Sex and sexuality have long been used to market a variety of consumer products in wealthy countries. But when it comes to HIV prevention and family planning in developing countries, global health practitioners have mostly shied away from using the titillating strategies so effective in the commercial world.
The Pleasure Project and a small group of like-minded nonprofit partners are trying to change that, by shaking up an international reproductive health community that tries to promote safer sexual behavior by influencing the most intimate aspects of the lives of people in developing countries. With their motto, "Putting the sexy back into safer sex," the Pleasure Project is spreading that message far and wide. At the XIX International AIDS Conference in Washington, D.C., this summer, they held a session entitled "Pleasure at AIDS 2012: Everything You Wanted to Know About Pleasurable Safer Sex but Were Afraid to Ask" that explored whether pleasure and eroticism can be harnessed to enhance HIV prevention. The conclusion was that they can indeed, even though most campaigns don’t even try.
DKT International, a Washington, D.C.,-based organization that uses social marketing to promote condom and contraceptive use, has been producing sexy, hard-hitting condom TV spots for years in such places as Brazil, Mozambique, and even in Muslim Indonesia.
DKT’s successful program in Brazil is a leader in using eroticism to promote reproductive health. Daniel Marun, head of DKT Brazil, said that he and his team realized years ago that "threatening people with disease and other bad things was not the way to go." So they decided to make the condom a natural part of the sex act. They did this by changing the image of their Prudence condom brand, extending their product line (introducing condoms with a variety of textures, colors, flavors, and other features) and using sexy advertising like this and like this one for flavored condoms. Marun said the subsequent increase in DKT Brazil’s condom sales—from 406,000 in 1991 to almost 102 million in 2011—showed that their attempts to eroticize safer sex were successful. DKT’s share of the Brazilian condom market also increased from 15% in 2008 to 21% in 2012.
"Sex sells," said Chris Purdy, executive vice president of DKT. "This kind of imagery works. We’ve tested lots of images in lots of countries and we have to run with what works best." Increased sales and use of condoms, of course, are the best testament to the wisdom of putting the sexy into safer sex. But there is also an academic basis to it.
Dr. Lori Scott-Sheldon of Brown University and the Miriam Hospital recently led a meta-analysis of educational, psychosocial, or behavioral interventions eroticizing safer sex. The analysis looked at the outcomes of such interventions: knowledge, attitudes, intentions, frequency of sex, and condom use. Dr. Scott-Sheldon and her team reviewed 19 studies and 36 interventions that used eroticism to promote safer sex among 5,000 "emerging adults." Despite certain limitations of the source material (there are not many studies, 89% of them were conducted in the U.S. and the degree of eroticism ranged widely from 9% to 100%), the review was able to conclude that the interventions using eroticism were successful at improving condom use and reducing risky sexual behavior.
One of the most surprising findings was how seldom pleasure and eroticism are used to promote safer sex.
"It was really appalling that, after looking at 20,000 studies, we could only find 19 that explicitly employed eroticism," said Dr. Scott-Sheldon. She acknowledged this limits the value of the findings, and also shows how much more research is needed, especially for at-risk populations.
Tstsi Masvawure, a Zimbabwean woman studying at Columbia University, believes that reproductive health campaigns generally communicate to young African women either as totally uninterested in sex or pressured (or forced) to have sex and does not acknowledge what she has discovered in her research—that some of them enjoy sex and even initiate sexual encounters. She calls them "active lust seekers."
She interviewed one woman who recounted her actions towards a man by saying "I did him." "Never once did she say ‘He did me,’" Masvawure said. "She portrayed herself as an agent of the sexual encounter." Although more and more young African women are choosing to have sex, she said, the public health community continues to portray women mostly as victims. "We’re not really getting to such women who are choosing to have sex [with information on safer sex]," she said.