I scrolled through my contacts, found his name, took a deep breath, and pressed call. Pacing on the sidewalk, my palms getting sweatier by the minute, I rehearsed what I wanted to say, but it was useless by this point because he was going to pick up any sec—
I struggled through mundane small talk, but finally broke out with the real reason for my call: to talk about sex, or more specifically, sexual history.
Sure, it’d been a few months since we’d slept together, but, at the time, neither of us had initiated that conversation — you know, the one about past partners, risky behavior, condom use, and sexually transmitted infections (STIs). It's the conversation we all should be having but rarely do. Not only did we not talk about these things, but we didn’t use protection either. I know, I know.
I figured it was time I owned up to my mistake.
It was time for some due diligence. After our conversation, I felt a lot more comfortable. I went in for testing not too long after for full confirmation, and I didn't have any positive results for any STIs. But that still didn't stop me from wondering why I didn't insist on protection in the first place.
The Limits Of Statistics
At the time of the phone call, I was in graduate school for public health. Naturally, STI statistics were swirling around in my head. I could easily rattle off data about chlamydia, gonorrhea, syphilis, HIV (especially new trends) — the list goes on. (For you number junkies out there, check out Sexually Transmitted Disease Surveillance for comprehensive STI statistics plus helpful charts and graphs.)
I knew I was putting myself at risk that night. What I didn't know was why I would do that to myself. There I was, a walking brochure for an STI clinic, but I couldn't even follow my own advice.
I got to thinking about all this again when I read a National Health Statistics Report that came out last week. It looked into behaviors that put people at increased risk for getting HIV (for example: injection drug use, male-to-male sex, having 5 or more partners in the past year, having another STI). The study interviewed people ages 15-44 from the general population . There's a lot of solid data, but what hit home was one line in particular. It's buried in the very last table of the report, but when I saw it, I paused.
I stared at the percentages that showed whether a person used a condom the last time he or she had sex — this is often used as a rough proxy for a person's condom use in general. For those who had at least one high risk behavior in the past year, about half of men and a third of women used a condom during their last sexual encounter.
A lot lower than any sex ed counselor or doctor would hope, right?
I called Ralph J. DiClemente, professor of behavioral sciences and health education at the Rollins School of Public Health at Emory. I wanted to find out why, despite the ubiquitous idea of "safe sex," so many of us fail to follow through.
When Complexity Trumps Rationality
"There are lots of things we know to do to improve our health," DiClemente pointed out. He explained that many of us know that we shouldn't smoke, drink and drive, or text and drive for that matter. We know we should be exercising regularly and eating plenty of fruits and vegetables every day. "But for whatever reason we don’t do them," he said. "People are really complex organisms; we are not as rational as we like to present ourselves."
He went on to explain that a lot of our safe sex education treats us as rational beings. We're taught a "repertoire of responses." But DiClemente explained, "Sex takes place in a hot space — you're excited, emotional. Emotions supercede the intellectual rationalism that we like to think people have."
[module align="right" width="half" type="pull-quote"]"Sex takes place in a hot space — you're excited, emotional. Emotions supercede the intellectual rationalism that we like to think people have."[/module]
We could have talked for days about all the contributing reasons why people do or don't do what they do. But a few reasons stood out to me; I think they get pushed to the side when we talk about why people engage in unprotected sex. We're so quick to blame a person for being "irresponsible" without understanding the nuances of their interpersonal relations or the powerful influence of society.
Here are five reasons (just some of many) why it's often difficult to initiate a sexual history conversation prior to having sex or to insist on using condoms.
High Hopes: "If you want to engage in a conversation about sex, you're presuming the person wants to have sex with you," DiClemente told me. He said it could easily be "ego deflating" if, well, that's just not the case. He explained how the possibility of hurt feelings can create a barrier, with questions like, "Aren’t I attractive and interesting? Don’t you like me?" hanging in the air.
Danger To Reputation: But what if you manage to get over that initial hurdle of the fear of a bruised ego? Say you initiate the conversation or bring out a condom. DiClemente pointed out this is especially problematic for women. "In many cases it’s the male partner who applies the condom; it's the male partner who has the condom. If a woman has a condom, is she seen as 'loose' or promiscuious? It shouldn’t be that way, but it’s a perceptual issue. If we want people to be safe, they have to carry around the tools to make them safe and not rely on others."
Wait And See: DiClemente also mentioned how some people don't want to "jeopardize the relationship before starts." He explained how some folks take the "wait and see approach" with budding relationships, so they delay talking about sexual history and about how condoms are going to fit into the picture in the here and now. That gray area, that time before there are labels, those first few dates — you barely know the person, and you're going to have to pepper them with sexual health questions? No wonder people are reluctant.
Monogamy: But say you get to the point where you're dating someone exclusively. You still want to use condoms, but DiClemente brought up a good point: "Condoms bring up the issue of infidelity." If the partner you care about is going to accuse you of being unfaithful, it makes it mighty hard to negotiate condom use. And now that you've found a significant other, do you compromise the relationship because he or she will learn more about your sexual history?
Sex, Sex Everywhere: The above four reasons are all very individually or interpersonally based, but what I think is really important is the fact that we live in a hypersexualized society. DiClemente pointed out how advertisements for everything from toothpaste to whiskey involve a sexual component: "What we do as a society values attractiveness, sex appeal, sex." He went on,"The bar is set really high, but most of us will never attain that status, go over that bar. But we’ll try." It is in that dogged trying that we may fail to have those important pre-sex conversations or practice safe sex at all. Living up to an image is never easy.
After I hung up the phone with DiClemente, I realized that I'd fallen into all those traps. It's hard for the rational voice to drown out all the other voices in my head. Like DiClemente said, emotions tend to win out.
It's not easy to find someone with whom you feel comfortable talking about these things. And DiClemente agreed, "Finding a partner who is receptive, open, not offensive about it, willing to engage in a candid conversation – it's difficult to find an appropriate, suitable, and attractive mate. That's been going on forever."
What I realized is the search is worth it. I'm currently in a monogamous relationship, and — for the first time, really — my partner and I have had honest, extended discussions about safe sex. Being able to talk freely about these things is the biggest breath of fresh air I've had in years. It was a challenge being able to come to this point, but it was most certainly worth it.
Resource: Looking to get tested for HIV and other STIs? Find a clinic near you.
This program aired on January 27, 2012. The audio for this program is not available.