This news article by Trenton Straub firrst appeared in POZ on-line August 4, 2011.
It’s not every day that we come across HIV-related research that explores health-promoting sexual behaviors. So when we came across the article “USA Study of Sex Toy Use by HIV-Positive Men Who Have Sex With Other Men: Implications for Sexual Health” in the International Journal of STD & AIDS, we wanted to know more.
Conducted by the Center for Sexual Health Promotion at Indiana University in collaboration with Online Buddies Inc., the survey included 2,275 HIV-positive men who have sex with men (MSM). Participants were recruited from Manhunt.net and spanned the United States; most were white (83 percent), Latino (7 percent) or black (4 percent).
The survey set out to look at sex toy use and its implications for health among positive MSM. It found that 70 percent of participants reported using at least one sex toy in the past year, including dildos (49 percent), butt plugs (31 percent), vibrators (28 percent), masturbation sleeves (17 percent) and anal beads or balls (16 percent). And 31 percent reported using toys in the previous four weeks. White men were more likely to use toys, and men in sexually active relationships were more likely to use toys than those not in such relationships.
Before beginning, the researchers hypothesized that using sex toys not only increased sexual pleasure but also lowered the rates of sexually transmitted infections (STIs) and lead to fewer instances of unprotected anal sex.
To find out the results, we spoke with Joshua G. Rosenberger, PhD, MPH, who’s an assistant professor in the Department of Global and Community Health at George Mason University in Virginia and has a joint research appointment at the Indiana University School of Medicine and the Center for Sexual Health Promotion.
Your survey results found that positive MSM who used sex toys were not statistically more likely to have an STI or to use condoms. How does this bode for your hypotheses going into the research?
Overall we saw relatively low rates of people reporting risk reduction as a primary reason for toy use. What we found with the sex toy use was, not surprisingly, it was more commonplace for sexual pleasure. When we created the survey, we were more interested first in documenting the [sex toy] behaviors—focusing on how much do you enjoy this, how do you incorporate this into your sexual life—because no one had ever done that. [Risk reduction] is important, but that wasn’t our main goal.
Now that you know more data about sex toy use, how would you like to see the data used among advocates and health practitioners?
First and foremost, it’s a way to educate them that MSM sex is not just anal sex and that there is a whole sexual repertoire that exists. There really needs to be more discussion and dialogue about what that looks like. We spend so much time on disease transmission, on labeling gay, bisexual and other MSM as having all this anal sex.
When you’re thinking about HIV, [sex toys are] just one other risk reduction strategy. You can easily recommend toy use as a safe way to engage in fun, healthy sexual activity in which both people can get satisfaction and pleasure without risk—and you can teach them the necessary steps around toy use, which would include making sure the toys are cleaned properly. And really just putting that message out as another alternative. It’s not just abstinence; it’s not just condoms; here’s one other tool that you can use to make sex possible.
You’ve done previous research on sex toy use among the larger U.S. population. How do the MSM results compare?
The numbers, in general, are mostly the same across the board in terms of rates of use and lifetime use, [but] slightly higher among MSM. There’s actually a paper under review right now that’s looking at a final study we just completed with women who have sex with women, and we have questions in there about HIV infection and women who are HIV positive.
Can any of the takeaways from this MSM survey be applied to other groups?
Absolutely. That’s why it’s important. The implication of what can be done [in terms of risk reduction and sexual health and satisfaction] can be extrapolated to any population, regardless of [HIV] status.
The survey did reveal some interesting aspects of the general health and sexual activities of MSM living with HIV. It was great to hear that 91 percent of them described their health as good, or excellent or very good, and then there were the findings that 53 percent were not dating, and yet that 88 percent were sexually active. What do these stats say about this population group?
I think that the overall data is saying that men living with HIV are actually not that much different from those who are negative. And I think that’s an element we’re often forgetting within the public health domain, [which is] always looking to point out all the differences. It’s overall a pretty healthy population. So it really demonstrates that HIV is not the end all be all and all of a sudden you’re doomed, and there’s no more sex, no more relationships. With medical treatment, there’s no reason that [people living with HIV] shouldn’t be engaging in safe and happy and healthy sexual behaviors.
The survey looked at whether condoms were used during the last 10 times participants engaged in anal intercourse. The HIV-positive MSM who were the insertive partner, or the top, reported using condoms an average of 5.85 times out of 10. Those who were receptive, or bottoms, reported 5.68 times. Can you put these figures in a larger context?
We don’t have partner data for these events. And a lot of research out there talks about, or asks, “Did you or did you not use a condom? Yes or No” without understanding the contextual factors, such as not knowing their status, whether people ejaculated during this event, [whether they were with a long-term partner or was it an anonymous encounter]—all those factors that actually, when you’re thinking about risk, are important.
Having said that, we found that the number of events that were protected [averaged at nearly 6 out of 10]. Some people interpret that as 40 percent of sexual events were condom non-protected. Data from national representative studies [show] that among gay and bisexual men, regardless of HIV status, the rates of condom use are higher than in the heterosexual population in the United States. I think that gives you a nice comparison. Condom use might not be perfect; it may not need to be perfect; if there’s not a risk of disease transmission, then there may not ever need to be a reason to use a condom.
And now the million-dollar question, if the data can answer it: Does using sex toys make you more sexually satisfied and healthier overall?
What we found was yes, individuals who reported more toy use were more likely to report higher rates of satisfaction, pleasure and all of the domains that are associated with sexual happiness. [However, here’s the chicken-or-the-egg conundrum: How do you know whether toy use makes people more sexually satisfied or whether] people who are more sexually satisfied use toys? We don’t have that answer. We can’t really indicate which one leads to which.
Finally, why is it important to study a topic such as sex toy use among HIV-positive MSM?
It’s important to understand how individuals living with HIV construct their sexual lives. Being optimistic, a day will come when we have a cure or vaccine for this disease. It will be a shame [if] we look back at the literature and media [in] 50 years and [will not know] about the sex lives of gay men because all we’ve done is research about this one single disease.
And while [risk reduction] is certainly important, we’re [not] really taking into account that [HIV-positive] individuals are living healthy, sexual lives and have their own sexual health issues just as anyone else. Sex toys are just one way to bridge this gap and still promote both pleasure and risk reduction.