues,” says Sean Strub, executive director of the Sero Project. “The CDC change is potentially a helpful step, but it is only a baby step towards ameliorating the problem of imprecise language. It is also complicated, because while treatment may provide protection against HIV transmission, and therefore [sex] without a condom is not ‘unprotected,’ anti-HIV treatment doesn’t protect against other sexually-transmitted diseases. So sex while on treatment is protected against HIV transmission but unprotected against other pathogens.”

Still, the shift in tone from the CDC could play a role in changing the conversation in the gay community, removing the current focus on “clean” and “dirty” gays, and instead putting the focus on fact-based risk assessment and prevention methods.